Deck 1: Role of an Insurance Billing Specialist

Question 1

What does the abbreviation MSHP designate?

A) Multiple service health care professional
B) Multiskilled health practitioner
C) Multiskilled health professional
D) Managed care solo health practice

Answer 1

Multiskilled health practitioner

Question 2

Which level of education is generally required for one who seeks employment as an insurance coder?

A) College diploma.
B) High school diploma.
C) Completion of an accredited program for coding certification.
D) No specific level of education is required.

Answer 2

Completion of an accredited program for coding certification.

Question 3

Medical etiquette refers to

A) consideration for others.
B) moral principles or practices.
C) laws.
D) the Oath of Hippocrates.

Answer 3

consideration for others.

Question 4

Which code of ethics is most appropriate for an insurance billing specialist who handles medical records?

A) The American Health Information Management Association (AHIMA) code of ethics
B) The American Association of Medical Assistants, Inc. (AAMA) code of ethics
C) The claims assistance professional (CAP) code of ethics
D) The Certified Coding Specialist (CCS) code of ethics

Question 5

What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980?

A) The Modern Standards of Conduct Code
B) The Principles of Medical Ethics
C) The Oath of Hippocrates
D) The American Medical Association Code of Ethics

Question 6

Which organization published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements for physician billing?

A) American Management Association (AMA)
B) American Academy of Professional Coders (AAPC)
C) American Association of Medical Assistants (AAMA)
D) American Health Information Management Association (AHIMA)

Question 7

The Internet Healthcare Coalition has developed

A) the AAMA Code of Ethics.
B) the eHealth Code of Ethics.
C) the AMA Code of Ethics.
D) the AHIMA Code of Ethics.

Question 8

A claims assistance professional

A) works for the consumer.
B) helps patients file insurance claims.
C) neither a nor
D) venipunctures.

Question 9

AHIMA publishes

A) diagnostic and procedure coding competencies for outpatient services.
B) diagnostic coding and reporting requirements.
C) diagnostic medical terminology.
D) both a and b

Question 10

Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring

A) specialized health care practitioners.
B) health care workers with college degrees.
C) multiskilled health care practitioners.
D) untrained health care practitioners.

Question 11

What is "cash flow" in a medical practice?

A) The actual money available to a medical practice
B) The amount of money received by a medical practice in 1 day
C) The amount of money received by a medical practice in 1 month
D) The amount of outstanding money on the accounts receivable

Question 12

The earliest written code of ethical principles for the medical profession is the

A) Oath of Hippocrates.
B) Socratic oath.
C) Code of Hammurabi.
D) Medicolegal oath.

Question 13

What should you do if you discover that a patient of your physician employer is under the care of another physician for the same ailment?

A) Notify your physician.
B) Honor the patient's choice and say nothing.
C) Notify the other physician.
D) None of the above.

Question 14

Medical ethics include

A) state laws.
B) federal laws.
C) standards of conduct.
D) civil torts.

Question 15

A billing specialist is entrusted with

A) holding patients' medical information in confidence.
B) collecting monies.
C) being a reliable resource for co-workers.
D) all of the above.

Question 16

Front office medical duties have become increasingly important because

A) diagnostic and procedure coding must be reviewed for its correctness and completeness.
B) the number of office visits for patients has increased.
C) the number of patients belonging to managed care plans has decreased.
D) the number of doctors has decreased.

Question 17

A self-employed medical insurance biller who does independent contracting is responsible for

A) advertising.
B) billing.
C) accounting.
D) all of the above.

Question 18

Administrative medical office responsibilities include

A) laboratory analyses.
B) claims submission.
C) taking x-rays.
D) venipunctures.

Question 19

Reporting incorrect information to private insurance carriers is considered

A) unethical.
B) poor etiquette.
C) criminal.
D) illegal.

Question 20

The amount of money an insurance billing specialist earns is dependent on which of the following factors?

A) Knowledge
B) Experience
C) Size of employing institution
D) All of the above

Question 21

MATCHING
Determine whether the following statements are (a) illegal, (b) unethical, or (c) both illegal and unethical. You may use the three choices as many times as needed.

Coding services that were not performed for payment.

A)Illegal
B)Unethical
C)Both illegal and unethical

Question 22

Why are multiskilled health practitioners (MSHPs) in demand?

A) They are cross-trained to provide more than one function.
B) They are often competent in more than one discipline.
C) They offer more flexibility to their employer.
D) All of the above.

Question 23

The AHIMA Code of Ethics is appropriate for

A) health information specialists.
B) coders.
C) insurance billing specialists.
D) all of the above.

Question 24

Standards of conduct by which an insurance billing specialist determines the propriety of his or her behavior in a relationship are known as medical ____________________.

Question 25

MATCHING
Determine whether the following statements are (a) illegal, (b) unethical, or (c) both illegal and unethical. You may use the three choices as many times as needed.

Reporting incorrect information to Medicare.

A)Illegal
B)Unethical
C)Both illegal and unethical

Question 26

In 1980 the AMA adopted a modern code of ethics called the ______________________________.

Question 27

Physicians are paid on the basis of _________________________ units.

Question 28

It is ____________________ to report incorrect information to private insurance carriers because this can possibly damage the individual and the integrity of the database.

Question 29

Obtaining and recording patient data using a questionnaire before that person's first visit is known as ____________________.

Question 30

Maintenance of health information records and distribution of mail to various departments in an office is done by a ____________________.

Question 31

The doctrine stating that physicians are legally responsible for both their own conduct and that of their employees is known as

A) respondeat superior.
B) let the master answer.
C) vicarious liability.
D) all of the above.

Question 32

An NPP is a ______________________________.

Question 33

Respondeat superior, which literally means "let the master answer," is also known as ____________________ liability.

Question 34

Insurance specialist certificate programs include

A) anatomy.
B) diagnostic coding.
C) computer technology.
D) all of the above.

Question 35

The Greek physician known as the Father of Medicine devised the ____________________.

Question 36

All insurance billing specialists should check with their physician employers to see whether the specialist is included in the medical professional ____________________ insurance policy.

Question 37

Reporting incorrect information to government-funded programs is

A) unethical.
B) illegal.
C) abuse.
D) fraud.

Question 38

The earliest written code of ethical principles of medicine is called the ____________________.

Question 39

To report incorrect information to a Medicare fiscal intermediary is ____________________.

Question 40

MATCHING
Determine whether the following statements are (a) illegal, (b) unethical, or (c) both illegal and unethical. You may use the three choices as many times as needed.

Using code numbers to increase payment when case documentation does not warrant it.

A)Illegal
B)Unethical
C)Both illegal and unethical

Question 41

MATCHING
Determine whether the following statements are (a) illegal, (b) unethical, or (c) both illegal and unethical. You may use the three choices as many times as needed.

Reporting incorrect information to a private insurance carrier.

A)Illegal
B)Unethical
C)Both illegal and unethical

Question 42

At certain times medical office staff members are allowed to make critical remarks about a physician to a patient.

Question 43

MATCHING
Determine whether the following statements are (a) illegal, (b) unethical, or (c) both illegal and unethical. You may use the three choices as many times as needed.

Unbundling services when an available single code includes all services.

A)Illegal
B)Unethical
C)Both illegal and unethical

Question 44

Insurance companies never require the patient to submit the claim form.

Question 45

Medical billing employees should be able to perform a variety of administrative duties pertaining to the business office.

Question 46

The primary goal of an insurance claims assistance professional (CAP) is to assist the consumer in obtaining maximum benefits and to tell the patient what checks to write to providers to make sure there are no overpayments.

Question 47

Physicians are legally responsible for any actions of their employees performed within the context of their employment; therefore, an employee cannot be sued or brought to trial.

Question 48

It is acceptable practice for medical office personnel to use a patient's first name when speaking to the patient about his or her insurance.

Question 49

The title used for medical billing personnel may depend on the region of the United States where they work.

Question 50

Generally, a high school diploma is not required for an insurance billing specialist.

Question 51

It is illegal to report incorrect information to government-funded programs such as Medicare, Medicaid, and TRICARE.

Question 52

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the physician.

Question 53

It is commonplace to find administrative duties shared by a number of specialists in the physician's office.

Question 54

In a medical practice, front office duties have lost importance.

Question 55

The Centers for Medicare and Medicaid Services, formerly known as the Health Care Financing Administration, adopted the Principles of Medical Ethics in 1980.

Question 56

Illegal coding practices are subject to penalties, fines, and/or imprisonment.

Question 57

Working in a physician's office as an insurance billing specialist carries greater responsibilities than operating a self-owned insurance billing business.

Question 58

MATCHING
Determine whether the following statements are (a) illegal, (b) unethical, or (c) both illegal and unethical. You may use the three choices as many times as needed.

Assigning a code without documentation from the provider.

A)Illegal
B)Unethical
C)Both illegal and unethical

Question 59

Electronic claims submissions are a format of the past.

Question 60

MATCHING
Determine whether the following statements are (a) illegal, (b) unethical, or (c) both illegal and unethical. You may use the three choices as many times as needed.

Coding a condition as primary when the majority of the treatment is for a preexisting condition.

A)Illegal
B)Unethical
C)Both illegal and unethical

Question 61

The best way for an insurance specialist to keep up to date in the profession is to read health care industry association publications, attend seminars on billing and coding, and participate in e-mail listserv discussions.

Question 62

A claims assistance professional (CAP) acts as an informal representative of patients and helps patients interpret insurance contracts.

Question 63

In some states, giving an insured client advice on purchase or discontinuance of insurance policies is construed as being an insurance agent.

Question 64

An insurance billing specialist uses general skills in following an employer's established policies when dealing with the health care contract.

Question 65

Rules of etiquette for e-mail and cell telephone calls fall under the Health Insurance Portability and Accountability Act.