Medical Practice Management
Exam Solutions
Course Introduction
Medical Practice Management explores the essential skills and knowledge required to effectively run a healthcare practice. The course covers a range of topics including medical office operations, financial management, billing and coding, regulatory compliance, human resource management, and patient relations. Students learn to navigate the intricacies of healthcare laws, insurance procedures, electronic health records, and quality improvement strategies. Emphasizing both administrative excellence and ethical considerations, this course prepares students to become competent leaders who can optimize the efficiency, financial viability, and overall success of medical practices.
Recommended Textbook
Insurance Handbook for the Medical Office 14th Edition by Marilyn Fordney
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18 Chapters
1231 Verified Questions
1231 Flashcards
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Page 2
Chapter 1: Role of an Insurance Billing Specialist
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65 Verified Questions
65 Flashcards
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Sample Questions
Q1) The AHIMA Code of Ethics is appropriate for A) health information specialists.
B) coders.
C) insurance billing specialists.
D) all of the above.
Answer: D
Q2) The title used for medical billing personnel may depend on the region of the United States where they work.
A)True
B)False
Answer: True
Q3) 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.
Answer: D
Q4) In 1980 the AMA adopted a modern code of ethics called the ______________________________.
Answer: Principles of Medical Ethics
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Chapter 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing
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70 Verified Questions
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Sample Questions
Q1) The process of meeting regulations, recommendations, and expectations of federal and state agencies that pay for health care services and regulate the industry is known as eHealth information management.
A)True
B)False
Answer: False
Q2) List five of the disciplinary standards resulting from misconduct.
Answer: Verbal warning; written warning; written reprimand; suspension or probation; demotion; termination of employment; restitution of any damages; referral to federal agencies for criminal prosecution.
Q3) Submitting a claim for services that is not medically necessary is a violation of the False Claims Act.
A)True
B)False
Answer: True
Q4) Explain when a physician's office would be considered a "covered entity."
Answer: If the physician's office transmits protected health information electronically.
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Chapter 3: Basics of Health Insurance
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93 Verified Questions
93 Flashcards
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Sample Questions
Q1) The insured may not necessarily be the patient seen for the medical service.
A)True
B)False
Answer: True
Q2) The cost-sharing amount a managed care patient must pay at the point of arriving in the office is referred to as the ________________.
Answer: copayment
Q3) Most physician/patient contracts are
A) implied.
B) expressed.
C) written.
D) verbal.
Answer: A
Q4) An emancipated minor is
A) a person younger than the age of 18 who lives independently.
B) a person older than the age of 21.
C) a person younger than the age of 16 who lives with his or her parents.
D) a person younger than the age of 18 who does not live with his or her parents.
Answer: A
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Chapter 4: Medical Documentation and the Electronic Health Record
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Sample Questions
Q1) An expanded problem-focused examination is a/an
A) expanded examination of a single organ system.
B) extended examination of the affected body area.
C) limited examination of the affected body area.
D) general examination of a single organ system.
Q2) An edit check is a good audit prevention measure to have in place.
A)True
B)False
Q3) Repair of lacerations that require layered closure of one or more of the deeper layers of the skin and tissues is known as
A) simple.
B) complex.
C) intermediate.
D) cosmetic.
Q4) The upper middle region above the stomach is known as the ____________________ region.
Q5) Skin repairs are coded according to the sum of the length of the repairs in centimeters.
A)True
B)False
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Chapter 5: Diagnostic Coding
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115 Flashcards
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Sample Questions
Q1) In what case should a Z code be used?
A) Sterilization
B) Hysterectomy
C) Antibiotic injection
D) Dermatitis
Q2) ICD-10-CM codes listed in Volume 1 of the ICD-10-CM manual contain seven characters.
A)True
B)False
Q3) Excludes 1 notes indicate codes that are not typically reported together; however it is possible for the patient to have both conditions at the same time and can be reported, when appropriate.
A)True
B)False
Q4) List the ICD-10-CM code(s) for a patient with glaucoma with recurrent iridocyclitis.
Q5) ICD-10-CM codes that begin with the letter D indicate that the condition is some sort of _____.
Q6) _____ codes are only reported by the provider who is initially treating a patient for an injury.
Page 7
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Chapter 6: Procedural Coding
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Sample Questions
Q1) Coding and billing numerous CPT codes to identify procedures that are usually described by a single code is called ____________________.
Q2) A 46-year-old new patient is seen in an internal medicine office for a routine annual checkup. The patient is asymptomatic, with no complaints. A comprehensive history is taken, and a comprehensive physical examination is performed. A chest x-ray (two views), an ECG, an automated urinalysis with microscopy, and an automated CBC with manual differential WBC count are obtained in the office. List the code(s) required to complete the Health Insurance Claim Form.
Q3) In coding a surgical procedure, postoperative care and follow-up visits may not be coded separately if they fall within the global period for the procedure. A)True B)False
Q4) Some private insurance companies may or may not accept HCPCS codes. A)True B)False
Q5) If you are billing services for an assistant surgeon, use modifier ____________________ after the surgery procedure number.
Q6) The E/M code 99203 is considered a level ____________________ code.
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Chapter 7: The Paper Claim: Cms-1500 02-12
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78 Verified Questions
78 Flashcards
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Sample Questions
Q1) A Medicare claim that contains complete, necessary information but is illogical or incorrect.
A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim
Q2) To conform to CMS-1500 OCR guidelines,
A) do not fold insurance claim forms when mailing.
B) do not use symbols with data on insurance claim forms.
C) do not strike over errors when making a correction on an insurance claim form.
D) all of the above.
Q3) A dirty claim is one that had coffee spilled on it before it was sent to the insurance carrier.
A)True
B)False
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Chapter 8: The Electronic Claim
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80 Verified Questions
80 Flashcards
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Sample Questions
Q1) Incorrect sequencing of patient information on an electronic claim results in inaccuracies that violate the HIPAA standard transaction format and are known as
A) batch errors.
B) claim errors.
C) syntax errors.
D) HIPAA errors.
Q2) The three-digit standard transaction for transmission of the electronic claim is referred to in the physician's office as ___.
Q3) What are the three kinds of information system safeguards and security measures?
Q4) Research unpaid claims.
A)Daily
B)Weekly
C)End of month
D)Daily or weekly
Q5) A/an __ is a preprinted document used by the provider to circle procedural and diagnostic codes that are then passed on to the insurance billing specialist and used to enter information into the computer system.
Q6) List three additional names for an encounter form.
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Chapter 9: Receiving Payments and Insurance Problem
Solving
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Sample Questions
Q1) The document together with the payment voucher that is sent to a physician who has accepted assignment of benefits is referred to as an A) EOB.
B) EOMB.
C) MRA.
D) MPS.
Q2) FTC stands for _________________________.
Q3) An insurance claim that is processed without following specific insurance carrier instructions is considered a/an ____________________ claim.
Q4) In any type of overpayment situation, always cash the third-party payers check and write a refund check payable to the originator of the overpayment.
A)True
B)False
Q5) In the case of a Medicare Part B redetermination, carriers have been instructed to pay an appealed insurance claim if the cost of the hearing process is more than the amount of the claim.
A)True
B)False
11
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Chapter 10: Office and Insurance Collection Strategies
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Sample Questions
Q1) When writing a collection letter
A) do not try to be friendly; just get to the point.
B) use a friendly tone and ask why payment has not been made.
C) do not suggest that the patient has overlooked a previous statement.
D) do not imply that the patient has good intentions to pay.
Q2) The patient information sheet is also known as the ______________________________.
Q3) When a physician continues to treat a patient with an overdue account, the courts have viewed this as an extension of credit; therefore, patients who fall into this delinquent status should be referred elsewhere.
A)True
B)False
Q4) Refunds may be made by check on accounts in which payment was made by credit card.
A)True B)False
Q5) The truth in lending consumer credit cost disclosure requires businesses to disclose all ____________________ and ____________________ costs related to granting credit.
Page 12
Q6) All discounted fees need to be noted on the patient's ____________________.
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Chapter 11: The Blue Plans, Private Insurance, and Managed Care Plans
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41 Flashcards
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Sample Questions
Q1) In an independent practice association (IPA), physicians are
A) paid salaries by their own independent group.
B) paid salaries by the practice association.
C) not employees and are not paid salaries.
D) not paid until the end of the year in which services were rendered.
Q2) How are physicians who work for a prepaid group practice model paid?
A) Salary paid by independent group
B) Salary paid by a health plan
C) Fee-for-service
D) Usual, customary, and reasonable charges
Q3) A copayment in a managed care plan is usually a fixed dollar amount (predetermined fee).
A)True
B)False
Q4) The term turfing means to transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer.
A)True
B)False
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Q5) The abbreviation MCO stands for ______________________________.
Chapter 12: Medicare
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Sample Questions
Q1) Medicare is a
A) state health insurance program.
B) federal health insurance program.
C) regional health insurance program.
D) local health insurance program.
Q2) The assignment on a patient with Medicare-Medicaid must always be accepted or Medicaid will not pick up the residual.
A)True
B)False
Q3) When a Medicare recipient chooses a Medicare senior plan, he or she forfeits the Medicare card.
A)True
B)False
Q4) Benefits of Medigap policies may vary from one state to another.
A)True
B)False
Q5) Medigap payments go directly to the beneficiary.
A)True
B)False
Q6) Medicare outpatient coverage is referred to as Part ____________________.
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Chapter 13: Medicaid and Other State Programs
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Sample Questions
Q1) Medicaid was legally established by Title ____________________ of the Social Security Act.
Q2) Medicaid is available to the needy and low-income people such as
A) the blind.
B) the disabled.
C) the aged (65 years or older).
D) all of the above.
Q3) The medically needy aged
A) require help in meeting costs of medical care.
B) qualify for cash assistance.
C) are classified as those with extremely low income.
D) qualify for housing assistance.
Q4) All states processing medical claims must bill using the CMS-1500 claim form.
A)True
B)False
Q5) The time limit to appeal a claim varies from state to state, but it is usually
A) 30-60 days.
B) 90-120 days.
C) 6 months.
D) 1 year.
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Chapter 14: Tricare and Veterans Health Care
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Sample Questions
Q1) The Privacy Act of 1974 establishes an individual's right to review his or her medical records maintained by
A) a federal medical care facility.
B) a VA hospital.
C) a U.S. Public Health Service facility.
D) all of the above.
Q2) The TRICARE fiscal year extends from
A) January 1 to December 31.
B) April 1 to March 31.
C) July 1 to June 30.
D) October 1 to September 30.
Q3) The health maintenance organization provided for dependents of active duty military personnel is called A) CHAMPUS.
B) TRICARE Prime.
C) TRICARE Extra.
D) TRICARE Standard.
Q4) All dependents ____________________ years of age or older are required to have a Uniformed Services (military) identification card.
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Chapter 15: Workers Compensation
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57 Verified Questions
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Sample Questions
Q1) A/An ____________________ expresses legal claim on the property of another for the payment of a debt.
Q2) If a worker's occupation takes a person into another state, most compensation laws are ____________________ and effective outside the state by either specific provisions or court decision.
Q3) Workers' compensation benefits are subject to income tax.
A)True
B)False
Q4) A ____________________ report is sent to the insurance carrier after 2-4 weeks of treatment to give information on the current status of the patient.
Q5) Beginning in the 1990s, increases in fraudulent workers' compensation claims have been noted throughout many large metropolitan cities.
A)True
B)False
Q6) Under health reform legislation of 2010, what is the fee per employee for employers with more than 50 employees when the government subsidizes their workers' insurance coverage?
Q7) Which types of employees fall under federal workers' compensation statutes?
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Chapter 16: Disability Income Insurance and Disability Benefit Programs
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Sample Questions
Q1) Disability income insurance is available from A) private insurance companies.
B) employer-sponsored plans.
C) government-funded programs.
D) all of the above.
Q2) When an employer provides disability income insurance and the employee leaves the company, the insurance terminates unless the employee is disabled.
A)True
B)False
Q3) California allows for state disability benefits in a normal routine pregnancy. A)True B)False
Q4) Which two programs managed by the Social Security Administration pay disability benefits to people younger than 65?
Q5) A reason for denial of disability income benefits is insufficient medical information. A)True B)False
Page 18
Q6) What are six major government disability programs?
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Chapter 17: Hospital Billing
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Sample Questions
Q1) Methods in which the plan advances cash to cover expected claims to the hospital.
A)Ambulatory payment
B)Bed leasing
C)Capitation or percentage of revenue
D)Case rate
E)Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems
Q2) ____________________ are used for CPT and HCPCS codes to modify or provide more detailed information on the procedure and/or medical supply.
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Chapter 18: Seeking a Job and Attaining Professional Advancement
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Sample Questions
Q1) It is discriminatory for an employer to ask if an applicant smokes.
A)True
B)False
Q2) An insurance billing specialist should join a professional organization of billers because this helps in keeping up to date with coding information.
A)True
B)False
Q3) A functional résumé
A) lists the most recent work experiences first with dates and descriptive data for each job.
B) states the applicant's qualifications or skills the individual is able to perform.
C) lists the applicant's job skills, education, and employment history.
D) introduces the applicant and summarizes all important data.
Q4) A résumé that provides recent experiences first, with dates and descriptive data for each job, is ____________________.
Q5) A résumé that summarizes the applicant's job skills, as well as educational and employment history, is of the ____________________.
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