Medical Records Management Test
Bank
Course Introduction
Medical Records Management explores the principles, procedures, and technologies involved in the creation, maintenance, and secure handling of patient health information. The course covers topics such as health information systems, regulatory compliance (including HIPAA), data privacy and security, record retention policies, and the transition from paper to electronic health records (EHR). Through a combination of theoretical knowledge and practical application, students learn how to ensure the accuracy, accessibility, and confidentiality of medical records while supporting healthcare delivery, administration, and legal requirements.
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) Reporting incorrect information to government-funded programs is A) unethical.
B) illegal.
C) abuse.
D) fraud.
Answer: B
Q2) Reporting incorrect information to Medicare.
A)Illegal
B)Unethical
C)Both illegal and unethical
Answer: A
Q3) Respondeat superior, which literally means "let the master answer," is also known as ____________________ liability.
Answer: vicarious
Q4) Standards of conduct by which an insurance billing specialist determines the propriety of his or her behavior in a relationship are known as medical
Answer: ethics
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Chapter 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing
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70 Verified Questions
70 Flashcards
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Sample Questions
Q1) A health care organization must not conduct business with any health care provider who has been listed as an __________________ by OIG.
Answer: excluded individual
Q2) Under HIPAA guidelines, a chiropractor or dentist's office would never be considered a covered entity.
A)True
B)False
Answer: False
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) Stealing money that has been entrusted to one's care is known as ___________________.
Answer: embezzlement
Q5) 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) Mrs. Thompsett leaves her place of employment. She is eligible to transfer her medical insurance coverage from a group to an individual contract. This is known as A) contract privilege.
B) conversion privilege.
C) coordination privilege.
D) exclusion privilege.
Answer: B
Q2) Workers' compensation insurance covers off-the-job injuries.
A)True
B)False
Answer: False
Q3) A two- or three-part form that incorporates a combination bill, insurance form, and routing document used in both computer- and paper-based systems is called an encounter form.
A)True
B)False
Answer: True
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Chapter 4: Medical Documentation and the Electronic Health Record
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94 Verified Questions
94 Flashcards
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Sample Questions
Q1) The abbreviation HPI stands for ______________________________.
Q2) The term ____________________ refers to a disease that persists over a long time.
Q3) WNL is the abbreviation for _________________________.
Q4) When a discussion takes place with a patient concerning the risks and benefits of treatment options, it is considered
A) an office visit.
B) a consultation.
C) counseling.
D) a "no-charge" visit.
Q5) Under the Medicare incentive program for implementation of EHR, eligible providers will
A) earn incentive payments for up to 4 years if they have demonstrated MU.
B) earn incentive payments for up to 10 years if they have demonstrated MU.
C) be penalized through payment adjustments starting in 2013 if they have not demonstrated MU.
D) be penalized through payment adjustments starting in 2015 if they have not demonstrated MU.
Q6) Explain the methods for disposing of both paper and electronic records.
Q7) PFSH is the abbreviation for ___________________________________. Page 6
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Page 7
Chapter 5: Diagnostic Coding
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115 Verified Questions
115 Flashcards
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Sample Questions
Q1) What is the consequence when a medical practice does not use diagnostic codes?
A) It affects the physician's level of reimbursement for inpatient claims.
B) Claims can be denied.
C) Fines or penalties can be levied.
D) All of the above.
Q2) It is possible for the primary diagnosis and the principal diagnosis to be the same.
A)True
B)False
Q3) ICD-10-CM codes have from ____ to ___ characters.
Q4) Why is the correct sequence of codes on an insurance claim important?
A) To make the chronology of patient care events understood.
B) To make the severity of disease understood.
C) It is not important as long as the correct indicator is used for each line of service.
D) Both a and b
Q5) Annual updates to the ICD-10-CM coding system are published in the _____, by the US Government Printing Office.
Q6) Routine outpatient prenatal care is reported with a code from category ___.
Q7) Provide the appropriate ICD-10-CM code for a cellulitis of the anus.
Page 8
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Chapter 6: Procedural Coding
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40 Flashcards
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Sample Questions
Q1) A patient required arthroplasty of the tibial plateaus of both knees. Code this procedure for the surgeon.
Q2) When there is a choice of two or three somewhat similar codes, the insurance claims examiner will choose the highest-paying code.
A)True
B)False
Q3) Deliberate manipulation of CPT codes for increased payment is called
Q4) CPT uses a basic ____________________-digit system for coding services rendered by physicians, plus ____________________-digit add-on modifiers.
Q5) 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.
Q6) The E/M code 99203 is considered a level ____________________ code.
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Page 9
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) What is the treating physician's NPI number?
Q2) The patient's insurance number is incorrect.
A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.
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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) A batch of claims is a group of claims for different facilities which are sent to the same clearinghouse.
A)True
B)False
Q2) Which of the following is the best way to protect computers and prevent data file damage during power outages?
A) All computers should be turned off prior to any type of storm.
B) All computers should be plugged into separate circuit breakers.
C) All offices should be equipped with a backup generator.
D) All offices should install uninterruptible power supplies.
Q3) Clearinghouses always charge a flat fee for claim processing.
A)True
B)False
Q4) Why was the HIPAA Transaction Code Set developed?
Q5) Audit claims batched and transmitted with confirmation reports.
A)Daily
B)Weekly
C)End of month
D)Daily or weekly
Q6) What does an electronic remittance advice (RA) do?
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Chapter 9: Receiving Payments and Insurance Problem
Solving
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65 Verified Questions
65 Flashcards
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Sample Questions
Q1) If the provider is notified by a commercial insurance carrier that an overpayment has been made, investigate the refund request.
A)True
B)False
Q2) In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is
A) $100 or more.
B) $300 or more.
C) $500 or more.
D) $1000 or more.
Q3) The highest level of a Medicare redetermination is with an administrative law judge hearing.
A)True
B)False
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
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Q5) Overdue payment on an insurance claim is referred to as
Chapter 10: Office and Insurance Collection Strategies
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87 Verified Questions
87 Flashcards
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Sample Questions
Q1) According to the FDCPA, debtors can never be contacted at work.
A)True
B)False
Q2) When collecting fees, your goal should always be to
A) leave the impression that you are a nice person.
B) collect at least one half the fee.
C) collect the full amount.
D) collect as much as possible.
Q3) Contracting a medical billing service for insurance claim submission is called
A) statement service.
B) centralized billing.
C) outsourcing.
D) cycle billing.
Q4) The term ____________________ is used when accounts are billed at spaced intervals during the month.
Q5) The collection abbreviation TTA means ____________________.
Q6) The patient registration form should be updated at least every
Q7) Patients' accounts turned over to a collection agency should have a/an ____________________ sent by certified mail.
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Chapter 11: The Blue Plans, Private Insurance, and Managed Care Plans
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41 Verified Questions
41 Flashcards
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Sample Questions
Q1) 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
Q2) The difference between an IPA and a PPG is that member physicians may not own an IPA, whereas a PPG is physician owned.
A)True
B)False
Q3) The abbreviation MCO stands for ______________________________.
Q4) Practitioners in an HMO program may come under peer review by a professional group called a
A) peer review group.
B) quality control group.
C) Quality Improvement Organization.
D) utilization management corporation.
Q5) Exclusive provider organizations (EPOs) are regulated by the federal government. A)True
B)False
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Chapter 12: Medicare
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Sample Questions
Q1) Medicare provides insurance for people ____________________ years of age or older who are retired on Social Security.
Q2) What type of coverage does a Medi-Medi patient have?
Q3) Each Medicare hospital benefit period consists of 60 consecutive days in a hospital or nursing facility.
A)True
B)False
Q4) The letters preceding the number on the patient's Medicare identification card indicate
A) wage earner, husband's number, widow, and disabled adult.
B) outpatient or hospital benefits.
C) railroad retiree.
D) Medicaid eligibility.
Q5) A Medicare patient with an HMO does not need a supplemental insurance policy. A)True
B)False
Q6) Medicare outpatient coverage is referred to as Part ____________________.
Q7) The Medicare HCPCS coding system has ____________________ levels.
Q8) On what basis are HMO enrollees classified into DCGs?
Q9) What is the amount of the check that Medicare sends to the physician? Page 15
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Page 16
Chapter 13: Medicaid and Other State Programs
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55 Verified Questions
55 Flashcards
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Sample Questions
Q1) Most states have ____________________ for Medicaid payments if a patient requires medical care while out of state.
Q2) Managed care Medicaid programs usually save money in health care delivery.
A)True
B)False
Q3) The federal government designs the Medicaid program for each state on the basis of the needs of the state.
A)True
B)False
Q4) Medicaid is an established program of medical assistance in 46 states.
A)True
B)False
Q5) The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act are federal legislation passed in _________________.
Q6) The federal aspects of Medicaid are the responsibility of the A) AMA.
B) AHA.
C) HIAA.
D) CMS.
Page 17
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Chapter 14: Tricare and Veterans Health Care
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Sample Questions
Q1) A certified nurse midwife is an authorized provider of health care for TRICARE beneficiaries.
A)True
B)False
Q2) Enrollment in TRICARE Prime is voluntary.
A)True
B)False
Q3) A person retired from a career in the armed forces is eligible for TRICARE until 65 years of age.
A)True
B)False
Q4) All Privacy Act requests from patients must be made in writing. A)True
B)False
Q5) TRICARE is subject to state regulatory agencies that control insurance policies. A)True
B)False
Q6) Where are claims for patients on active duty sent?
Q7) Individuals who qualify for TRICARE are known as ____________________.
Q8) What does the acronym CHAMPVA stand for?
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Chapter 15: Workers Compensation
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57 Verified Questions
57 Flashcards
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Sample Questions
Q1) State compensation laws that require each employer to accept its provisions and provide for specified benefits are
A) compulsory laws.
B) elective laws.
C) regional laws.
D) local laws.
Q2) Name the five types of workers' compensation benefits.
Q3) An abnormal condition caused by exposure to environmental factors associated with employment is termed a/an
A) physical injury.
B) occupational illness.
C) temporary disability.
D) permanent disability.
Q4) Workers' compensation benefits include
A) medical care.
B) disability income.
C) death benefits.
D) all of the above.
Q5) The three types of disability claims are ____________, ________________, and _____________.
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Chapter 16: Disability Income Insurance and Disability Benefit Programs
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Sample Questions
Q1) Which two programs managed by the Social Security Administration pay monthly disability benefits to people younger than age 65 who cannot work for at least a year because of a severe disability?
A) CCRS and FERS
B) Armed Services Disability and Veterans Affairs (VA) disability program
C) SSDI and SSI
D) SSI and FERS
Q2) Medical requirements are the same for both the SSDI and SSI programs.
A)True
B)False
Q3) For people trying to qualify for SSDI or SSI, determination is made by the physician. A)True
B)False
Q4) If the validity of a State Disability Insurance case is in question, a/an _______________________________ may be asked by the insurance company to examine the disabled individual.
Q5) In an insurance contract, a/an ____________________ of premiums means that while disabled the employee does not have to pay any premiums because they are paid by the policy.
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Chapter 17: Hospital Billing
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Sample Questions
Q1) Insurances from different states have the same standards for reimbursement.
A)True
B)False
Q2) Which organization is responsible for admission review, readmission review, procedure review, day and cost outlier review, DRG validation, and transfer review?
A) QIO
B) APC
C) PPS
D) MRO
Q3) In an effort to reduce the processing time for each health insurance claim submitted and to reduce costs related to health care delivery, Medicare uses a ______________ prospective payment system on which hospital fee reimbursements are based.
Q4) Emergency department charges are billed along with the inpatient stay on the CMS-1500 claim form.
A)True
B)False
Q5) On the CMS 1450 (UB-04) claim form, the second digit of the four-digit bill code in Field 4 indicates the type of ____________________.
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Chapter 18: Seeking a Job and Attaining Professional Advancement
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Sample Questions
Q1) Accounts receivable bookkeeping experience would be listed on a résumé under the heading
A) skills.
B) education.
C) professional experience.
D) references.
Q2) A résumé that summarizes the applicant's job skills, as well as educational and employment history, is of the ____________________.
Q3) List five ways to search for a job.
Q4) A claims assistance professional should promote and market to
A) family practitioners, surgeons, and psychiatrists.
B) podiatrists, chiropractors, and physical therapists.
C) small hospitals and clinics.
D) Medicare recipients.
Q5) In completing an application for employment, abbreviations are not used unless space is extremely limited.
A)True
B)False
Q6) What should a cover letter end with?
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