Elance Medical Billing Test Answers



An illegal practice of assigning an ICD-9 diagnosis code that does not agree with the patient records for the purpose of increasing the reimbursement from the insurance payor is called:

Code banking
Upcoding
ICD skimming
Pocketlining

 

 

In which month do commercial insurance and Medicare deductibles start each year?

January
March
June
October

 

 

Is a co-payment an out of pocket expense?

Sometimes
No
Yes

 

 

A patient on an HMO plan typically needs a _________ to receive care from a specialist.

prescription
referral
validation
clearance

 

 

What is Dx refer to?

Diagnosis code
Cancelled diagnosis
Bill cancellation
Post-mortem diagnosis

 

 

The predetermined (flat) fee, a patient usually has to pay on each office visit is a:

Code
Co-pay
Carrier
Co-insurance

 

 

What organ is measured in an EKG/ECG?

Heart
Lung
Kidney
Brain

 

 

Which of these would be a valid reasons for a claim to be denied?

The medical condition was deemed by the insurance company as being preexisting
The service was considered as not being medically necessary
The service was not covered under the patient’s health insurance contract.
All are valid reasons

 

 

What is COBRA insurance?

It is an insurance plan specific to the military
Insurance for exotic injuries
Insurance available to individuals after they become unemployed
It is a slang term used to describe uninsured emergency room patients

 

 

The date the insurance policy is set to begin or when benefits or covered services are allowed is most commonly known as the:

Effective date
Startup date
Float date
Coverage blanket date

 

 

Which federal law strengthens the privacy of a patient's PHI and allows a patient to review their medical record?

Medicare
HEDIS
COBRA
HIPAA

 

 

Place of service codes on claims are there to define?

The type of service
The time of service
The place of service where services were rendered
The payment qualifier

 

 

True or false? Sometimes multiple treatments will fall under one billing code.

False
True

 

 

The amount paid, often in monthly installments, for an insurance policy by the employer or patient themselves, is the:

Deductible
Co-pay
Premium
OOP

 

 

What does COB commonly refer to?

Course of Body
Cost of Billing
Cost on Bottom
Coordination of Benefits

 

 

The federal law that allows a worker to continue to purchase employer paid health insurance for up to 18 months if they lose their job or your coverage is otherwise terminated is known as:

Medicaid
COBRA
NOSSCR
HMO

 

 

What is a premium?

Name-brand medication
The amount paid for an insurance policy
The copay
Paying extra for a private hospital room

 

 

What do the CPT codes refer to?

The procedures performed by a physician or a practitioner
The procedures performed by Medical biller
The diagnoses performed on the patient
The names of the medicines prescribed by the practitioner
The disease that the patient is suffering from

 

 

In medical billing, what is the function of a clearinghouse?

It checks bills for errors then transmits them to the insurance company
It runs background checks on patient credit history
It calculates total patient bills
It processes all of the payments

 

 

True or False? Tertiary insurance is intended to cover gaps in coverage the primary and secondary insurance may not cover.

True
False

 

 

HIPAA stands for:

Health Insurance Protected Act of America
Health Insurance Portability Accountability Act

 

 

This health insurance coverage is available to an individual and their dependents after becoming unemployed - either due to voluntary or involuntary termination of employment for reasons other than gross misconduct.

USICA
COBRA Insurance
Medicare Insurance
GovCare
Co - Insurance

 

 

The exact abbreviation of RA in medical billing terminology?

Rheumatoid Arthritis
Regular Appointment
Remote Agent
Remittance Advice
Right Atrium

 

 

Which of these are NOT standard statuses of a claim in a typical EOB?

Paid
Denied
Pending
Transition

 

 

________ billing is when a patient is charged for the difference between what a doctor bills and what the provider and insurance company agree upon.

Fair
Balanced
Upcoding
Downcoding

 

 

Health Insurance Claim (HICN) is a number assigned by the Social Security Administration to an individual identifying him/her as a _______ beneficiary

Medicare
COBRA
Medicaid
CHIP

 

 

Hospital beds, wheelchairs and oxygen equipment would be considered examples of:

COBRA
DME
EBSA
DOS

 

 

A type of health coverage that typically allows a patient to go to any doctor or provider without permission is known as:

On-call fees
Fee-for-Service
Contractor insurance
Descriptor insurance

 

 

If a physician uses an open-panel HMO, can they see non-HMO patients?

Yes
No

 

 

True or False? AWP laws are state laws that require health insurance companies to accept into their PPO and HMO networks any provider willing to agree to the insurance company's terms and conditions.

False
True

 

 

When submitting a secondary claim, what is the name of the document that must be attached?

Certificate of codding
Certificate of Medical Necessity
Explanation of Benefits
Benefits of Explanation
Explanation of Medical Necessity

 

 

What is capitation?

A system that pays physicians and nurses a set amount per enrolled patient assigned to them
A payment scheduling method
The hierarchy of payments
The process of cutting down the price of a medical bill

 

 

What is the purpose of an Advanced Beneficiary Notice?

To alert a patient to a change in their premium payments
To alert the hospital to changes in Medicare's coverage policies
To alert a patient that Medicare may deny payment for a specific procedure or treatment
To confirm receipt of a patient's payment

 

 

Which of the following would you likely use if billing Medicare?

HCFA1500
UB-92
UB-04
W-4

 

 

With the implementation of HIPAA, all the following systems became mandatory EXCEPT:

HCPCS
ADT
CPT
ICD

 

 

Which part of Medicare is the drug prescription coverage?

Part A
Part B
Part D
Part C

 

 

The Employer Identification Number is also known as the:

Health Department Identification Number
Federal Tax Identification Number
Social Security Identification Number
Employer Group Health Plan

 

 

What is a clearing house?

Payment clearing authority
Intermediary between provider and insurance
None of these
Hygienic Place
All of these

 

 

True or False? ERISA includes PPOs, POS, and HMO benefit plans.

False
True

 

 

The ICD-9-CM coding classification to identify health care for reasons other than injury or illness is

V-code
H-code
T-code
A-code

 

 

True or False? A Medicaid MCO provides comprehensive services to Medicaid beneficiaries, but not commercial or Medicare enrollees.

True
False

 

 

Which of the following is an agreement made between the insurance company and the insured to send payments directly to the physician?

Referral
Preauthorization
Coordination of Benefits
Assignment of Benefits
Pre-Existing Conditions

 

 

True or false? Undercoding is illegal.

FALSE
True

 

 

Who is eligible for Medicare part C

An individual who is covered under Parts A and B
An individual who has an HMO plan
An individual who pays all premiums
An individual who has a supplemental Plan

 

 

The form the provider uses to document the treatment and diagnosis for a patient visit which typically includes ICD-9 diagnosis and CPT procedural codes is the:

Advanced payment form
Superbill
Focused item bill
IPC-450 form

 

 

The HIPAA approved standard paper claim form submitted to insurance companies to have the outpatient health benefit or the contracted provider visit paid is the:

CMS 1450
HIPAA 1500
CMS 1500
HIPAA 1450

 

 

Health insurance coverage which is contracted to supplement Medicare coverage is called:

Medigap
HMO extension
Medicaid
SSDI

 

 

What does UCR stand for?

Ultra Conservative Response
Usual, customary, or reasonable
Unique Client Referral
Unusual Chronic Illness

 

 

What could POS exactly stand for in Medical Billing?

Point of Service
Place of Service
Polycystic Ovary Syndorme

 

 

Charging for services that are not medically necessary are included under:

Abuse
Custodial care
Information models
Low cost alternatives

 

 

What are modifiers used for?

They are an indicator to show that a procedure is linked to more than one diagnosis
They are used to add more information about a ICD10 CM code
They are used to add more information about a ICD-9 CM code
They help in establishing "medical necessity"
They are used to add more information about a CPT code

 

 

True or False? The difference between the Medicare and Medicaid allowable is that Medicaid does NOT pay a percentage of the allowed amount.

True
False

 

 

Level II HCPCS codes are formatted as a single letter followed by _________.

Four numeric digits
five numeric digits and one letter
Two numeric digits and three letters
Two numeric digits and 2 letters

 

 

The claim form for billing for facility fees which replaces the UB92 form is the _______ form.

UB04
UB100A
CMS 1450
SNF20

 

 

How many digits are in a National Provider Identifier?

4
9
11
8
10

 

 

True or false? The coder should NOT correct any errors in a bill.

TRUE
False

 

 

Which one of the following was known as Medicare + Choice?

Part B
Part D
Part A
Part C

 

 

The average amount Medicare will pay a provider or hospital for a procedure is the:

PTAN
RVU
SNF
CCRC

 

 

Medical care, other than those provided by the physician or hospital, which are related to a patient’s care, are called:

Focused care
Ancillary care
Extraneous services
All of these are correct

 

 

A 3-digit number used on hospital bills to tell the insurer where the patient was when they received treatment, or what type of item a patient received, is the:

SMI code
Policy identification number
Medical Code
Revenue Code

 

 

Tricare was formerly known as

United States Department of Defense Military Health System
Civilian Health and Medical Program of the Uniformed Services(CHAMPUS)
Civilian Health and Medical Program of the United States(CHAMPUS)
None of the above
Humana Military Healthcare Services

 

 

Coding for a name-brand medication when a generic brand was used is called __________.

Upcoding
Swapping
Upgrading
Value-coding

 

 

What is a challenge of processing medical bills off site?

None of these
Governmental regulations
The biller may not be able to contact the physician
It is illegal to process medical bills off site

 

 

The difference between the summarized income rate and the summarized cost rate over a given valuation period is the:

Actuarial Balance
Administrative discrepancy
MediGap
Cost restraints

 

 

Submitting several CPT treatment codes when only one code is necessary is called:

Unbundling
Fraud
Facility charges
Abuse

 

 

A health benefit plan allowing the patient to choose to receive a service from a group of contracted providers is a:

OOP
PCP
PPT
POS

 

 

The form which is specifically used to bill dental services is called?

UB-04 form
Dental Claim form
ADA form
HCFA 1500 form

 

 

True or False? Med pay is a form of no-fault insurance.

True
False

 

 

The federal law that was originally created to safeguard an employees retirement benefits is abbreviated as:

COBRA
TRICARE
NOSSCR
ERISA

 

 

Will Medicare accept a UB-92 form?

No
Sometimes
Yes

 

 

What is the abbrevation for SSI?

Supplemental Security Information
Social Security Information
None of the above
Supplemental Security Income
Social Security Income

 

 

True or false? An individual on an HMO plan would need a referral to get a yearly mammogram.

TRUE
False

 

 

Medicare Advantages Plans cover consultation codes?

Yes
No
Partially

 

 

Which one of the following is the largest Blue Cross Blue Shield member?

Highmark
Premera
WellPoint
CareFirst

 

 

This type of workers compensation would be described as: abnormal conditions or disorders caused by exposure to enviromental factors. Examples of these could be exposure to a chemical, inhalation, ingestion or direct exposure.

Federal Employment Liability Act
Industrial accident
Occupational illness
State Workers Compensation
Occupational Safety and Health Administration

 

 

According to the MBAA, up to _____ % of US medical bills contain errors.

50%
80%
5%
35%

 

 

A ________ limits the amount of out-of-pocket expenses a patient will have to pay for TRICARE-covered medical services.

Care ceiling
HMO cap
catastrophic cap
TRICARE cap

 

 

If a provider is non-par, any allowed claim amount that is ______ billed charges should be unacceptable.

equal to
more than
less than

 

 

In DME claims which of the following is necessary: Referring physician or Ordering physician?

Neither
Both
Ordering Physician
Referring Physician

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