Physician Office Billing Practice Test

These questions are part of the practice quiz. Start practicing

• The type of payment structure that PPO's usually offer in their contracts with providers is called?
• Which term refers to the process of checking a patient's insurance coverage?
• What is an example of a self-funded health plan?
• Which skills are essential for medical insurance specialists when completing claims?
• What are the consequences of not verifying a patient’s eligibility before billing?
• Hospital benefits are provided under which part of Medicare?
• How does the use of technology impact medical billing?
• If a patient receives a service worth $127 and has a $15 copayment, what is their estimated balance?
• What key elements should be included in compliance training for billing staff?
• Patients may have fill-in-the-gap insurance called?
• If a patient has coverage under two insurance plans, which one is the primary plan?
• What Medicare form is used to show charges to patients for noncovered services?
• What is a common source of frustration for practices related to timely billing submissions?
• Which type of data is NOT typically collected by billing systems during the revenue cycle?
• What is a claims denial?
• What does the insured's ID number refer to?
• What are the different types of insurance plans commonly encountered in physician office billing?
• What is the name of the process that allows for immediate claim submission and response during patient checkout?
• What is the difference between CPT codes and ICD codes?
• What is one benefit of receiving prompt answers from insurance plans?
• Under which rule is a child's primary insurance coverage under the father's plan when both parents have insurance?
• What is the first step in the claim submission process in medical billing?
• What does the term "self-pay" refer to in medical billing?
• What is typically required for a patient to release medical information?
• What type of services does EPSDT encompass?
• What does SSI stand for in financial assistance programs?
• Which of the following information is gathered on the patient information form?
• What does "secondary claims" refer to in medical billing?
• Which terms have the same meaning as "subscriber"?
• What kind of assistance does TANF provide?
• Explain the benefit that COBRA offers to employees who are leaving a job.
• What is an explanation of benefits (EOB)?
• Which entity would be given a referral number?
• A patients insurance card usually shows:
• Which service is covered by Medicaid?
• What does COB stand for in the context of medical insurance?
• Why is patient eligibility verification important before billing?
• How is the secondary insurance billed after the primary plan?
• Which charges do medical practices typically collect at the time of service?
• What is the primary difference between primary and secondary insurance?
• What does understanding payer contracts involve?
• What is the primary purpose of coordination of benefits (COB)?
• Who may be covered under a Group Health Plan (GHP)?
• What might happen if a healthcare provider does not adhere to patient feedback in billing?
• What document is used to summarize the services provided during a patient visit?
• What type of software checks claims for errors?
• How frequently may eligibility for Medicaid change?
• All of the following must be covered by state Medicaid programs EXCEPT?
• What is the primary purpose of a billing statement?
• A Medi-Medi beneficiary is defined as someone who?
• When should a medical insurance specialist check patients' Medicaid eligibility?
• Which of the following is NOT considered an asset?
• The amount of time that must pass before an employee can enroll in a health plan is called?
• Which rule determines a child's primary coverage based on the earlier date of birth of the parents?
• What is the health insurance program for federal government employees called?
• Which form is typically completed to provide personal information to a healthcare provider?
• Which of the following type of plan do employers or employee organizations offer their employees?
• Who is typically responsible for documenting a patient's vital signs?
• What does an Acknowledgement of Receipt of Notice of Privacy Practices state?
• A list of drugs that are covered under an insurance plan is called the?
• What is the effect of inaccurate coding in medical billing?
• How many million people is the Affordable Care Act expected to add to the Medicaid Program?
• What is a payment plan in the context of patient billing?
• What is required from patients to allow the sharing of their health information with insurance providers?
• Which of the following is a requirement for Medicaid eligibility?
• Which document notifies patients of their rights regarding medical information?
• When is the best time to begin collecting patient information?
• What key factor defines someone as categorically needy under Medicaid?
• What are the key components of a billing statement?
• What is a fee schedule in the context of physician billing?
• What term describes the amount a patient must pay out-of-pocket before their insurance coverage begins?
• Why is the timely submission of claims important in physician office billing?
• Why is it essential to document services in the medical record?
• Which of the following describes a common role of medical billing specialists in relation to Medicaid?
• What does TANF represent in social services?
• What is the significance of the National Provider Identifier (NPI)?
• What does EPSDT stand for in healthcare?
• What can be used to verify insurance company information?
• What type of provider is required to have patients sign an acknowledgment?
• In the context of medical billing, what does "upcoding" mean?
• What is the role of a billing specialist in a physician's office?
• What is the typical content of a superbill?
• Which of the following services is NOT included in the Children's Health Insurance Program?
• Which term refers to an individual who enrolls in a health plan after the original enrollment date?
• In patient billing, what does the term "guarantor" mean?
• What type of plan requires premiums, deductibles, and coinsurance payments while typically covering 70 to 80 percent of costs for covered benefits after deductibles are met?
• What does the term "allowed amount" refer to?
• What is the primary purpose of coding in physician office billing?
• If a retired patient with Medicare also has coverage under a working spouse's plan, which plan is considered primary?
• In the context of patient billing, what does the term "coinsurance" refer to?
• What type of insurance policy helps cover out-of-pocket expenses not covered by primary insurance?
• What type of plan is structured to permit the funding of premiums with pretax payroll deductions?
• Which statement is true regarding the categorically needy and medically needy in the Medicaid Program?
• Medicare benefits are available to individuals in how many beneficiary categories?
• In which scenario is timely filing of claims most critical?
• Which coding system is used to report inpatient hospital services?
• What term describes a physician who sends a patient to another physician?
• What does PHI stand for in a healthcare context?
• How can timely billing contribute to a healthcare practice?
• What is a potential risk of a poor payer mix?
• In billing terminology, what is generally considered primary insurance?
• What type of information is not found on an insurance card?
• Identify the type of deductible which must be met for each separate enrollee.
• Identify the document self-funded plan members receive that states their benefits and legal rights.
• To qualify for Medicaid, beneficiaries must meet which requirements?
• What impact do healthcare regulations have on billing practices?
• What type of insurance plan is often referred to as dual coverage?
• What are HCPCS Level II codes used for?
• What type of information is included in a patient's social history?
• What is the role of the accounts receivable department in a physician's office?
• Third-party claims administrators are classified as?
• What is the role of patient education in the billing process?
• What information is included in a formulary?
• The first health plan to pay when more than one plan is active is referred to as what?
• What does "capitation" mean in health insurance?
• Which of the following is a way that an employer can reduce prices for their Group Health Plans (GHPs)?
• What is the purpose of billing audits in a medical office?
• In which scenario would a modifier code be necessary?
• What is "balance billing"?
• What is the significance of the "remittance advice" in billing?
• Providers in capitated managed care plans who receive flat monthly fees:
• What is necessary for a provider to bill an insurance company for services rendered?
• An example of a claim submission should include which of the following?
• Which of the following is most accurate for a patient who has not visited the provider in several years?
• In billing terminology, what does it mean if a service is "denied"?
• In which situation would a state Medicaid beneficiary be ineligible in another state?
• What is the main focus of the Health Insurance Portability and Accountability Act (HIPAA)?
• What does TPO stand for in relation to health information?
• What is one benefit of offering a Group Health Plan (GHP) to employees?
• What kind of information should billing systems track for effective revenue cycles?
• What does "payer mix" indicate in healthcare practices?
• What is another common term for encounter forms?
• Approximately what percent of the population are covered under individual health plans (IHPs)?
• What does the abbreviation HIPAA stand for?
• What type of information is found in blocks 1 through 13 of the CMS-1500?
• How can improper billing affect an insurance claim?
• Which is a common reason why people elect to enroll in individual health plans?
• Which insurance coverage pays after the primary insurance has made a payment?
• Why is it essential for a practice to manage self-pay situations effectively?
• What is another term for a HIPAA-mandated electronic transaction for claims?
• In what formats do encounter forms typically come?
• The eligibility for Medicaid can change based on what factor?
• For a patient last visited on March 5, 2014, what is the best action upon arrival?
• Which type of patient would not have a copayment?
• A person eligible for Medicaid in one state is:
• What is the purpose of insurance coding in medical billing?
• How does medical necessity affect billing and reimbursement?
• What is the primary consequence of missing timely filing limits in claims processing?
• Which type of provider actually delivers services to patients?
• What type of private payer offers lower costs, but also has the most stringent guidelines and the narrowest choice of providers?
• How recent must a signature on file be for the release of information to be permissible?
• What role do insurance verification processes play in billing?
• What does the term "COB" mean in insurance billing?
• Which of the following accurately describes a “co-payment”?
• How does a billing audit function in a practice?
• In healthcare billing, what does "out-of-network" mean?
• Where is an assignment of benefits statement filed?
• Who receives payment from a health insurance claim?
• Patients who elect to pay a higher co-payment, greater coinsurance, or both, are most likely visiting a:
• Which option may include additional benefits beyond basic coverage in GHPs?
• What is a charge capture system in physician billing?
• A provider such as a facility who does not have face-to-face interaction with a patient is called a(n):
• Why are accurate patient demographics important in billing?
• Define copayment in the context of insurance billing.
• What does "denied claims follow-up" involve in the billing cycle?
• ________ adults may be eligible for Medicare benefits.
• Outpatient hospital benefits are provided under which part of Medicare?
• In which section of the CMS-1500 is the carrier block located?
• What is the purpose of modifier codes in billing?
• What is another term for the insured?
• How is the Children's Health Insurance Program (CHIP) primarily funded?
• What happens to a claim that lacks an ICD-9 (or ICD-10-CM) code?
• The term maximum benefit limit applies to?
• Which of the following best describes a billing error?
• Self-funded health plans pay premiums to?
• What does CHIP stand for in healthcare?
• How does patient feedback contribute to billing and collection processes?
• What is true about Medicaid-participating providers?
• What does the abbreviation FMAP represent?
• What does NonPAR stand for?
• What is the definition of an established patient?
• What is the most likely destination for a patient referred by another physician?
• Upon arrival, what should a patient who last visited on May 14, 2013 be asked to do?
• What type of patient is defined as having no insurance coverage?
• What does the spend-down program in Medicaid allow beneficiaries to do?
• Which regulation governs employee benefits and requires disclosure of plan benefits?
• When is Medicare typically the secondary payer?
• What type of insurance is needed when a third payer is necessary after two health plans have made payments?
• What federal law regulates companies that establish employee health and pension plans?
• What does "deductible" refer to in patient billing?
• What is the significance of coding updates issued by the AMA?
• What is a write-off in medical billing?
• What is the significance of prompt payment laws?
• What is the role of a billing policy in a healthcare practice?
• According to the NUCC manual, how many diagnosis pointers can be included per service line?
• What is the primary goal of efficient medical billing practices?
• What is a superbill?
• What information is typically required for a patient intake form?
• In a spend down program, beneficiaries are required to do what?
• What does the term "bundled payments" mean in billing?
• What is the main purpose of an open enrollment period?
• How can a clear billing policy impact patient trust?
• Where should you locate information about a patient's health plan during an appointment?
• What does "patient balances" refer to in the billing process?
• Why is it important to keep up-to-date with coding changes?
• Patients with end-stage renal disease are entitled to Medicare benefits until:
• Which of the following is considered a non-participating provider?
• Pick the type of use of PHI that a practice would employ to train their staff to improve the quality of their health care.
• Who typically arranges payment for claims in a self-funded plan?
• Which type of healthcare provider often handles administrative duties but does not typically provide patient care?
• What do "noncovered" charges generally refer to?
• A provider who directly treats a patient is called a(n):
• What does the term "clearinghouse" mean in medical billing?
• What name is given to the time between the date of an employee's hire and the earliest effective date of insurance coverage?
• Which of the following is the most popular type of group health plan?
• Which document is essential for verifying a patient's identity during billing?
• What does ABN stand for in medical billing?
• What is the purpose of pre-authorization for medical services?
• What should be included in a patient’s billing statement?
• Which of these documents will the patient not complete?
• What may be used to define the terms of an insurance contract?
• What is the Medical Billing Revenue Cycle?
• How does inpatient billing differ from outpatient billing?
• What can result from consistent training on billing procedures for staff?
• Which codes are used to indicate that a procedure occurred in a medical office?
• What type of plan is a hybrid of two networks where members may choose from a primary or secondary network?
• Generalize the advantages provided by employers by offering Group Health Plans (GHPs).
• To locate a patient's insurance information, which document should be used?
• Medicaid's spend-down program operates on what basis?
• The deductible for Medicare Part A is:
• What defines a new patient?
• What are the consequences of improper coding in medical billing?