Work+Brain/Hireizon Medical Billing Assessment

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Question 1: Medical Billing

Sam Taylor calls Dr. Johnson's office for an appointment as a new patient. Sam carries CareFirst Insurance. Which of the following options best represents the correct sequence of steps to take when registering new patients?

A) 3, 5, 1, 2, 4 B) 5, 3, 2, 1, 4 C) 5, 1, 3, 4, 2 D) 3, 5, 1, 4, 2 E) 5, 1, 3, 2, 4

Question 2: Medical Billing

Which of the following time periods is the minimum CMS requirement for providers to retain copies of government insurance claims and copies of all attachments filed by a health care provider?

A) 3 years B) 5 years C) 6 years D) 8 years E) 10 years

Question 3: Medical Billing

Time units, which is the total time in minutes spent performing a certain procedure, is usually calculated for the claim submission. If a procedure lasts 120 minutes, the number of time units would be 10.

True False

Question 4: Medical Billing

Which of the following providers or facilities can bill claims using the CMS-1500 claim form?

A) A comprehensive outpatient rehabilitation facility B) A certified registered nurse anesthetist C) A clinical diagnostic laboratory D) A skilled nursing facility E) A clinical psychologist

Question 5: Medical Billing

A billing specialist reviews the diagnostic statements and their corresponding main terms presented in the image below. Which diagnostic statements have the wrong main terms associated with them?

A) 1, 2, 3 B) 2, 5 C) 4, 5 D) 3, 4, 5 E) 2, 3, 4

Question 6: Medical Billing

An E code is used as a supplementary diagnosis during coding to indicate a cause of injury. Which of the following E codes takes priority over all other E codes?

A) The E code for an earthquake B) The E code for a tornado C) The E code for a watercraft accident D) The E code for child abuse E) The E code for a motorcycle accident

Question 7: Medical Billing

A patient goes to a physician and presents an adverse reaction to the drug haloperidol. It is determined that the patient took the medication as prescribed. The proper diagnosis sequencing for this visit would be the manifestation or effect coded first, followed by the E code for the haloperidol.

True False

Question 8: Medical Billing

Jane Miller, a 54-year-old female, was admitted to the hospital with a severe headache, vomiting, and possible dehydration. Jane had received treatments for colon cancer almost three years ago, during which the affected region of the colon was resected. Jane is now in remission. However, the physician determines that the patient's history of colon cancer has an impact on her current care. Which of the following demonstrates the correct coding sequence?

A) Her history of colon cancer is coded as the principal diagnosis. B) Her history of colon cancer and dehydration are coded as the principal diagnoses. C) Her history of colon cancer is coded as both the principal and the secondary diagnoses. D) Her history of colon cancer is coded as the secondary diagnosis. E) Her history of colon cancer is coded as neither a principal diagnosis nor a secondary diagnosis.

Question 9: Medical Billing

Michael Green, a 37-year-old male, is admitted to the hospital after vomiting bright red blood. The patient complains of having experienced indigestion, fever, and abdominal pain for the past three days. After viewing the results of the laboratory and diagnostic tests, Dr. Wilson dictates, "Vomiting of blood due to gastric ulcer or gastritis." Based upon these details, the principal diagnosis would be a gastric ulcer.

True False

Question 10: Medical Billing

Which of the following patients can be classified as outpatients?

A) A patient with contact dermatitis who was treated in the physician's office B) A patient with asthma who was treated in an emergency department and stayed for 20 hours C) A patient who was admitted to an ambulatory surgery center for a cataract surgery and released in 12 hours D) A patient with severe abdominal pain who was admitted to a hospital for observation and stayed for 35.5 hours E) A patient who was admitted to a same-day surgery unit for an incision repair and stayed for 8 hours

Question 11: Medical Billing

Anna Mead, a female patient, was admitted to an inpatient facility for a scheduled coronary artery bypass graft. Which of the following options best describes the reason for ordering the CABG in order for it to be entered as the principal procedure?

A) As a definitive treatment B) To resolve a complication C) For diagnostic purposes D) As an alternative treatment E) As the last treatment option

Question 12: Medical Billing

Dr. Roberts completes a physical for Jack Harris, who is applying for insurance coverage and must have a physical examination in order to complete the enrollment process. To which of the following entities should the doctor send the bill for the physical?

A) The referring party B) Jack Harris C) The insurance company D) Both Jack Harris and the insurance company E) Both the insurance company and Jack Harris's employer

Question 13: Medical Billing

Dr. Carter, who is a participating provider with United Health Plan, performs a routine examination on Lisa, who is an enrolled member of the United Health Plan. Dr. Carter normally charges $50 per visit; however, Dr. Carter's contracted PAR rate with United Health Plan is $40. Which of the following statements is true regarding the proper procedure for Dr. Carter?

A) Lisa will incur higher out-of-pocket expenses when seeing Dr. Carter than she would when seeing a nonparticipating provider. B) Dr. Carter will not bill Lisa for any amount. C) Dr. Carter will bill the United Health Plan in the amount of $40. D) Dr. Carter will collect $10 from Lisa for the visit. E) Dr. Carter will pay Lisa an additional $10 for the physician visit.

Question 14: Medical Billing

Dr. Lee is a participating provider with the 123 Health Insurance Plan. Nicole Parker, who is insured by the 123 Health Insurance Plan, is treated by Dr. Lee in the physician's office, and a $35 fee is charged for the visit. The participating provider contract rate for the visit is $28. If Nicole's copayment is $7, how much money is the insurance company expected to pay?

A) $28 B) $35 C) $7 D) $21 E) $5.25

Question 15: Medical Billing

James has a procedure done by Dr. Watson, a physician who does not participate in James's insurance company's provider program. Dr. Watson's normal fee for this procedure is $500, which is more than the usual and customary rate of $480. If James's health plan covers 80% of the usual and customary rate, how much is James's total financial responsibility?

A) $20 B) $384 C) $96 D) $19.20 E) $116

Question 16: Medical Billing

Dr. Brown, who does not participate in Sarah's insurance company's provider program, treats Sarah in the physician's office. The fee for the visit is $50. The usual and customary rate for this type of visit is $45. If Sarah's insurance plan covers 80% of the usual and customary charges, how much should Dr. Brown collect from Sarah?

A) $36 B) $14 C) $5 D) $9 E) $10

Question 17: Medical Billing

A physician's office has received an official notice indicating that a patient who had received care from the physician has declared bankruptcy. Which of the following actions is the most appropriate one for the physician's office to take immediately after receiving this type of letter?

A) Send a statement to the patient and collect the remaining account. B) Discontinue providing care and treatment to the patient until the remaining balance is paid. C) Keep a copy of the statement and wait to be notified of a creditor's meeting. D) Attempt to collect the remaining amount from the patient without specifying whether or not the patient may continue seeing the physician. E) Accept the money received from the court and credit the account, but discontinue seeing the patient until the remaining balance is fully paid.

Question 18: Medical Billing

Researchers and experts agree that the acceptable amount of money received by physicians for customary fee-for-service from a managed care plan is between 75% and 110% of the customary charge. Dr. Anderson calculates that if his patients were charged fee-for-service, the total would have been $75,000. The total amount of money received from Health Care Inc., the managed care plan, is $58,000. Based on this information, did Dr. Anderson receive an acceptable percentage of the customary fee-for-service from Health Care Inc.?

A) Yes, Dr. Anderson received 77% of his customary fee-for-service charge from Health Care Inc. B) Yes, Dr. Anderson received 100% of his customary fee-for-service charge from Health Care Inc. C) No; Dr. Anderson received 129% of his customary fee-for-service charge from Health Care Inc. D) No; Dr. Anderson received 23% of his customary fee-for-service charge from Health Care Inc. E) No; Dr. Anderson received 47% of his customary fee-for-service charge from Health Care Inc.

Question 19: Medical Billing

Dr. Morgan, a participating provider, provided Eva Jones with evaluation and management services during an office visit. According to Eva's insurance company, the contracted rate for this E/M service is $70. Eva's health plan has a $200 annual deductible, which was met earlier this year, and a 20% copayment. Which of the following statements are true about this situation?

A) Eva must pay Dr. Morgan $70. B) Eva's health plan must pay Dr. Morgan $56. C) Eva must pay $14 to Dr. Morgan. D) Eva's health plan must pay Dr. Morgan $70. E) Dr. Morgan must collect $35 from Eva and $35 from Eva's health plan.

Question 20: Medical Billing

Dr. Evans is found guilty of insurance abuse. Which of the following acts has Dr. Evans likely committed?

A) Billing for a service already reimbursed by another insurer B) Overcharging for services C) Billing Medicare at a higher rate than private insurance companies D) Completing Certificates of Medical Necessity for patients she never saw E) Exceeding the limiting charges

Question 21: Medical Billing

Rachel Collins contacts her physician's office to request a copy of the remittance advice for her last date of service. Which of the following is the most appropriate action for the physician's office to take?

A) Turn down the request; the patient should contact her insurance company. B) Make a copy of the page on which Rachel's information is found, and mail the copy to Rachel. C) Send the batched remittance advice. D) Using a copy of the page on which Rachel's information is found, remove all other patients' information and send her the edited remittance advice. E) Send an unedited copy of the page on which Rachel's information is found by email.

Question 22: Medical Billing

Dr. Peterson's office is sending a claim to HealthStreet Insurance Company to request payment for services rendered to Michelle Spencer, who is insured by their company. Which of the following is the least appropriate action for Dr. Peterson's office staff to take when requesting payment for services rendered?

A) Get Michelle's signature on file. B) Ask permission from Michelle to have Dr. Peterson's office file a claim on her behalf. C) Have Michelle sign and date a form from the Centers for Medicare and Medicaid Services. D) File the claim with HealthStreet without getting permission from Michelle. E) Have Michelle write the current date on the permission form.

Question 23: Medical Billing

Healthcare fraud can take on many forms. Which of the following actions can result in a healthcare provider being charged with insurance fraud?

A) Billing a patient for an item that was not provided B) Overcharging a patient for services rendered C) Charging a patient for a service that was not medically necessary D) Receiving money for referrals E) Violating participating provider agreements

Question 24: Medical Billing

A preferred provider organization, which is commonly referred to as a PPO, is a group of physicians and hospitals that have merged together to contract with insurance companies, employers, or other organizations intending to provide health care services to members for a discounted fee. Which of the following statements is true about PPOs?

A) They routinely establish contracts for laboratory services. B) They allow their members to use non-PPO providers with an associated higher out-of-pocket expense. C) They create risk pools, where the members are grouped for insurance purposes. D) Their members are required to get a referral to see physicians who are not part of the network. E) Their copayments are generally lower than those required by health maintenance organizations (HMOs).

Question 25: Medical Billing

Dr. Williams treats Mr. Anderson in the office for a tibial fracture caused by a work-related incident. Mr. Anderson is covered by HealthWay, an employer-sponsored group health plan. Mr. Anderson's employer provides workers' compensation insurance coverage for on-the-job injuries. The insurance claim for the treatment of Mr. Anderson's injury should be submitted to HealthWay.

Question 26: Medical Billing

Which of the following situations does liability insurance cover?

A) Losses to a third party caused by an object owned by the insured B) Losses to a third party caused on premises owned by the insured C) Financial compensation for lost wages and hardship suffered by a third party D) Losses to the insured caused by an earthquake E) Repayment of loans in case of the disability of the insured

Question 27: Medical Billing

Which of the following individuals does not qualify for disability benefits?

A) An individual who was employed when he or she was disabled B) An individual who has disability insurance coverage C) An individual who was treated and cared for by a licensed physician during their initial disability D) An individual who obtained the disability medical certification document from a licensed provider E) An individual who is receiving workers' compensation benefits at a weekly rate that is equal to or greater than the disability rate

Question 28: Medical Billing

In January, the St. Martin Medical Group received a $150,000 capitation payment to cover the healthcare costs of 200 managed care enrollees of the HealthWellness Managed Care Health Plan. By January of the following year, $120,000 had been spent to cover the health care services provided. Which of the following statements best describes what happens to the remaining $30,000?

A) It is refunded to HealthWellness. B) It is retained by St. Martin Medical Group as a profit. C) It is distributed equally among the 200 enrollees. D) It is turned over to the federal government. E) It is added to the current year's capitation payment.

Question 29: Medical Billing

Which of the following may cover health care or medical expenses, services, and costs that are not covered by any of the Medicare plans?

A) TRICARE B) Primary care C) Medigap D) Medicaid E) Blue Cross Blue Shield

Question 30: Medical Billing

Mr. Williams, a patient with a chronic illness, is a Medicare Part D beneficiary. Which of the following are classified as out-of-pocket costs for Medicare Part D beneficiaries like Mr. Williams?

A) Deductible amount B) Expenses paid on Mr. Williams's behalf by his employer's group health plan C) Expenses made by a Medigap plan D) Premium amount E) Copayment amount

Question 31: Medical Billing

Medicaid and Medicare programs are sponsored by CMS, a branch of the US Department of Health and Human Services. Which of the following statements most accurately applies to the Medicare program?

A) It is income-based. B) It is administered by state governments. C) Coinsurance and copayments are not applicable. D) Most services require prior approval. E) A premium payment is required for medical coverage.

Question 32: Medical Billing

Which of the following is not covered by Medicare Part B (also known as Supplementary Medical Insurance)?

A) Blood transfusions B) Prosthetic devices C) Immunosuppressive drugs after an organ transplant D) Ambulance transportation E) A semi-private hospital room

Question 33: Medical Billing

Which of the following statements most accurately describes the practice of concurrent review?

A) A physician reviews the treatment of a patient before the treatment is administered. B) The evaluation of a patient's health care while undergoing treatment. C) A managed care plan covers only a fixed number of visits to a health care provider within a calendar year. D) The evaluation of a patient's health care after treatment has been administered. E) The evaluation of health care provided to a patient outside of the managed care network.

Question 34: Medical Billing

Dr. Thomas provided medical services to Laura, a patient insured by HealthCover. Dr. Thomas's office manager mailed the completed CMS-1500 claim form to HealthCover, requesting payment. Which of the following information is needed on the CMS-1500 form?

A) A copy of the insurance card B) Patient's date of birth C) Type of health insurance D) Patient's name E) Date(s) of service

Question 35: Medical Billing

Which of the following entities is responsible for providing the National Provider Identifier (NPI) for healthcare providers?

A) Centers for Medicare and Medicaid Services (CMS) B) Department of Health and Human Services (DHHS) C) Health Insurance Portability and Accountability Act (HIPAA) D) American Medical Association (AMA) E) National Committee for Quality Assurance (NCQA)

Question 36: Medical Billing

Which of the following statements accurately describes an indemnity plan?

A) Patients are limited to seeing providers within a network. B) Referrals from a primary care provider are required for specialist visits. C) The patient pays a percentage of the cost of services as coinsurance. D) Preventive services are usually not covered. E) Out-of-pocket costs are typically higher than managed care plans.

Question 37: Medical Billing

Which of the following is a primary responsibility of a utilization review committee in a hospital setting?

A) Ensuring that the hospital is accredited by The Joint Commission B) Reviewing patient records to determine whether the hospital is providing adequate care C) Developing policies for medical staff appointments D) Monitoring the quality of care provided to patients E) Approving the hospital's annual budget

Question 38: Medical Billing

Which of the following codes is used to indicate a primary diagnosis on a CMS-1500 claim form?

A) CPT code B) ICD-10-CM code C) HCPCS code D) NDC code E) SNOMED code

Question 39: Medical Billing

Which of the following situations is an example of upcoding?

A) Charging for a service that was not provided B) Using a higher-paying code than the one that accurately reflects the service provided C) Billing for multiple services that should be combined under a single code D) Failing to code a service that was provided E) Charging a higher fee for an in-network patient

Question 40: Medical Billing

Which of the following is a potential consequence of failing to comply with the Health Insurance Portability and Accountability Act (HIPAA)?

A) Civil penalties B) Criminal penalties C) Loss of medical license D) Exclusion from federal healthcare programs E) All of the above

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