Medical billing MCQs

Medical billing MCQs

Our experts have gathered these Medical billing MCQs through research, and we hope that you will be able to see how much knowledge base you have for the subject of Medical billing by answering these 100+ multiple-choice questions.
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1: A Remittance Advice statement is most similar to a(n):

A.   Medigap

B.   HMO extension

C.   EOB

D.   Co-pay

2: Who is eligible for Medicare part C

A.   An individual who has an HMO plan

B.   An individual who pays all premiums

C.   An individual who has a supplemental Plan

D.   An individual who is covered under Parts A and B

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


B.   Medicare


D.   Medicaid

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

A.   UB-92

B.   W-4

C.   UB-04

D.   HCFA1500

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

A.   Pending

B.   Denied

C.   Paid

D.   Transition

6: What does COB commonly refer to?

A.   Coordination of Benefits

B.   Course of Body

C.   Cost of Billing

D.   Cost on Bottom

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



C.   Medicare


8: What is COBRA insurance?

A.   Insurance available to individuals after they become unemployed

B.   It is a slang term used to describe uninsured emergency room patients

C.   It is an insurance plan specific to the military

D.   Insurance for exotic injuries

9: Place of service codes on claims are there to define?

A.   The payment qualifier

B.   The place of service where services were rendered

C.   The time of service

D.   The type of service

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

A.   Carrier

B.   Co-insurance

C.   Code

D.   Co-pay

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

A.   The service was not covered under the patient’s health insurance contract.

B.   The medical condition was deemed by the insurance company as being preexisting

C.   The service was considered as not being medically necessary

D.   All are valid reasons

12: What is Dx refer to?

A.   Bill cancellation

B.   Post-mortem diagnosis

C.   Cancelled diagnosis

D.   Diagnosis code

13: What organ is measured in an EKG/ECG?

A.   Lung

B.   Brain

C.   Kidney

D.   Heart

14: What is a premium?

A.   Name-brand medication

B.   The amount paid for an insurance policy

C.   Paying extra for a private hospital room

D.   The copay

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

A.   False

B.   True

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

A.   prescription

B.   validation

C.   clearance

D.   referral

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

A.   Startup date

B.   Effective date

C.   Float date

D.   Coverage blanket date

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

A.   Premium

B.   OOP

C.   Co-pay

D.   Deductible

19: Is a co-payment an out of pocket expense?

A.   Yes

B.   No

C.   Sometimes

20: Which activities may be indicative of fraudulent coding/billing?

A.   The application of modifiers, such as 25 and 59, to the majority of services

B.   All of the above

C.   A high percentage of highest-level E/M coding

D.   A high number of re-billings with claim modifications

21: CDI programs are best applied in which situations?

A.   Inpatient Facility

B.   Outpatient facility

C.   All outpatient and inpatient settings, for all payers

D.   Only for Medicare claims

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

A.   False

B.   True

23: To what payer address should you mail an appeal?

A.   The address on the back of the patient’s insurance card

B.   None of the above

C.   The address that has been verified with the payer for appealed claims

D.   The corporate office of the payer

24: HIPAA stands for:

A.   Health Insurance Portability Accountability Act

B.   Health Insurance Protected Act of America

25: 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.

A.   False

B.   True

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

A.   It processes all of the payments

B.   It calculates total patient bills

C.   It runs background checks on patient credit history

D.   It checks bills for errors then transmits them to the insurance company

27: What do the CPT codes refer to?

A.   The disease that the patient is suffering from

B.   The names of the medicines prescribed by the practitioner

C.   The procedures performed by a physician or a practitioner

D.   The procedures performed by Medical biller

E.   The diagnoses performed on the patient

28: 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:


B.   Medicaid

C.   HMO


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

A.   No

B.   Yes

30: The exact abbreviation of RA in medical billing terminology?

A.   Right Atrium

B.   Remittance Advice

C.   Regular Appointment

D.   Rheumatoid Arthritis

E.   Remote Agent

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

A.   Fair

B.   Balanced

C.   Upcoding

D.   Downcoding

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

A.   March

B.   June

C.   October

D.   January

33: What is capitation?

A.   The process of cutting down the price of a medical bill

B.   The hierarchy of payments

C.   A payment scheduling method

D.   A system that pays physicians and nurses a set amount per enrolled patient assigned to them

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

A.   Contractor insurance

B.   Fee-for-Service

C.   On-call fees

D.   Descriptor insurance

35: 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.

A.   GovCare

B.   Medicare Insurance

C.   Co - Insurance


E.   COBRA Insurance

36: True or False: If a payer requests medical records, you have an obligation to comply.

A.   True

B.   False

C.   True

D.   False

37: What is the purpose of an Advanced Beneficiary Notice?

A.   To confirm receipt of a patient's payment

B.   To alert the hospital to changes in Medicare's coverage policies

C.   To alert a patient to a change in their premium payments

D.   To alert a patient that Medicare may deny payment for a specific procedure or treatment

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

A.   True

B.   False

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


B.   DOS

C.   DME


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

A.   Explanation of Medical Necessity

B.   Certificate of Medical Necessity

C.   Benefits of Explanation

D.   Explanation of Benefits

E.   Certificate of codding

41: Which part of Medicare is the drug prescription coverage?

A.   Part D

B.   Part C

C.   Part B

D.   Part A

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

A.   ICD


C.   CPT

D.   ADT

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

A.   True

B.   False

44: True or false? Undercoding is illegal.

A.   True


45: The Employer Identification Number is also known as the:

A.   Social Security Identification Number

B.   Health Department Identification Number

C.   Federal Tax Identification Number

D.   Employer Group Health Plan

46: Which best describes how rules for Medicaid are set:

A.   Medicaid is administered by a non-governmental regulatory body created under the federal Social Security Act.

B.   Medicaid is administered through a combination of federal and state regulation.

C.   Medicaid is administered by the individual state governments.

D.   Medicaid is administered by the federal government.

47: What is a clearing house?

A.   Intermediary between provider and insurance

B.   Hygienic Place

C.   Payment clearing authority

D.   None of these

E.   All of these

48: What does UCR stand for?

A.   Usual, customary, or reasonable

B.   Unusual Chronic Illness

C.   Ultra Conservative Response

D.   Unique Client Referral

49: 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:

A.   ICD skimming

B.   Code banking

C.   Upcoding

D.   Pocketlining

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

A.   H-code

B.   V-code

C.   A-code

D.   T-code