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
A. CHIP
B. Medicare
C. COBRA
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?
A. COBRA
B. HEDIS
C. Medicare
D. HIPAA
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:
A. NOSSCR
B. Medicaid
C. HMO
D. COBRA
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
D. USICA
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:
A. EBSA
B. DOS
C. DME
D. COBRA
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
B. HCPCS
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
B. FALSE
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
51: 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:
A. Advanced payment form
B. IPC-450 form
C. Focused item bill
D. Superbill
52: Charging for services that are not medically necessary are included under:
A. Abuse
B. Custodial care
C. Low cost alternatives
D. Information models
53: 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:
A. HIPAA 1450
B. HIPAA 1500
C. CMS 1450
D. CMS 1500
54: Which of the following is an agreement made between the insurance company and the insured to send payments directly to the physician?
A. Referral
B. Assignment of Benefits
C. Preauthorization
D. Pre-Existing Conditions
E. Coordination of Benefits
55: Health insurance coverage which is contracted to supplement Medicare coverage is called:
A. HMO extension
B. Medicaid
C. Medigap
D. SSDI
56: True or False? The difference between the Medicare and Medicaid allowable is that Medicaid does NOT pay a percentage of the allowed amount.
A. False
B. True
57: When is it acceptable for a physician to accept a gift from a patient?
A. Always
B. If the gift is of minimal value, and/ or can be displayed or shared with staff (e.g., chocolates, flowers, baked goods, etc.)
C. If the gift is highly personal and/or expensive
D. Never
58: What is the minimum number of patients affected by a breach of PHI that requires you to personally notify the patient(s) of a breach?
A. 5
B. 1
C. 100
D. 25
59: What could POS exactly stand for in Medical Billing?
A. Polycystic Ovary Syndorme
B. Point of Service
C. Place of Service
60: In March 2013, Noridian (Medicare Part B contractor in jurisdictions E and F) issued what type of review in Arizona?
A. Service Specific Review
B. Probe Review
C. Provider on Review
D. Service on Review
61: True or False: The patient must have had at least 13 visits to report a global OB care code (e.g., 59400 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care.
A. False
B. True
62: The claim form for billing for facility fees which replaces the UB92 form is the _______ form.
A. CMS 1450
B. SNF20
C. UB04
D. UB100A
63: What are modifiers used for?
A. They are used to add more information about a ICD-9 CM code
B. They are used to add more information about a ICD10 CM code
C. They are used to add more information about a CPT code
D. They are an indicator to show that a procedure is linked to more than one diagnosis
E. They help in establishing "medical necessity"
64: True or false? The coder should NOT correct any errors in a bill.
A. TRUE
B. False
65: Level II HCPCS codes are formatted as a single letter followed by _________.
A. Two numeric digits and three letters
B. Four numeric digits
C. five numeric digits and one letter
D. Two numeric digits and 2 letters
66: How many digits are in a National Provider Identifier?
A. 8
B. 11
C. 4
D. 10
E. 9
67: The average amount Medicare will pay a provider or hospital for a procedure is the:
A. RVU
B. CCRC
C. PTAN
D. SNF
68: HEAT is an effort of which federal agency(ies)?
A. HHS and DOJ
B. OIG
C. OIG and CMS
69: Which one of the following was known as Medicare + Choice?
A. Part C
B. Part A
C. Part D
D. Part B
70: True or False: A Heralding Notice from a payer is a notice that your office has been targeted for an audit.
A. False
B. True
71: 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:
A. SMI code
B. Policy identification number
C. Revenue Code
D. Medical Code
72: Tricare was formerly known as
A. United States Department of Defense Military Health System
B. None of the above
C. Civilian Health and Medical Program of the United States(CHAMPUS)
D. Civilian Health and Medical Program of the Uniformed Services(CHAMPUS)
E. Humana Military Healthcare Services
73: Medical care, other than those provided by the physician or hospital, which are related to a patient’s care, are called:
A. Focused care
B. All of these are correct
C. Extraneous services
D. Ancillary care
74: Coding for a name-brand medication when a generic brand was used is called __________.
A. Swapping
B. Value-coding
C. Upcoding
D. Upgrading
75: After the claim is paid, the payer requests documentation to support coding. What type of audit is this?
A. Pre-payment
B. Post-payment
C. Comprehensive review
D. Claim-focused audit
76: Submitting several CPT treatment codes when only one code is necessary is called:
A. Facility charges
B. Fraud
C. Unbundling
D. Abuse
77: What is a challenge of processing medical bills off site?
A. None of these
B. Governmental regulations
C. It is illegal to process medical bills off site
D. The biller may not be able to contact the physician
78: A health benefit plan allowing the patient to choose to receive a service from a group of contracted providers is a:
A. OOP
B. PPT
C. PCP
D. POS
79: The difference between the summarized income rate and the summarized cost rate over a given valuation period is the:
A. MediGap
B. Administrative discrepancy
C. Cost restraints
D. Actuarial Balance
80: The incident-to rule:
A. Is applicable only to commercial (third-party) payers
B. Applies specifically to CMS payers
C. Applies only to inpatient services
81: Will Medicare accept a UB-92 form?
A. Yes
B. Sometimes
C. No
82: True or False? Med pay is a form of no-fault insurance.
A. True
B. False
83: The federal law that was originally created to safeguard an employees retirement benefits is abbreviated as:
A. ERISA
B. TRICARE
C. COBRA
D. NOSSCR
84: The form which is specifically used to bill dental services is called?
A. HCFA 1500 form
B. ADA form
C. UB-04 form
D. Dental Claim form
85: You must notify the local media if a breach of PHI involves ___ or more patients.
A. 100
B. 250
C. 50
D. 500
86: Your office has discovered a breach of a patient’s PHI. How long do you have to notify the patient?
A. No more than 45 days from the time you discover the breach.
B. No more than 60 days from the time you discover the breach.
C. No more than 90 days from the time you discover the breach.
D. No more than 30 days from the time you discover the breach.
87: What is the abbrevation for SSI?
A. Social Security Income
B. Supplemental Security Information
C. None of the above
D. Social Security Information
E. Supplemental Security Income
88: True or false? An individual on an HMO plan would need a referral to get a yearly mammogram.
A. TRUE
B. False
89: According to the MBAA, up to _____ % of US medical bills contain errors.
A. 5%
B. 35%
C. 80%
D. 50%
90: Medicare Advantages Plans cover consultation codes?
A. No
B. Yes
C. Partially
91: Which one of the following is the largest Blue Cross Blue Shield member?
A. WellPoint
B. CareFirst
C. Highmark
D. Premera
92: 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.
A. Industrial accident
B. Occupational illness
C. Federal Employment Liability Act
D. State Workers Compensation
E. Occupational Safety and Health Administration
93: A ________ limits the amount of out-of-pocket expenses a patient will have to pay for TRICARE-covered medical services.
A. TRICARE cap
B. HMO cap
C. catastrophic cap
D. Care ceiling
94: If a provider is non-par, any allowed claim amount that is ______ billed charges should be unacceptable.
A. more than
B. less than
C. equal to
95: In DME claims which of the following is necessary: Referring physician or Ordering physician?
A. Both
B. Referring Physician
C. Neither
D. Ordering Physician
96: What are modifiers?
A. They are used to add more information about a ICD-9 CM code
B. They help in establishing
C. They are used to add more information about a CPT code
D. They are an indicator to show that a procedure is linked to more than one diagnosis
97: Electronic Medical Claims (EMC) help to ___________.
A. get the carrier more quickly than the paper claims
B. pay more quickly than the paper claims
C. notify more quickly in case the claim is rejected
D. All of the above
A. employer
B. the name of the insured
C. the name of the insurance company
D. third party administrator
99: CPT Codes are updated ________.
A. once every 2 years
B. annually
C. whenever changes are necessary
D. None of the above
100: What does the UB-04 form include?
A. National Provider Identifier
B. Taxonomy
C. Guarantor Information
D. Additional Codes
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Medical billing MCQs
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