Test Bank for Medical Insurance 8th Edition By Valerius

Test Bank for Medical Insurance 8th Edition By Valerius

Medical Insurance, 8e (Valerius)

Chapter 1   Introduction to the Revenue Cycle

 

1) The employment forecast for well-trained medical insurance and coding specialists is/are A) decreasing opportunities.

B)   staying the same as today.

C)   increasing opportunities.

D)  remaining stagnant.

 

Answer:  C

Explanation:  Knowledgeable medical office employees are in demand.

Difficulty: 1 Easy

Topic:  Working in the Medical Insurance Field

Learning Objective:  01.01

Bloom's:  Remember

ABHES:  1.a Graduates will be able to: Describe the current employment outlook for the medical assistant

CAHIIM:  VI.E.2 Explain return on investment for employee training/development

 

2) Medical insurance specialists ensure financial success of the medical practice by A) using health information technology.

B)   setting their own rules and regulations.

C)   failing to communicate effectively.

D)  recording only cash payments.

 

Answer:  A

Explanation:  Providers must compete in a complex environment of various health plans, managed care contracts, and federal and state regulations.

Difficulty: 2 Medium

Topic:  Working in the Medical Insurance Field

Learning Objective:  01.01

Bloom's:  Understand

ABHES:  7.b Graduates will be able to: Navigate electronic health records systems and practice management software

CAHIIM:  III.A.1 Utilize software in the completion of HIM processes

 

                 

3) According to the textbook, pick the rising occupation in the health care industry that requires the employee to have the highest level of proficiency in dealing with the public professionally and pleasantly.

A)  health information technician

B)   medical assistant

C)   lab technician

D)  radiology technician

 

Answer:  B

Explanation:  Medical assistants who are expected to excel are those best fit to deal with the public through a courteous, pleasant manner and a professional demeanor.

Difficulty: 2 Medium

Topic:  Working in the Medical Insurance Field

Learning Objective:  01.01

Bloom's:  Understand

ABHES:  1.a Graduates will be able to: Describe the current employment outlook for the medical assistant; 1.b Graduates will be able to: Compare and contrast the allied health professions and understand their relation to medical assisting

CAHIIM:  VI.E.2 Explain return on investment for employee training/development

 

4) A computerized lifelong health care record for an individual that incorporates data from all sources is known as a(n)

A)  electronic health record (EHR).

B)   practice management program (PMP).

C)   computerized health record (CHR).

D)  lifelong health care record (LHR).

 

Answer:  A

Explanation:  Electronic health record (EHR) is a computerized lifelong health care record for an individual that incorporates data from all sources.

Difficulty: 1 Easy

Topic:  Working in the Medical Insurance Field

Learning Objective:  01.01

Bloom's:  Remember

ABHES:  4.b.2 Institute federal and state guidelines when: Entering orders in and utilizing electronic health records; 7.b Graduates will be able to: Navigate electronic health records systems and practice management software

CAHIIM:  III.A.1 Utilize software in the completion of HIM processes

 

                 

5) In a medical practice, cash flow is required to A) pay for office expenses.

B)   pay for hospital supplies.

C)   pay for nursing home employees.

D)  pay for the staff of an insurance company.

 

Answer:  A

Explanation:  Cash flow, the movement of monies into and out of the practice, is needed in order to pay for office expenses such as salaries and overhead.

Difficulty: 1 Easy

Topic:  Working in the Medical Insurance Field

Learning Objective:  01.01

Bloom's:  Remember

ABHES:  7.c Graduates will be able to: Perform billing and collection procedures

CAHIIM:  IV.A.2 Evaluate the revenue cycle management processes; IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

6) What is the definition of revenue cycle?

A)  clinical care provided for patients, from appointment to discharge

B)   all administrative and clinical functions which ensure that sufficient monies flow into the practice to pay bills

C)   all coding and billing steps involved in preparing correct claims

D)  complete documentation that is submitted to third-party payers

 

equired in healthcare reimbursement

 

72) Determine which method a self-funded health plan most often uses in setting up its provider network.

A)  hire a PCP to provide a network

B)   set up their own provider network

C)   buy the use of existing networks from managed care organizations D) are not required to set up a network

 

Answer:  C

Explanation:  Self-funded health plans most often buy the use of existing networks from managed care organizations.

Difficulty: 1 Easy

Topic:  Medical Insurance Payers

Learning Objective:  01.07

Bloom's:  Remember

ABHES:  7.d Graduates will be able to: Process insurance claims

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

                 

73) Which of the following is an example of a private-sector payer?

A)  Medicare

B)   Medicaid

C)   workers' compensation insurance

D)  insurance company

 

Answer:  D

Explanation:  An insurance company is considered a private-sector payer, as opposed to government programs such as Medicare.

Difficulty: 1 Easy

Topic:  Medical Insurance Payers

Learning Objective:  01.07

Bloom's:  Remember

ABHES:  7.d Graduates will be able to: Process insurance claims

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

74) Which of the following covers patients who are age 65 and over?

A)  Medicare

B)   Medicaid

C)   TRICARE

D)  CHAMPUS

 

Answer:  A

Explanation:  Medicare covers the age 65 and over population.

Difficulty: 1 Easy

Topic:  Medical Insurance Payers

Learning Objective:  01.07

Bloom's:  Remember

ABHES:  7.d Graduates will be able to: Process insurance claims

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

                 

75) Which of the following programs covers people who cannot otherwise afford medical care? A) Medicare

B)   Medicaid

C)   TRICARE

D)  CHAMPUS

 

Answer:  B

Explanation:  Medicaid covers people who otherwise could not afford medical care. Difficulty: 1 Easy

Topic:  Medical Insurance Payers

Learning Objective:  01.07

Bloom's:  Remember

ABHES:  7.d Graduates will be able to: Process insurance claims

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

76) Scheduling appointments is part of which revenue cycle step? A) Step 1, preregister patients.

B)   Step 10, follow up on patient payments.

C)   Step 8, monitor patient adjudication.

D)  Step 5, review coding compliance.

 

Answer:  A

Explanation:  Scheduling appointments is the first step in the revenue cycle.

Difficulty: 1 Easy

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Remember

ABHES:  7.e Graduates will be able to: Apply scheduling principles

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

                 

77) Collecting copayments is part of which revenue cycle step? A) Step 3, check in patients.

B)   Step 10, follow up payments and collections

C)   Step 8, monitor patient adjudication.

D)  Step 5, review billing compliance

 

Answer:  A

Explanation:  Collecting copayments is done during patient check-in.

Difficulty: 1 Easy

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Remember

ABHES:  7.c Graduates will be able to: Perform billing and collection procedures CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

78) When medical insurance specialists work with patient billing programs, they need A) computer skills.

B)   communication skills.

C)   knowledge of anatomy.

D)  flexibility.

 

Answer:  A

Explanation:  Most medical practices use computers to handle billing and process claims. Difficulty: 2 Medium

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Understand

ABHES:  7.b Graduates will be able to: Navigate electronic health records systems and practice management software

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

                 

79) A patient ledger records A) the patient's illnesses.

B)   the patient's financial transactions.

C)   the patient's relatives.

D)  the day's appointments and payments.

 

Answer:  B

Explanation:  A patient ledger is a record of a particular patient's financial transactions with the practice. Difficulty: 1 Easy

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Remember

ABHES:  7.c Graduates will be able to: Perform billing and collection procedures CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

80) Imagine you are a medical insurance specialist; identify the impact your ability to prepare accurate, timely claims can have on the practice.

A)  Preparing accurate and timely claims generally leads to full and timely reimbursement from the health plan.

B)   Preparing accurate and timely claims generally leads to a higher capitation payment.

C)   Preparing accurate and timely claims generally leads to a higher coinsurance rate.

D)  Preparing accurate and timely claims generally leads to more patients.

 

Answer:  A

Explanation:  When medical insurance specialists prepare accurate, timely claims, the practice is most likely to receive full and timely reimbursement from the health plan.

Difficulty: 3 Hard

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Apply

ABHES:  7.c Graduates will be able to: Perform billing and collection procedures CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

                 

81) What step is used when patient payments are later than permitted under the financial policy? A) Step 3, check in patients.

B)   Step 10, follow up patient payments and collections.

C)   Step 2, establish financial responsibility for the visit.

D)  Step 4, review coding compliance.

 

Answer:  B

Explanation:  A collection process is often started when patient payments are later than permitted under the practice's financial policy.

Difficulty: 1 Easy

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Remember

ABHES:  7.c Graduates will be able to: Perform billing and collection procedures CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

82) Verifying insurance is part of which revenue cycle step? A) Step 3, check in patients.

B)   Step 10, follow up patient payments.

C)   Step 2, establish financial responsibility for the visit.

D)  Step 4, review coding compliance.

 

Answer:  C

Explanation:  Verifying insurance is part of establishing financial responsibility for a visit.

Difficulty: 1 Easy

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Remember

ABHES:  7.d Graduates will be able to: Process insurance claims

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

                 

83) Describe the process of adjudication.

A)  the practice's monitoring of the money that is needed to run the practice

B)   the payer's process of putting a claim through a series of steps designed to judge whether it should be paid

C)   the process of appealing a rejected claim

D)  the practice's comparison of each payment sent with a claim

 

Answer:  B

Explanation:  A health plan's process of examining claims and determining benefits is adjudication. Difficulty: 2 Medium

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Understand

ABHES:  7.d Graduates will be able to: Process insurance claims

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

84) In what step does the medical insurance specialist verify that charges are in compliance with insurance guidelines?

A)  Step 3, check in patients.

B)   Step 10, follow up patient payments.

C)   Step 2, establish financial responsibility for the visit.

D)  Step 5, review billing compliance.

 

Answer:  D

Explanation:  Medical insurance specialists apply their knowledge of payer guidelines to analyze what can be billed on health care claims.

Difficulty: 1 Easy

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Remember

ABHES:  7.d Graduates will be able to: Process insurance claims

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

                 

85) What term is used to describe the action of satisfying official requirements?

A)  adjudication

B)   compliance

C)   accounts receivable (A/R)

D)  accounts payable (A/P)

 

Answer:  B

Explanation:  Compliance means actions that satisfy official requirements, such as the proper assigning of codes.

Difficulty: 1 Easy

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Remember

ABHES:  7.d Graduates will be able to: Process insurance claims

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

86) What adds up to form a practice's accounts receivable?

A)  money due from health plans

B)   money due from patients

C)   money due from both health plans and patients

D)  money owed to patients

 

Answer:  C

Explanation:  The money due from plans, as well as payments due from patients, add up to form the practice's accounts receivable (A/R).

Difficulty: 1 Easy

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Remember

ABHES:  7.c Graduates will be able to: Perform billing and collection procedures CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

                 

87) Practice management programs may be used for A) scheduling appointments and financial record keeping.

B)   financial record keeping and billing.

C)   billing only.

D)  scheduling appointments, financial record keeping, and billing.

 

Answer:  D

Explanation:  PMPs are used for scheduling appointments, billing, and financial record keeping. Difficulty: 1 Easy

Topic:  The Revenue Cycle

Learning Objective:  01.08

Bloom's:  Remember

ABHES:  7.b Graduates will be able to: Navigate electronic health records systems and practice management software

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

88) Which of the following characteristics should medical insurance specialists use when working with patients' records and handling finances?

A)  able to work as a team member

B)   honesty and integrity

C)   knowledge of medical terms

D)  communication skills

 

Answer:  B

Explanation:  Handling financial matters requires honesty and integrity.

Difficulty: 3 Hard

Topic:  Achieving Success

Learning Objective:  01.09

Bloom's:  Apply

ABHES:  4.a Graduates will be able to follow documentation guidelines; 4.g Graduates will be able to display compliance with the Code of Ethics of the profession

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

                 

89) The statement that "coding professionals should not change codes. . .to increase billings" is an example of

A)  professional ethics.

B)   professional services.

C)   professional etiquette.

D)  personal ethics.

 

Answer:  A

Explanation:  Each professional organization has a code of ethics that is to be followed by its membership.

Difficulty: 3 Hard

Topic:  Achieving Success

Learning Objective:  01.09

Bloom's:  Apply

ABHES:  4.a Graduates will be able to follow documentation guidelines; 4.g Graduates will be able to display compliance with the Code of Ethics of the profession

CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

90) Courteous treatment of patients who visit the medical practice is an example of medical A) ethics.

B)   etiquette.

C)   coding.

D)  insurance.

 

Answer:  B

Explanation:  Medical etiquette requires courteous treatment of patients.

Difficulty: 1 Easy

Topic:  Achieving Success

Learning Objective:  01.09

Bloom's:  Remember

ABHES:  5.c Graduates will be able to: Assist the patient in navigating issues and concerns that may arise (i.e., insurance policy information, medical bills, and physician/ provider orders) CAHIIM:  IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

 

                 

91) In large medical practices, a medical insurance specialist is more likely to A) need to use professionalism.

B)   handle a variety of billing and collections tasks.

C)   have more specialized duties.

D)  have less specialized duties.

 

Answer:  C

Explanation:  In large medical practices, the duties of medical insurance specialists may be more specialized. Difficulty: 1 Easy

Topic:  Achieving Success

Learning Objective:  01.09

Bloom's:  Remember

ABHES:  1.b Graduates will be able to: Compare and contrast the allied health professions and understand their relation to medical assisting

CAHIIM:  VI.E.2 Explain return on investment for employee training/development

 

92) The most important characteristic for a medical insurance specialist to possess is A) professionalism.

B)   punctuality.

C)   friendliness.

D)  quickness.

 

Answer:  A

Explanation:  The most important characteristic that medical insurance specialists should evidence is professionalism. Difficulty: 1 Easy

Topic:  Achieving Success

Learning Objective:  01.09

Bloom's:  Remember

ABHES:  4.g Graduates will be able to display compliance with the Code of Ethics of the profession

CAHIIM:  II.B.1 Apply confidentiality, privacy and security measures and policies and procedures for internal and external use and exchange to protect electronic health information 93) What skills and attributes are required for successful mastery of the tasks of a medical insurance specialist?

A)  professional appearance and attention to detail

B)   courtesy and good attendance

C)   initiative and communication skills

D)  attention to detail and ability to work as a team member

 

Answer:  D

Explanation:  A number of skills and attributes are required for successful mastery of the tasks of a medical insurance specialist, including knowledge of medical terminology, anatomy, physiology, and medical coding; communication skills; attention to detail; flexibility; health information technology skills; honesty and integrity; and ability to work as a team member.

Difficulty: 1 Easy

Topic:  Achieving Success

Learning Objective:  01.09

Bloom's:  Remember

ABHES:  4.g Graduates will be able to display compliance with the Code of Ethics of the profession

CAHIIM:  II.B.1 Apply confidentiality, privacy and security measures and policies and procedures for internal and external use and exchange to protect electronic health information

 

94) Professional organizations generally have a(n) ________ that its members should follow/possess.

A)  employee policy and procedure manual

B)   list of attributes C) code of ethics

D) financial policy

 

Answer:  C

Explanation:  Each professional organization has a code of ethics that is to be followed by its membership.

Difficulty: 1 Easy

Topic:  Achieving Success

Learning Objective:  01.09

Bloom's:  Remember

ABHES:  4.g Graduates will be able to display compliance with the Code of Ethics of the profession

CAHIIM:  II.B.1 Apply confidentiality, privacy and security measures and policies and procedures for internal and external use and exchange to protect electronic health information 95) The designation of Registered Medical Assistant (RMA) is awarded by A) AAMA.

B)   AAPC.

C)   AMT.

D)  AHIMA.

 

Answer:  C

Explanation:  The RMA is awarded by the AMT.

Difficulty: 1 Easy

Topic:  Moving Ahead

Learning Objective:  01.10

Bloom's:  Remember

ABHES:  1.c Graduates will be able to: Describe and comprehend medical assistant credentialing requirements, the process to obtain the credential and the importance of credentialing CAHIIM:  VI.E.2 Explain return on investment for employee training/development

 

96) Certification as a Certified Professional Coder (CPC) is awarded by

A)  AAMA.

B)   AAPC.

C)   AMT.

D)  AHIMA.

 

Answer:  B

Explanation:  The American Academy of Professional Coders grants the Certified Professional Coder.

Difficulty: 1 Easy

Topic:  Moving Ahead

Learning Objective:  01.10

Bloom's:  Remember

ABHES:  1.c Graduates will be able to: Describe and comprehend medical assistant credentialing requirements, the process to obtain the credential and the importance of credentialing CAHIIM:  VI.E.2 Explain return on investment for employee training/development

 

                 

97) The titles of Certified Coding Specialist (CCS) and Certified Coding Specialist–Physicianbased (CCS-P) are awarded by A) AMA.

B)   CNN.

C)   ABC.

D)  AHIMA.

 

Answer:  D

Explanation:  The CCS and CCS-P certifications are awarded by AHIMA.

Difficulty: 1 Easy

Topic:  Moving Ahead

Learning Objective:  01.10

Bloom's:  Remember

ABHES:  1.c Graduates will be able to: Describe and comprehend medical assistant credentialing requirements, the process to obtain the credential and the importance of credentialing CAHIIM:  VI.E.2 Explain return on investment for employee training/development

 

98) Pick the most accurate definition of certification.

A)  recognition of professionalism

B)   recognition of a superior level of skill by an official organization

C)   recognition of a successful career

D)  recognition of higher level of degree of schooling

 

Answer:  B

Explanation:  Certification is recognition of a superior level of skill by an official organization.

Difficulty: 2 Medium

Topic:  Moving Ahead

Learning Objective:  01.10

Bloom's:  Understand

ABHES:  1.c Graduates will be able to: Describe and comprehend medical assistant credentialing requirements, the process to obtain the credential and the importance of credentialing CAHIIM:  VI.E.2 Explain return on investment for employee training/development

 

                 

99) What is typically required of professional organizations?

A)  good attendance

B)   continuing education sessions

C)   membership in more than one organization

D)  there are no requirements

 

Answer:  B

Explanation:  Most professional organizations require certified members to keep up-to-date by taking annual training courses

Difficulty: 1 Easy

Topic:  Moving Ahead

Learning Objective:  01.10

Bloom's:  Remember

ABHES:  1.c Graduates will be able to: Describe and comprehend medical assistant credentialing requirements, the process to obtain the credential and the importance of credentialing CAHIIM:  VI.E.2 Explain return on investment for employee training/development