MDCA 1343 EXAM 1 REVIEW QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026

MDCA 1343 EXAM 1 REVIEW QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026 what does the abbreviation MSHP designate? - Answers Multiskilled health practitioner Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring - Answers multiskilled health care practitioners Administrative medical office responsibilities include - Answers claims submission A claims assistance professional - Answers works for the consumer helps patients file insurance claims What is "cash flow" in a medical practice? - Answers The actual money available to a medical practice Front office medical duties have become increasingly important because - Answers diagnostic and procedure coding must be reviewed for its correctness and completeness Which level of education is generally required for one who seeks employment as an insurance coder? - Answers completion of an accredited program for coding certification Which organization published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements for physician billing? - Answers American Health Information Management Association The amount of money an insurance billing specialist earns it dependent on which of the following factors? - Answers knowledge, experience, size of employing institution A billing specialist is entrusted with: - Answers holding patient's medical information in confidence, collecting monies, being a reliable resource for co-workers Medical etiquette refers to - Answers consideration for others Medical ethics include - Answers standards of conduct The earliest written code of ethical principles for the medical professional is the - Answers Code of Hammurabi What is the name of the modern code of ethics that the American Medical Association (AMA) - Answers The Principles of Medical Ethics What should you do if you discover that a patient of your physician employer is under the care of another physician for the same ailment? - Answers notify your physician Reporting incorrect information to private insurance carriers is considered: - Answers unethical Which code of ethics is most appropriate for an insurance billing specialist who handles medical records? - Answers The American Health Information Management Association (AHIMA) code of ethics AHIMA publishes - Answers diagnostic and procedures coding competencies for outpatient services diagnostic coding and reporting requirements A self-employed medical insurance biller who does independent contracting is responsible for - Answers billing, advertising, accounting The Internet Healthcare Coalition has developed - Answers the eHealth Code of Ethics Reporting incorrect information to government-funded program is - Answers illegal Insurance specialist certificate programs include - Answers anatomy, diagnostic coding, computer technology The doctrine stating that physicians are legally responsible for both their own conduct and that of their employees is known as - Answers respondeat superior, let the master answer, vicarious liability The AHIMA Code of Ethics is appropriate for - Answers health information specialists, coders, insurance billing specialists Why are multiskilled health practitioners (MSHPs) in demand: - Answers They are cross-trained to provide more than on function, They are often competent in more than one discipline, They offer more flexibility to their employer The focus on the health care practice setting and reducing administrative costs and burdens are the goals of - Answers HIPAA Title II Administrative Simplification The Office of Civil Rights enforces - Answers privacy and Security Rules Confidential information includes: - Answers everything that is heard about the patient, everything that is read about the patient, everything that is seen regarding a patient what is the correct response when a relative calls asking about a patient: - Answers Have the physician return the telephone call Nonprivileged information about a patient consists of the patient's - Answers city of residence Exceptions to the right of Privacy Rule include - Answers gunshot wound cases Confidentiality is automatically waived in cases of - Answers gunshot wounds, child abuse, extremely contagious diseases What is the best response when telephoning a patient about an insurance matter and the patient's voice mail is reached? - Answers Use care in the choice of words when leaving the message To bill Medicare beneficiaries at a higher rate than other patients is considered - Answers abuse When an insurance billing specialist bills for a physician and completes a Medicare claim form with information that does not reflect the true situation, - Answers he or she may be subject to fines and imprisonment What action could happen if an employee knowingly submits a fraudulent Medicare or Medicaid claim at the medical practice is audited: - Answers The employees and the employer could be brought into litigation by the state or federal government Identify which of the following would NOT typically be considered as a form of discipline for situations that involve fraudulent and malicious misconduct: - Answers Verbal warning Most legal issues of private health insurance claims fall under: - Answers civil law When does the physician/patient contract begin? - Answers We the physician accepts the patient and agrees to treat the patient Most physician/patient contract are: - Answers implied When a patient carries private medical insurance, the contract for treatment exists between: - Answers The physician and the patient An emancipated minor is - Answers a person younger than the age of 18 who lives independently The contract in a worker's compensation case exists between: - Answers the physician and the insurance company In health insurance, the insured is also known as - Answers The subscriber, the member, the policyholder The insured is always: - Answers The individual enrollee or organization protected A policy in which the insurer cannot increase premium rates and must renew the policy until the insured reaches the age specified in the contract is a : - Answers noncancelable policy The reason for a coordination of benefits statement in a health insurance policy is: - Answers to prevent duplication or overlapping of payments for the same medical expense Mr. Talili has two medical insurance policies. To prevent duplication of payment for the same medical expense, the policies include a - Answers coordination of benefits statement In cases of divorce, the decision as to which parent should be responsible for payment of the child's services should be made by: - Answers the court system If a child has health insurance coverage from two parents, according to the birthday law - Answers the health plan of the person whose birthday (month and day) falls earlier in the calendar year will pay first According to the birthday law, if both the mother and the father have the same birthday - Answers the plan of the person who has coverage longer is the primary payer Conditions that existed and were treated before the health insurance policy was issued are called: - Answers preexisting An attachment to an insurance policy that excludes certain illnesses or disabilities that would otherwise be covered is referred to as a/an - Answers wavier What is the correct term used to determine if a procedure is covered and medically necessary: - Answers preauthorization Mrs. Thompsett leaves her place of employment. She is eligible to transfer her medical insurance coverage from a group to an individual contract. This is known as - Answers conversion privilege Why would conversion from a group policy to an individual policy be advantageous: - Answers no physical examination is required Mr. Ott was laid off from his job. He is protected by the Consolidated Omnibus Budget Reconciliation Act (COBRA), which requires his employer to - Answers extend group health insurance coverage for 18 months What is the minimum number of employees a company must have to meet the criteria of the COBRA for continued medical benefits if an employee is laid off form a company: - Answers 20 The act created to protect workers and their families so that they can get and maintain health insurance if they change or lose their jobs is called the - Answers Health Insurance Portability and Accountability Act (HIPAA) An organization of physicians, sponsored by a state or local medical association, concerned with the development and delivery of medical services and the cost of health care is known as a/an - Answers foundation for medical care A type of managed care organization created by the 1982 Tax Equity and Fiscal Responsibility Act (TEFRA) that allows for enrollment of Medicare beneficiaries into manage care plan is a/an - Answers competitive medical plan (CMP) A state and federal program for children who are younger than 21 years of age and have special health care needs is - Answers Maternal and Child Health Programs (MCHP) a patient intake sheet is also called a - Answers patient registration form The first document obtained in the initial patient visit is a/an - Answers patient information form Assignment of benefits is - Answers the transfer of one's legal right to collect an amount payable under an insurance contract An encounter form may also be known as a - Answers patient services slip The source document for insurance claim data is the - Answers CMS-1500 A daily record sheet used to record daily business transactions is called a/an - Answers daysheet Under HIPAA guidelines, physicians must send all claims electronically - Answers if they have more than 10 full-time employees An insurance claims register facilitates - Answers follow-up of insurance claims When the physician's services have been submitted to the patient's insurance company - Answers be sent a monthly statement indicating the insurance company has been billed The key to substantiating procedure and diagnostic code selections for proper reimbursement is - Answers supporting documentation in the electronic health record An electronic medical report is a - Answers permanent legal document; part of the health record An advantage of electronic medical records is - Answers greater standardization in clinical medical terminology When each entry in the medical record is worded similar to the previous entries, this is considered - Answers cloned documentation Under the Medicare incentive program for implementation of EHR, eligible providers will - Answers be penalized through payment adjustments starting in 2015 if they have not demonstrated MU The chronological recording of pertinent facts and observation about the patient's health is known as - Answers documentation Reason for documentation include - Answers defense of a professional liability claim; insurance carriers require accurate documentation that supports procedure and diagnostic codes The SOAP in patient medical record charting - Answers s-subjective, o-objective, a-assessment, p-plan When a patient fails to return for needed treatment, documentation should be made - Answers in the patient's medical record in the appointment book on the financial record or ledger card How should an entry in a patient's electronic medical record be corrected? - Answers Input a note of which section is in error and enter correct data with details of why the correction is necessary and authenticate with electronic signature, date, and time A concise statement describing the symptom, problem, condition, diagnosis physician-recommended return, or other factor that is the reason for the encounter is abbreviated as - Answers CC Levels of evaluation and management services are based on type(s) of physical examination that may be - Answers problem focused An expanded problem-focused examination is a/an - Answers limited examination of the affected body area A diseased condition or state is known as - Answers morbidity