Consist of 120 multichoice Questions with Answers
1. A specialist is submitting a batch of claims to the clearinghouse and re- ceived a
report stating three claims were rejected. What should the specialists next steps be?
A. Build a patient for service is not covered
B. Reviews of scrubber report
C. Call the third-party payer to determine the reason for rejection
D. Appeal the rejection
Answer
Review the scrubber report
2. Which of the following actions should be taken by a specialist to ensure a patient's
health information is protected? A. Confirming test results with the patient over the
phone at the reception area.
B. Asking the patients reason for their visit during check-in.
C. Using data encryption software on office workstation.
D. Leaving the workstation unlocked while stepping away to assist another patient.
Answer
Using data encryption software on office workstations
,3. Which of the following is an advantage of an electronic claims submission?
A. Claims are expedited.
B. Claims are scrubbed.
C. Claims are clean.
D. Claims are paid.
Answer
Claims are expedited
4. Which describes a CPT modifier that is used to indicate a provider super- vised and
interpreted a radiology procedure?
A. Technical component.
B. Professional component.
C. Descriptive qualifier.
D. Physical status.
Answer
Professional component
5. A specialist is assisting a patient who has a capitatef HMO and presented to the
office with a sinus infection. The specialist should identify that which of the following is a
statement that is true regarding a capitated HMO?
A. Payment for the encounter is based on the flat rate.
B. A claim should be submitted to the third-party payer for the encounter.
C. Patients are billed directly for the encounter.
,D. A claim should be provided to the patient following the encounter.
Answer
Payment for the encounter is based on a flat rate
6. A specialist is training a new employee on a claim for consultation.The new employee
asks " What is a consultation ", which of the following responses fits best?
A it's when a provider request medical advice from nursing staff.
, B. It's a meeting between the provider and patient's family.
C. It's when a provider requests medical advice from a specialist.
D. It's a meeting between the provider in a third-party payer.
Answer
It's when a provider request medical advice from a specialist
7. The provider charges $135 for a visit. The third-party payer usual custom- ary
reasonable amount is $120 with a 20% coinsurance. Which of the following is the
patient's responsibility.?
A. $39
B. $24
C. $27
D. $42
Answer
$39
8. When should a specialist initiate the collection of information needed to process
a payments insurance claim form?
A. When a patient signs the HIPAA form at check-in.
B. When the patient contacts the providers office and schedule an appoint- ment.
C. When the patient pays the co-pay or deductible. D. When the patient checks out of
the providers office.
Answer
When the patient contact the provider's office and schedule an appointment
9. A provider's office receives a subpoena requesting medical documenta- tion form