AMCA medical coding/billing certification
1. What type of insurance allows treatment virtually anywhere with a high deductible that policy holders
are willing to pay?: PPO
2. Veterans with service related disabilities are eligible for case under which program?: CHAMPVA
3. is usually sponsored and partially paid by an employer: Group Health Insurance
4. are used to report encounters for circumstances other than a disease or injury in the ICD-
10-CM: E codes
5. The abbreviation PMPM stands for: Per Member Per Month
6. Schedule of benefits means: medical service covered under the insured's policy
7. Medicare is funded by: Federal funds
8. physicians establish a list of their usual fees for:: the procedures and services they frequently perform
9. the insurance carrier is allowed to use nay method to determine the amount for a service, also known as the::
allowed amount
10. Which of the following statements is true under the doctrine of respondeat superior?: The physician is
responsible for any errors made by the medical staff
11. HIPAA stands for which of the following?: Health Insurance Portability and Accountability Act
12. Information given by a patient to medical personnel that cannot be dis- closed without consent
constitutes:: privileged communication
13. Why is a super bill/encounter form an important document in the office?-
: it's ensures the correct patient data information and procedures
14. Which of the following facilities does NOT use CMS-1500 forms?: Nursing home
15. Physicians usually submit claims for patients and receive payments di- rectly for the payers. The policy
holder authorizes this by signing and dating a:: Assignment of benefits
16. Under the HIPAA Privacy Rule, providers do not need specific authorization in order to release a patients PHI
for TPO purposes. What does TPO stand for?: Treatment, Payment, and Health Care operations
17. If both parents cover dependents on their plan, the child's primary insur- ance is usually determined by the
birthday rule.What is meant by the birthday rule?: The parent whose birthday is earlier in the calendar year is the
primary
18. There are three participants in the medical insurance relationship: the first party, the second party and the
third party. Who is referred to as the second party?: physician
19. Co-insurance is calculated based on:: A percentage of a charge
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, AMCA medical coding/billing certification
20. If a health plan member receives medical services from a provider who does not participate in the plan, the
cost for the member is typically:: Higher
21. the tertiary payer pays: After the first and second payer
22. A certification number for a procedure is the result of which transaction and process?: referral and
authorization
23. Which of the following is one of the sections in the CPT Coding Manual?-
: Pathology and Laboratory
24. A late effect may be indicated in documentation by the use of the expres- sion (s):: due to an old-due to a
previous
25. Multigravida is a term associated with:: pregnancy
26. What insurance company is the payer of last resort?: Medicaid
27. An unintentional, harmful reaction to the correct dosage of a drug is called:: An adverse effect
28. Which of the following CPT conventions indicates the code description is revised?: Blue triangle
29. What is meant by the term "Code to the Highest Level of Specificity"?: Us- ing the most specific code possible
30. A medical term that contains the root word meaning "uterus":: hysterecto- my
31. If the patient is treated for both an acute and chronic condition, each of which has a separate code, how
should the codes be listed?: acute code, chronic code
32. A new patient is one who has not received services from the physician or any other physician in that group
for:: 3 years
33. The abbreviation for PFSH is:: Past, family and/or social history
34. The three key factors in selecting E/M codes are:: History, examination and medical decision making
35. When a panel code from the Pathology and Laboratory section is report- ed:: all the listed tests must have
been performed
36. What is the Medicare Coverage Gap also know as the "donut hole"?: The amount of out of pocket costs after a
certain amount of money has been spent from Medicare on prescription drugs
37. CPT is what level of Healthcare Common and Procedure coding system?-
: Level I
38. Most individuals receiving TANF payments are limited to a benefit period.-
:5
39. Which of the following is not a commonly used transmission method for HIPAA claims?: fax
40. Medicare Part B covers:: physician services
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1. What type of insurance allows treatment virtually anywhere with a high deductible that policy holders
are willing to pay?: PPO
2. Veterans with service related disabilities are eligible for case under which program?: CHAMPVA
3. is usually sponsored and partially paid by an employer: Group Health Insurance
4. are used to report encounters for circumstances other than a disease or injury in the ICD-
10-CM: E codes
5. The abbreviation PMPM stands for: Per Member Per Month
6. Schedule of benefits means: medical service covered under the insured's policy
7. Medicare is funded by: Federal funds
8. physicians establish a list of their usual fees for:: the procedures and services they frequently perform
9. the insurance carrier is allowed to use nay method to determine the amount for a service, also known as the::
allowed amount
10. Which of the following statements is true under the doctrine of respondeat superior?: The physician is
responsible for any errors made by the medical staff
11. HIPAA stands for which of the following?: Health Insurance Portability and Accountability Act
12. Information given by a patient to medical personnel that cannot be dis- closed without consent
constitutes:: privileged communication
13. Why is a super bill/encounter form an important document in the office?-
: it's ensures the correct patient data information and procedures
14. Which of the following facilities does NOT use CMS-1500 forms?: Nursing home
15. Physicians usually submit claims for patients and receive payments di- rectly for the payers. The policy
holder authorizes this by signing and dating a:: Assignment of benefits
16. Under the HIPAA Privacy Rule, providers do not need specific authorization in order to release a patients PHI
for TPO purposes. What does TPO stand for?: Treatment, Payment, and Health Care operations
17. If both parents cover dependents on their plan, the child's primary insur- ance is usually determined by the
birthday rule.What is meant by the birthday rule?: The parent whose birthday is earlier in the calendar year is the
primary
18. There are three participants in the medical insurance relationship: the first party, the second party and the
third party. Who is referred to as the second party?: physician
19. Co-insurance is calculated based on:: A percentage of a charge
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, AMCA medical coding/billing certification
20. If a health plan member receives medical services from a provider who does not participate in the plan, the
cost for the member is typically:: Higher
21. the tertiary payer pays: After the first and second payer
22. A certification number for a procedure is the result of which transaction and process?: referral and
authorization
23. Which of the following is one of the sections in the CPT Coding Manual?-
: Pathology and Laboratory
24. A late effect may be indicated in documentation by the use of the expres- sion (s):: due to an old-due to a
previous
25. Multigravida is a term associated with:: pregnancy
26. What insurance company is the payer of last resort?: Medicaid
27. An unintentional, harmful reaction to the correct dosage of a drug is called:: An adverse effect
28. Which of the following CPT conventions indicates the code description is revised?: Blue triangle
29. What is meant by the term "Code to the Highest Level of Specificity"?: Us- ing the most specific code possible
30. A medical term that contains the root word meaning "uterus":: hysterecto- my
31. If the patient is treated for both an acute and chronic condition, each of which has a separate code, how
should the codes be listed?: acute code, chronic code
32. A new patient is one who has not received services from the physician or any other physician in that group
for:: 3 years
33. The abbreviation for PFSH is:: Past, family and/or social history
34. The three key factors in selecting E/M codes are:: History, examination and medical decision making
35. When a panel code from the Pathology and Laboratory section is report- ed:: all the listed tests must have
been performed
36. What is the Medicare Coverage Gap also know as the "donut hole"?: The amount of out of pocket costs after a
certain amount of money has been spent from Medicare on prescription drugs
37. CPT is what level of Healthcare Common and Procedure coding system?-
: Level I
38. Most individuals receiving TANF payments are limited to a benefit period.-
:5
39. Which of the following is not a commonly used transmission method for HIPAA claims?: fax
40. Medicare Part B covers:: physician services
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