solutiontestbank.

com
Student name:__________
1) Scheduling appointments in a(n) __________ manner creates an efficient patient flow.

2) Prior to scheduling appointments, you need to prepare the appointment book. The first
step in this process is to establish the __________.

3) Because the appointment book is considered a(n) __________ record, entries must be
clear and easy to read.

4) The scheduling system in which patients are seen on a first-come, first-served basis is
__________ scheduling.

5) Time-specified or __________ scheduling assumes a steady flow of patients throughout

the day at regular, specified intervals.

6) A practice that needs flexibility to allow for appointments that take more or less time than
anticipated could use __________ scheduling.

7) When a service such as ultrasound is available only at certain times, __________

scheduling is used to group ultrasound appointments together.

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8) Mr. Jones just completed his annual physical exam and wants to schedule the
appointment for next year. This is called __________ scheduling.

9) A(n) __________ scheduling system can lock out selected appointment slots for various
purposes and can provide the provider with a variety of reports that can help improve efficiency.

10) Appointment __________ can take various forms, but all help patients keep track of their
appointments.

11) A patient who arrives without an appointment expecting to see the practitioner is referred
to as a(n) __________ patient.

12) A patient who does not call to cancel an appointment but does not come to the
appointment is called a(n) __________.

13) It is important to avoid __________ appointments because doing so creates stress for the
provider and other staff and causes the office schedule to fall behind.

14) When making travel arrangements for the provider, you should obtain a(n) __________
of travel plans and make sure both the provider and the office has copies of it.

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15) The monthly office staff meeting will be held tomorrow. One of your responsibilities to
prepare for the meeting is to develop the __________ of topics to be discussed.

16) During the monthly staff meeting, you are responsible for taking detailed notes so you
can prepare the report of what was discussed and decided upon at the meeting. These notes are
known as the __________ of the meeting.

17) A practitioner who is hired to see patients while the regular practitioner is away from the
practice is referred to by the legal term __________.

18) Before changing to __________ scheduling, the practice should assess its needs, survey
patients for Internet access, and investigate privacy issues.

19) Before a practice can use e-mail to schedule appointments, patients must sign a(n)
__________ allowing communication via e-mail.

20) After you have scheduled a patient for an outpatient procedure, you should answer any
questions the patient may have and make sure she understands that if the __________
instructions are not followed, the procedure may need to be rescheduled or repeated.

21) The open-hours scheduling system is also known as a __________ system.

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22) An efficient schedule depends on the practitioner’s __________ and habits, the available
facilities, and patient need.

23) A basic outline of the times the practitioners are and are not available to see patients is
known as a __________.

24) Most patients are willing to wait no more than __________ minutes to be seen by a
medical provider.

A) 20
B) 30
C) 45
D) 60
E) 90

25) The first step in preparing the appointment book is to __________.

A) schedule new patient appointments

B) plan for double booking
C) establish the matrix of the appointment book
D) schedule routine appointments
E) have the practitioners approve schedule

26) Which of the following is the common abbreviation for Pap smear?

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A) PS
B) ps
C) Psm
D) PSM
E) Pap

27) The typical amount of time for a complete physical examination is __________.

A) 10 minutes
B) 15 to 20 minutes
C) 20 to 30 minutes
D) 30 to 60 minutes
E) 90 minutes

28) Which of the following appointments typically takes 5 to 15 minutes?

A) emergency office visit

B) new patient visit
C) follow-up office visit
D) complete physical examination
E) pelvic exam and Pap smear

29) A woman going to the practitioner for a routine prenatal examination can expect the
appointment to last __________.

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A) 5 to 10 minutes
B) 15 minutes
C) 30 minutes
D) 45 minutes
E) 60 minutes

30) A new patient calls the provider’s medical office and asks how long the appointment will
take. The best response is __________.

A) "10 minutes"
B) "15 to 20 minutes"
C) "20 to 30 minutes"
D) "30 minutes or more"
E) "60 to 90 minutes"

31) The typical time allotted for a routine Pap smear and pelvic examination is __________.

A) 5 to 10 minutes
B) 15 to 30 minutes
C) 30 to 45 minutes
D) 45 to 60 minutes
E) more than 60 minutes

32) In-office minor surgery such as a mole removal typically lasts __________.

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A) 10 minutes
B) 20 minutes
C) 30 minutes
D) 45 minutes
E) 60 minutes

33) A disadvantage of the open-hours scheduling system is that __________.

A) it causes problems due to broken appointments

B) the patient records must be pulled before the patients arrive
C) it still requires the use of an appointment book
D) it increases the possibility of inefficient downtime for the provider
E) patients may be irritated if they find they have the same appointment time

34) Which of the following appointment scheduling systems allows patients to arrive at their
own convenience with the understanding that they will be seen on a first-come, first-served
basis?

A) wave scheduling
B) open-hours scheduling
C) cluster scheduling
D) modified-wave scheduling
E) double booking

35) The appointment scheduling system that assumes a steady stream of patients all day long
at regular, specified intervals is __________.

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A) time-specified scheduling
B) advance scheduling
C) computerized scheduling
D) open-hours scheduling
E) cluster scheduling

36) The appointment scheduling system that is based on the reality that some patients will
arrive late and others will require more or less time than expected with the provider is
__________.

A) time-specified scheduling
B) wave scheduling
C) double-booking
D) cluster scheduling
E) stream scheduling

37) The appointment scheduling system in which two or more patients are scheduled for the
same appointment time is __________.

A) cluster scheduling
B) combination scheduling
C) time-specified scheduling
D) double-booking
E) wave scheduling

38) The appointment scheduling system that groups similar appointments together during the
day or week is __________.

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A) wave scheduling
B) combination scheduling
C) time-specified scheduling
D) double-booking
E) cluster scheduling

39) In some specialties, patients may be booked weeks or months ahead in

__________scheduling.

A) cluster
B) advance
C) time-specified
D) wave
E) modified-wave

40) Which of the following appointment scheduling systems is also called stream scheduling?

A) wave scheduling
B) modified-wave scheduling
C) time-specified scheduling
D) double-booking system
E) combination scheduling

41) Which appointment scheduling system is also called categorization scheduling?

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A) cluster scheduling
B) wave scheduling
C) time-specified scheduling
D) combination scheduling
E) modified-wave scheduling

42) In which appointment scheduling system is the number of patients to be seen each hour
calculated by dividing the hour by the length of the average visit?

A) cluster scheduling
B) combination scheduling
C) wave scheduling
D) time-specified scheduling
E) advance scheduling

43) A disadvantage of the wave scheduling system is that __________.

A) it assumes that two patients will actually be seen by the provider within the
scheduled period
B) it prevents the medical assistant from pulling the patient's charges before they arrive
C) patients become annoyed or angry when they realize that they have appointments at
the same time as other patients
D) patients may have a considerable wait before seeing the provider
E) it does not allow flexibility to work with patients who arrive late for their
appointments

44) Scheduling four patients to arrive at planned intervals during the first half hour, leaving
the second half hour unscheduled, is an example of __________.

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A) double-booking
B) wave scheduling
C) modified-wave scheduling
D) cluster scheduling
E) open-hours scheduling

45) Which type of appointment scheduling system can be helpful if a patient calls and needs
to be seen that day but no appointments are available?

A) double-booking
B) wave
C) modified-wave
D) cluster
E) advanced

46) Physical examinations or procedures such as physical therapy or ultrasound are scheduled
only at certain times in __________.

A) advance scheduling
B) wave scheduling
C) cluster scheduling
D) combination scheduling
E) time-specified scheduling

47) An advantage of a computerized scheduling system is that it __________.

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A) can identify patients who routinely are late, forget their appointments, or cancel
B) eliminates a wait for patients when coming to the office
C) cancels any chance that two patients can be scheduled at the same time
D) prevents the need to allow time for catching up before the next hour begins
E) does not need color-coding to clarify the appointment schedule

48) The practitioner has recommended that a patient have an annual physical to include a
breast examination. What is the best way to help a patient remember to schedule next year’s
appointment?

A) Call the patient to remind her to call you for an appointment

B) Give the patient a note when she leaves the office to remember to call in a year for
an appointment
C) Place the patient's name in a tickler file so when the time arrives, a form can be sent
to remind the patient to call for an appointment
D) Tell the patient when she leaves the office to call in a year to schedule an
appointment
E) Schedule the appointment before the patient leaves the office

49) Appointment reminders include appointment cards, reminder mailings, reminder calls,
and __________.

A) referrals
B) repeat visits
C) recall notices
D) special appointments
E) superbills

50) Which of the following appointment reminders is best used for appointments that need to
be scheduled 6 months to a year away from the patient's current appointment?

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A) appointment card
B) reminder mailing
C) reminder call
D) recall notice
E) superbill

51) Which appointment reminder is especially helpful for patients with a history of late
arrivals or no-shows?

A) recall notice
B) reminder call
C) appointment card
D) reminder mailing
E) superbill

52) For which type of appointment reminder does the patient self-address a card when
leaving the office that is sent to the patient a week before the scheduled appointment?

A) recall notice
B) reminder call
C) appointment card
D) reminder mailing
E) superbill

53) Which of the following should you do when scheduling a patient for a fasting procedure?

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A) Instruct the patient to eat and take all medications as usual.

B) Schedule the procedure as early in the day as possible.
C) Tell the patient to eat breakfast and then have only liquids before the procedure.
D) Allow the patient to come at any time throughout the day for the procedure.
E) Avoid scheduling the patient in the morning.

54) A medical assistant tells a patient that fasting prior to having blood drawn means
__________.

A) avoiding food except liquids for 2 hours before having blood drawn
B) eating a diet low in carbohydrates and fats for 12 hours before having blood drawn
C) eating and drinking as usual, but not taking medications prior to the test
D) refraining from eating and drinking anything, beginning the night before the blood is
drawn
E) following a clear liquid diet for 24 hours before having blood drawn

55) A patient with __________ requires extra consideration when scheduling and should not
be scheduled for late morning.

A) arthritis
B) diabetes
C) asthma
D) back pain
E) kidney disease

56) The main reason a diabetic patient who takes insulin must eat meals and snacks at regular
times is to __________.

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A) lower the blood sugar

B) keep the blood sugar from dropping too low
C) keep the blood pressure from dropping too low
D) lower the blood pressure
E) increase the heart rate

57) A patient with diabetes whose blood sugar falls too low may experience __________.

A) pain
B) fever
C) diarrhea.
D) confusion
E) shortness of breath

58) The best time to schedule a patient who needs a regular appointment, such as a prenatal
checkup, is __________.

A) at the first available time in the weekly schedule

B) early in the day
C) late in the day
D) on the same day and time each week
E) at noon so the patient does not have to take off work

59) What is the best way to deal with patients who are routinely late for their appointments?

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A) Notify them that they can no longer be seen.

B) Charge them a fee for being late.
C) Schedule them for an appointment toward the end of the day.
D) Tell them how rude and inconsiderate their behavior is.
E) Schedule all patients who are routinely late on the same day.

60) The appropriate procedure to follow with a cancellation is to __________.

A) erase the patient's name from the appointment book and tell the patient to call later
to reschedule
B) draw a single line through the patient's name and write "canceled" in the
appointment book before entering the rescheduled time
C) reschedule the appointment but leave the original appointment in the appointment
book
D) tell the patient she must come to the office to cancel the appointment in person
E) enter the rescheduled time in the appointment book and make a note to cancel the
original appointment

61) Yvonne had a cyst removed from her right hand three weeks ago. You scheduled her
follow-up appointment for one week after the surgery, but she did not show up for the
appointment. Today she called to say that the incision is red and oozing and has a foul smell. She
thinks the surgeon "messed up" and is threatening a lawsuit. Which of the following statements
applies in this situation?

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A) Yvonne may win the lawsuit if the incision turns out to be infected.
B) The provider is not responsible because patients sign a form waiving their right to
sue before the surgery is performed.
C) The provider is protected from legal action if a "no-show" was documented when
Yvonne missed her follow-up appointment.
D) The provider should ask Yvonne to come into the office so he can correct his error
and avoid a lawsuit.
E) Yvonne can file a lawsuit against both the provider and the entire practice because
her incision was not properly cared for.

62) The appropriate procedure to follow for a patient who misses an appointment is to
__________.

A) notify the patient that she will be charged for the missed appointment and interest
will be applied
B) refuse to reschedule an appointment for the patient
C) document the no-show in the appointment book and in the patient's chart
D) schedule another appointment for the patient, but tell her the appointment will be
cancelled if she does not call the day before to confirm it
E) call the patient and ask her why she did not come in for her appointment

63) What is the best way to handle a practitioner who consistently throws off the office
schedule by returning late from lunch?

A) Organize the entire office staff to be late for work one day.
B) Reprimand the practitioner for being rude and inconsiderate.
C) At a staff meeting, demand that the practitioner start being more punctual.
D) Have the entire staff threaten to quit if the practitioner does not start being more
prompt.
E) Avoid scheduling patients for the first appointment after lunch when possible.

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64) When scheduling a patient for an outpatient surgical procedure, the medical assistant
should __________ before choosing the facility or surgeon.

A) talk with the patient to find convenient appointment times

B) ask the patient if she would rather schedule the appointment herself
C) ask the patient to verify the exact procedure to be performed
D) determine the day and time the procedure must be done
E) check with the patient’s insurance company to verify coverage

65) Carrie is to be scheduled for an elective outpatient surgical procedure. When you ask if
she has a preferred date and time for the procedure, she tells you she would really like to have
the surgery done on Monday of next week because her sister will be in town to help care for her.
You check with the outpatient facility, and they have an operating room open at 11:30 on
Monday morning. However, the surgeon is scheduled to leave for vacation on Monday at noon.
What should you do?

A) Tell Carrie that next week is impossible because the surgeon will be on vacation.
B) Tell the surgeon that he'll have to postpone his vacation to perform Carrie's surgery.
C) Explain the situation to the surgeon and ask for his advice.
D) Schedule Carrie for Friday instead, even though her sister will not be here yet.
E) Schedule the surgery for Monday at 11:30 and hope the OR is running ahead of
schedule.

66) A medical assistant can help a practitioner make the most efficient use of his time by
__________.

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A) double-booking patients all day to eliminate slow times

B) allowing the practitioner several rest periods throughout the day
C) asking the practitioner to plan his own daily schedules
D) avoiding overbooking or underbooking
E) squeezing appointments in between closely scheduled meetings

67) A detailed travel plan that lists dates and times of flights and events, locations, and
telephone numbers is a(n) __________.

A) itinerary
B) locum tenens
C) agenda
D) program
E) roster

68) Another name for a substitute practitioner who is hired to see patients while the regular
practitioner is away is __________.

A) res ipsa loquitur

B) respite practitioner
C) locum tenens
D) respondeat superior
E) duces tecum

69) A medical assistant may be responsible for setting up the list of topics to be discussed or
presented at a meeting in the order of presentation. This list is called __________.

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A) a list of objectives
B) an agenda
C) a goals list
D) minutes
E) an itinerary

70) Which patient information would the medical assistant provide when scheduling a
patient's surgery?

A) diagnosis and insurance information

B) education level and income
C) occupation and hobbies
D) religion and professional organizations
E) driver's license number and next-of-kin

71) What situations can result in the practitioner having large, unused gaps in the schedule?

A) underbooking and patient cancellations

B) the practitioner spending too much time with each patient
C) meetings and conferences
D) the practitioner arriving late in the morning
E) double-booking every other time slot

72) What is the best approach to handling patient cancellations?

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A) Send the patient a letter pointing out that he canceled a necessary appointment.
B) Attempt to schedule another patient in the cancellation slot.
C) Encourage the provider to take the time off.
D) Schedule other activities in cancellation slots.
E) Leave the time open so the provider can decide what to do.

73) A patient who is currently in the office needs immediate attention, but the practitioner has
been called away to an emergency at the hospital. The best solution is to __________.

A) have the patient wait until the practitioner returns

B) make sure the patient is seen by another practitioner
C) let the patient leave, but have him return later that day
D) cancel the patient’s appointment and ask him to call to talk to the practitioner
E) document that the patient could not be seen because the practitioner had an
emergency

74) What is the common abbreviation for a complete physical examination?

A) CPE
B) PE
C) ce
D) cp
E) CPH

75) When you are obtaining patient information for an appointment, you should include the
__________.

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A) purpose of the visit

B) patient's occupation
C) patient's marital status
D) patient's religion
E) patient's diagnosis

76) What is the standard abbreviation for blood pressure?

A) Bld P
B) BP
C) BPr
D) BlPr
E) BPR

77) What is the standard abbreviation for an electrocardiogram?

A) ELCG
B) EG
C) ECG
D) ECAG
E) ECGM

78) A patient calls for an appointment because she has had a sore throat for four days. How
much time should you schedule for her appointment?

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A) 5 minutes
B) 15 minutes
C) 20 minutes
D) 30 minutes
E) 45 minutes

79) E-scheduling is another term for __________.

A) emergency scheduling
B) online scheduling
C) inpatient scheduling
D) scheduling for elective surgery
E) laboratory and diagnostic scheduling

80) The appointment book is a legal record and as such experts feel the old appointment
books should be kept by the practice for at least __________ years.

A) two
B) three
C) four
D) five
E) seven

81) Expenses that are not covered by an insurance plan are called __________.

82) The __________ is a fixed percentage payable by the patient after the deductible is met.

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83) The health plan that pays for medical services is known as a __________ payer.

84) The list of drugs approved by an insurance company is called a(n) __________.

85) The __________ is the annual payment made to an insurance company by the patient to
keep the insurance policy in effect.

86) Payments made by a health plan for medical services provided to the patient are known
as __________.

87) The __________ is a fixed amount that must be paid by the policyholder each year before
a third-party payer begins to cover medical expenses.

88) A small fee that is collected at the time of service is called a(n) __________.

89) The __________ fee is considered the maximum charge that the health plan will pay a
provider for a particular procedure or service.

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90) A fixed prepayment is made under contract to a medical provider for each plan member
in the __________ payment method.

91) The provider should have the patient sign a(n) __________ of benefits statement under
which the provider agrees to prepare healthcare claims for the patient and to receive payments
directly from the payer.

92) Billing the patient for the difference between a higher usual fee and a lower allowed
charge is called __________ billing.

93) Three major methods are used to transmit claims electronically: direct transmission to the
payer, __________ use, and direct data entry.

94) Legal clauses in insurance policies that prevent duplication of payment are called
__________ of benefits clauses.

95) Because Medicare pays 80% of approved charges and the patient is responsible for the
remaining 20%, individuals enrolled in the Original Medicare Part B plan often buy additional
insurance called a(n) __________ plan.

96) A(n) __________ procedure is a medical procedure that is not required to sustain life and
that is planned in advance to be done at the convenience of the provider or surgeon and the
patient.

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97) Billing programs used to exchange health information about the practice's patients with
health plans use an electronic data __________ to send information quickly and securely.

98) Insurers include either an explanation of payment or a(n) __________ advice along with
payment to the practice or to the patient, depending on whether an assignment of benefits was
signed.

99) Under a Medicare managed care plan, the primary care physician (PCP) provides
treatment and manages the patient’s medical care through __________ and authorizations to
specialists when additional care is required.

100) The oldest and most expensive type of healthcare plans repay policyholders for costs of
healthcare due to illness and accidents and are called __________ plans.

101) The payment system used by __________ is called the resource-based relative value
scale (RBRVS).

102) The electronic claim transaction preferred by Medicare is the X12 837 Health Care
Claim, commonly referred to as the "__________ claim."

103) Federal law requires employers to purchase and maintain a certain minimum amount of
workers' __________ insurance for their employees.

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104) CHIP allows states to provide health coverage to uninsured __________ in families that
do not qualify for Medicaid but cannot afford private health insurance.

105) Some payers offer an Internet-based service called __________ data entry, or DDE, that
allows medical offices to enter data without EDI formatting.

106) A(n) "__________" healthcare claim is one that is error-free and is accepted for
processing by the payer.

107) If your office submits paper claims, you should create and maintain a claims __________
to track the progress of submitted claims.

108) Insurance carriers perform a review for medical __________ on each claim to determine
whether the treatment is needed for the diagnosis listed.

109) The main goal of the __________ model is to change the organization and delivery of
primary health care in America.

110) When the medical assistant confirms with the insurance company that the patient has
coverage for a procedure before scheduling, the process is called __________.

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111) Of the federal programs providing healthcare, the largest is __________, which provides
health insurance for citizens aged 65 and older.

A) Medicaid
B) Medicare
C) disability insurance
D) liability insurance
E) CHAMPVA

112) Who most frequently files insurance claims and handles insurers' payments for a
medical practice?

A) Patient
B) Nurse
C) Medical assistant
D) Provider
E) Physician assistant

113) What is the authorization called that directs an insurance carrier to pay the medical
provider or the medical practice directly?

A) copayment
B) provider of medical services
C) assignment of benefits
D) health insurance provider
E) preauthorization

114) The person whose name the insurance is carried under is called the __________.

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A) carrier
B) subscriber
C) coinsurer
D) provider
E) third party

115) When the insured person pays an annual cost for healthcare insurance, it is called a
__________.

A) coinsurance
B) premium
C) copayment
D) capitation
E) benefit

116) The fixed dollar amount a subscriber must pay or "meet" each year before the insurer
begins to cover expenses is the __________.

A) copayment
B) premium
C) coinsurance
D) capitation
E) deductible

117) Patients who belong to a managed care health plan, such as an HMO, are responsible for
a small per-visit fee collected either prior to seeing the practitioner or at the time the patient is
leaving the office. This fee is commonly called a(n) __________.

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A) copayment
B) premium
C) coinsurance
D) capitation
E) deductible

118) In a typical medical practice, insurance claims are filed __________.

A) the day before the filing limit is reached

B) the day before the date of service
C) a few business days after the date of service
D) 9 months after the service is rendered
E) 1 year from the date of service

119) The most likely outcome of an insurance claim submitted with a diagnosis code of a sore
throat and a treatment code indicating a cast for a broken leg would be __________.

A) coverage at 100 percent for both the sore throat and the broken leg
B) the fee for service would be applied toward the patient's deductible
C) denied because the treatment was not medically necessary based on the diagnosis
D) a reprimand to the provider for not treating the sore throat
E) the patient may have to pay a coinsurance after the deductible is met

120) An insurance claims department compares the fee the doctor charges with the benefits
provided by the patient's health plan. This is called the __________.

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A) payment of benefits
B) review of medical necessity
C) explanation of benefits
D) review for allowable benefits
E) payment and remittance advice

121) Which of the following is what the patient owes after the insurance company has paid?

A) premium
B) exclusion
C) patient liability
D) comorbidity
E) capitation

122) Which of the following types of insurance covers injuries that are caused by the insured
or that occurred on the insured's property?

A) medical
B) liability
C) disability
D) medicare
E) medicaid

123) To be covered under Medicare Part B, patients must __________.

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A) remain in the hospital for more than 90 days

B) receive medical care at home
C) purchase private insurance
D) enroll, because coverage is not automatic
E) be terminally ill

124) Which insurance covers a patient who has been hospitalized up to 90 days for each
benefit period?

A) Medicare Part A
B) CHAMPVA
C) Medicare Part B
D) Medicaid
E) TRICARE Prime

125) Which of the following is a characteristic of Medicaid?

A) It is a health cost assistance program.

B) It provides health benefits to people aged 65 and older.
C) Patients are enrolled automatically.
D) Rules are the same from state to state.
E) It is an insurance program for low-income, blind, and disabled patients.

126) Patients under the age of 65 who are blind or widowed or who have serious long-term
disabilities, such as __________, may be entitled to Medicare.

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A) asthma
B) kidney failure
C) pneumonia
D) stomach ulcers
E) gallstones

127) Which of the following is included in Medicare benefits for respite care?

A) The patient must be terminally ill with 2 years or less to live.

B) Medicare has no respite care benefits.
C) The terminally ill patient is moved to a care facility for the respite.
D) Medicare provides a respite for the terminally ill patient.
E) The terminally ill patient's caregiver is admitted to the respite facility.

128) An organization that provides pain relief to terminally ill patients and supports these
patients and their families is a __________.

A) respite
B) hospital
C) outpatient clinic
D) rehabilitation center
E) hospice

129) Which of the following statements applies to a provider who agrees to accept Medicaid
patients?

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A) The provider can bill the patient for services that Medicaid does not cover.
B) The provider may see Medicaid patients as a last resort when he does not have
enough patients with insurance.
C) If the provider fee is higher than the Medicaid payment, the patient is billed for the
difference.
D) The provider does not have to agree to accept the established Medicaid payment for
covered services.
E) The provider can bill Medicare for any services not covered by Medicaid.

130) What percent of the allowable fee does Medicare pay the healthcare provider after the
annual deductible is met?

A) 20%
B) 50%
C) 75%
D) 80%
E) 100%

131) Which of the following is not part of Medicare's resource-based relative value scale?

A) the nationally uniform relative value

B) a nationally uniform conversion factor
C) Medigap, to reduce the gap in coverage
D) a geographic adjustment factor
E) adjustments according to the cost-of-living index

132) Which of the following guidelines is applicable when filing a Medicaid claim and
interacting with Medicaid patients?

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A) Allow a 2-year time limit on all claim submissions.

B) Submit claims without proving patient eligibility for benefits.
C) Treat the patient as if he or she has private insurance.
D) Submit claims without proving Medicaid membership.
E) Send claims to the national claims center.

133) Which statement is true about TRICARE?

A) TRICARE Extra can be used only after enrollment in the program.

B) TRICARE is a health insurance plan.
C) Providers must accept all TRICARE patients.
D) TRICARE for Life acts as a secondary payer to Medicare.
E) TRICARE Standard is a health maintenance organization.

134) In which program can enrollees who are aged 65 and older continue to obtain medical
services at military hospitals and clinics as they did before they turned 65?

A) TRICARE Standard
B) TRICARE for Life
C) TRICARE Prime
D) TRICARE Extra
E) CHAMPVA

135) Which of the following is included under Workers' Compensation insurance in most
states?

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A) Rehabilitation costs are covered to return an employee to work.

B) A monthly amount is paid to the patient for a temporary disability.
C) There are no death benefits.
D) Only selected medical expenses are covered, and no inpatient expenses are covered.
E) It covers workers who are injured while they are on vacation.

136) One advantage of submitting claims electronically is __________.

A) it increases the time between submission and payment

B) patients can submit their own claims easily
C) electronic claims cannot be rejected
D) the practice can receive larger payments
E) electronic submissions are cost-efficient

137) Which statement is true regarding health maintenance organizations?

A) They focus on medical procedures and services rather than on wellness and
preventive care.
B) They require subscribers to complete paperwork and file claims for routine
procedures.
C) Providers with HMO contracts are often paid a capitated rate.
D) Routine annual physical examinations are discouraged.
E) Patients generally do not have to make copayments.

138) A husband and wife are both employed and have work-sponsored insurance plans that
cover each other and their three children. Which insurance plan is the primary payer?

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A) the husband's insurance plan, because he makes more money

B) the insurance plan of the person whose birthday comes first in the calendar year
C) the wife's insurance plan, because it has the most comprehensive coverage
D) whichever the husband and wife want to declare as primary
E) the insurance plan of the person whose policy went into effect first

139) Using a clearinghouse to transmit electronic media claims __________.

A) makes more paperwork than paper claims

B) requires a greater amount of time to process claims
C) includes data elements that are transmitted in a computer file
D) enables a 30-day turnaround time from submission to payment
E) requires a translator and technology to conduct electronic data interchange

140) Which of the following is correct regarding electronic claim submissions?

A) Claims cannot be transmitted directly by electronic data interchange (EDI).

B) Claims cannot be entered into the health plan's computer system.
C) Clearinghouses will modify data as necessary to ensure a standard format.
D) Claims are prepared for transmission after all required data elements have been
entered.
E) Claim submissions cannot be integrated with EHR systems.

141) An appropriate approach to maintaining patient confidentiality on the computer is to

__________.

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A) make sure a coworker knows your password in case you are sick
B) allow former employees to keep their passwords
C) change your password every 90 days
D) provide each patient with a unique password
E) send confidential information only by fax, never by computer

142) Under a contracted or fixed prepayment called __________, providers are paid a fixed
amount of money to provide needed care.

A) preauthorization
B) copayment
C) managed care
D) capitation
E) dual coverage

143) Which of the following groups are not covered by TRICARE or CHAMPVA?

A) active military personnel

B) veterans who served in active combat
C) non-military government employees
D) families of all military personnel
E) disabled veterans

144) The payment system used by Medicare is based on __________.

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A) prevailing rates in the region

B) resources
C) the price of medical equipment used
D) fee-for-service agreements
E) the providers’ minimum charges

145) How should data in medical billing programs be entered?

A) use prefixes such as Mr., Mrs., or Ms.

B) enter information using capital letters
C) include invalid data only if necessary
D) use "see above" for repeated data
E) use hyphens, commas, and apostrophes as appropriate

146) The process of deciding the amount of money that will be paid by a third-party payer for
a procedure is __________.

A) preauthorization
B) copayment
C) precertification
D) deductible
E) predetermination

147) The request for approval for payment from a third-party payer prior to a procedure is the
__________.

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A) coinsurance
B) elective procedure
C) preauthorization
D) predetermination
E) explanation of payment

148) When a provider agrees to accept assignment for a Medicare patient, this means the
provider __________.

A) bills Medicare for the cost of service not covered by Medicaid

B) will accept Medicare but not Medicaid patients
C) will accept the amount of money Medicare pays as payment in full
D) will accept only emergency patients covered by Medicaid
E) bills the patient for the cost of service not covered by Medicare

149) Eligibility for Medicaid is __________.

A) automatic for patients aged 65 and older

B) based on the patient's reported income and assets from the previous month
C) based on the patient's reported income and assets from the previous year
D) based on the patient's reported income and assets for the previous three months
E) based on the patient's reported income and assets for the previous six months

150) Which of the following is not part of the process for verifying workers' compensation
coverage?

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A) getting the name and policy number of the patient's personal health insurance policy
B) obtaining the employer's verification that the accident was work-related
C) asking the verifier at the patient's company for the original date of the injury
D) getting the name of the verifier at the patient's company
E) asking if the company has opened a workers’ compensation case with the insurance
company

151) What is the birthday rule?

A) Coverage for the year begins on the policyholder's birthday.

B) Dependent children lose coverage on their 18th birthday.
C) The policyholder's primary insurance coverage ends on his 80th birthday.
D) The insurance policy of the policyholder whose birthday comes first in the calendar
year is the primary payer for all dependents.
E) Insurance coverage for all dependents ends on the policyholder's 65th birthday.

152) The usual fees that are listed on the medical office's fee schedule are fees __________.

A) paid by the third-party provider

B) charged over what most third-party payers will pay
C) charged to most of their patients most of the time under typical conditions
D) charged as a professional courtesy
E) charged only to patients who have private insurance

153) What is the term for the 10-digit number that identifies the provider’s medical specialty?

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A) taxonomy code
B) national identifier
C) capitation
D) provider code
E) DEA number

154) Which of the following must be verbally discussed with a Medicare beneficiary to enable
the beneficiary to consider options and make informed choices?

A) CHIP
B) DRG
C) RBRVS
D) ABN
E) GAF

155) If providers submit a claim for a simple procedure when in fact a more complicated
procedure was documented in the medical record, __________ may occur.

A) no payment
B) underpayment
C) overpayment
D) denial of claim
E) recovery audit

156) Mrs. Lawrence is an elderly diabetic patient who is on Medicare. She recently injured her
lower left leg, and since then has had trouble with open sores or ulcers on that leg. She came to
the office last week to have the provider examine and treat the ulcers. At that time, you checked,
and she qualified for Medicaid as well as Medicare. She has come to the office today for follow-
up care and treatment. Which of the following should you do first?

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A) Ensure that the provider signs the Medicaid claim.

B) Contact Medicare for preauthorization.
C) Contact Medicaid to verify her eligibility.
D) Send the claim to Medicaid.
E) Notify Mrs. Lawrence that she will not have to pay anything.

157) Mr. Johnson came to the office today complaining of headache and upset stomach. He
has the traditional Medicare fee-for-service (or indemnity) plan. Your office's usual fee for an
established patient visit is $125. Medicare's allowable charge is $100. If Mr. Johnson does not
have Medigap insurance, how much will he have to pay for this visit?

A) $20
B) $25
C) $80
D) $100
E) $125

158) Greg Owen is in the office today for treatment of a small but deep cut he received while
cutting laminate for the new floor in his kitchen. He has employer-provided insurance and also is
listed as a dependent on his wife's insurance. His DOB is 7/19/1973 and his wife's DOB is
5/23/1978. Who is the primary payer in this case?

A) Greg's insurance, because he was born 5 years earlier than his wife
B) Greg's wife's insurance, because her birthday occurs earlier in the calendar year
C) Medicare, because Greg is over 65
D) Medicaid, because Greg does not think he can afford to have sutures
E) Workers' Compensation, since Greg is employed full-time

159) A managed care plan that establishes a network of providers to perform services for plan
members is known as which of the following?

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A) PCP
B) MCO
C) HMO
D) PPO
E) PCMH

160) Which Medicare plan covers prescription medications?

A) Part A
B) Part B
C) SSI
D) Part C
E) Part D

161) The __________ Index is organized by the condition, not by the body part in which it
occurs.

162) In ICD-10, three-digit categories known as __________ are used for diseases, injuries,
and symptoms.

163) The list of abbreviations, punctuation, symbols, typefaces, and instructional notes that
appears at the beginning of the ICD and provides guidelines for using the code set are called
__________.

164) When "see" appears after a main term, you must look up the term that follows the word
“see” in the index. This is an example of a __________.

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165) The primary condition for which a patient is receiving care is communicated to the third-
party payer through a(n) __________ code on the healthcare claim.

166) The diseases and injuries in the __________ List of the ICD are organized into chapters
according to the source or body system.

167) The ICD coding system was originally created for the classification of patient
__________ (sickness) and mortality statistics and to provide access for medical research,
education, and administration.

168) Patients' description of their medical problem is called their __________ complaint and is
documented at each visit.

169) In ICD-10, each category in the Tabular List has 3 characters, and each __________ has
4 or 5 characters, with the final code consisting of up to 7 characters.

170) Unlike outpatient coding, which uses the patient's primary diagnosis, hospital coding uses
the __________ diagnosis, which is the condition that was chiefly responsible for the patient's
admission to the hospital.

171) Payment for inpatient claims are based on a system known as __________.

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172) All ICD-10 codes begin with a(n) __________ character.

173) ICD-10 contains many more __________ codes than ICD-9, which cuts down the need to
use multiple codes for a single diagnosis.

174) To assign a proper code for a neoplasm in ICD-10, the documentation must state whether
it is benign, __________, in situ, or of uncertain behavior.

175) When hypertension is caused by an underlying condition, two codes are required. The
first identifies the underlying __________, or cause, and the second codes the hypertension.

176) After listening to the patient's statements, performing an examination, and evaluating the
information received from these sources, the physician establishes a(n) __________ that
describes the primary condition for which a patient is receiving care.

177) ICD stands for "International __________ of Diseases."

178) One of the original reasons for the ICD coding system was to classify patient morbidity
(sickness) and __________ (death) statistics.

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179) Additional terms that are needed to select correct codes are indented after the main term
in the Alphabetic Index. These terms are called __________.

180) When a practitioner does not document an exact diagnosis, outpatient coding rules
require that unclear diagnosis be coded using the __________ that led the patient to seek care,
until an absolute diagnosis is made.

181) A(n) __________ diagnosis is used in addition to the primary diagnosis to describe
another condition that also is affecting the patient at the time of the visit.

182) Implementing ICD-10 is meant to allow greater __________ for diagnosis classifications.

183) The use of ICD codes is mandated by __________.

A) HIPAA
B) HMOs
C) CDC
D) NIH
E) AMA

184) A patient’s diagnosis for a visit, as established by the practitioner, __________.

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A) includes all of the conditions the patient is treated for

B) describes the primary condition for which the patient is receiving treatment
C) is the chief complaint of the patient
D) must comply with WHO terminology guidelines to be accepted by third-party
payers
E) can be coded directly from the Alphabetic Index

185) How often are the ICD codes updated?

A) weekly
B) monthly
C) yearly
D) every two years
E) every five years

186) The Alphabetic Index is organized by __________.

A) the part of the body involved

B) the symptoms displayed by the patient
C) codes found in the Tabular List
D) diseases, conditions, and related terms
E) the severity of the disease or condition

187) When you encounter the word see in the Alphabetic Index, you know that __________.

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A) the term you found is the correct one for the patient's condition
B) you must look in another category to find the correct term
C) there is more information about the patient's condition somewhere else
D) you need to turn to another research source
E) the term is considered "not otherwise specified"

188) The Tabular List is mainly organized by __________.

A) the patient's condition

B) the codes found in the Alphabetic Index
C) the patient's symptoms
D) the body system involved
E) the severity of the disease or condition

189) Which of the following ICD-10-CM conventions is used around synonyms, alternative
wordings, or explanations?

A) ( )
B) [ ]
C) : :
D) { }
E) ; ;

190) Which of the following ICD-10-CM conventions is used in the Tabular List after an
incomplete term that needs one of the terms that follow to make it assignable to a given
category?

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A) Includes
B) Excludes
C) }
D) :
E) NOS

191) Which of the following conventions, which will always be surrounded by a box, is used
in ICD-10 to indicate that the entries following it further define the content of a preceding entry?

A) NOS
B) Includes
C) Excludes
D) NEC
E) Code Also

192) Which of the following ICD-10 conventions encloses a series of terms, each of which is
modified by the statement that appears to the rig

A) ]
B) )
C) }
D) :
E) (

193) Which convention is used in ICD-10 to indicate that an entry is not classified as part of
the preceding code?

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A) NOS
B) Includes
C) Excludes
D) NEC
E) Code Also

194) Which convention is used in ICD-10 to set off nonessential or supplementary terms that
do not affect the code?

A) [ ]
B) ( )
C) { }
D) : :
E) ; ;

195) In the ICD-10, the convention code first underlying disease means __________.

A) the code may not be used as the first code

B) the disease is not otherwise specified
C) alternative wording must be used
D) two codes are required separately to code the diagnosis
E) ICD does not provide a code specific enough for the patient's condition

196) What does the ICD convention NEC indicate?

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A) may not be used as the first code

B) not otherwise specified
C) not elsewhere classified
D) alternative wording
E) two codes must be used together

197) Jenni is a healthy 24-year-old patient who is in the office today for routine obstetric care.
Which chapter of the ICD-10 is used to code for pregnancy, childbirth, and the puerperium?

A) Chapter 5
B) Chapter 10
C) Chapter 15
D) Chapter 19

198) Mary was excited at her last visit to find that she is pregnant. She came in for a prenatal
checkup today because she wants to take excellent care of herself and her baby. Everything
seems fine, and the physician told her to keep up the good work. The ICD-10 code for routine
obstetric care will be found in which of the following series of codes?

A) C00–D49
B) H00–H59
C) O00–O9A
D) P00–P96
E) Z00–Z99

199) Jeremy is a 44-year-old patient who has been diagnosed with mitral regurgitation. He has
been having some shortness of breath lately, so today he is having an echocardiogram to evaluate
whether the condition has worsened. The ICD-10 code for Jeremy's procedure today is found in
which of the following series of codes?

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A) I00–I99
B) G00–G99
C) P00–P96
D) E00–E89
E) F01–F99

200) Kevin is a 63-year-old patient who was diagnosed with congestive heart failure two years
ago. He is having an echocardiogram today so his practitioner can monitor the progression of the
disease. The ICD-10 code for Kevin’s procedure today is found in which of the following series
of codes?

A) A00–B99
B) E00–E89
C) G00–G99
D) H00–H59
E) I00–I99

201) Ellie was playing softball and was accidentally hit on the nose with a bat. After
examining her nose, the practitioner tells her that her nose is broken and orders a complete
radiologic examination of the nasal bones. Where will the ICD-10 code for this radiologic
examination be located?

A) C00–D49
B) G00–G99
C) L00–L99
D) S00–T88
E) V01–Y99

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202) Eight-year-old Geri climbed the oak tree in her back yard to rescue her cat, who had
climbed the tree but could not get back down. Unfortunately, Geri slipped and fell out of the tree
and hurt her left arm. The lower arm is bent at an odd angle and the radius bone is visible. The
physician diagnoses an open fracture and orders X-rays of the lower arm. Where will you locate
the ICD-10 code for this?

A) C00–D49
B) E00–E89
C) H60–H95
D) M00–M99
E) S00–T88

203) Barry is a healthy 32-year-old established patient who has come in for his annual physical
exam. When asked if he has any current problems or complaints, he says no. The ICD-10 code
for his visit will be found in which of the following code ranges?

A) 290–319
B) 460–519
C) 760–779
D) Z00–Z99
E) E800–E999

204) Mrs. Evans has brought her child in for surgery to correct a cleft palate. Which code
range in ICD-10 applies to this procedure?

A) A00–B99
B) D50–D89
C) Q00–Q99
D) V01–Y99
E) Z00–Z99

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205) Phillip is in the office today for a pre-employment physical that includes a drug test. In
which ICD-10 series will you locate the code for this?

A) 390–459
B) 460–519
C) 760–779
D) 800–999
E) Z00–Z99

206) Teresa is being seen today in the urgent care center after spilling a pot of boiling water
over her stomach and legs, which resulted in second-degree burns. In which ICD-10 series will
you locate the code for her treatment?

A) C00–D49
B) G00–G99
C) L00–L99
D) S00–T88
E) V01–Y99

207) To find the ICD-10 code for anesthesia for surgery to correct a benign prostatic
hypertrophy (BPH), you will look in which series?

A) N00–N99
B) 630–679
C) 760–799
D) 800–999
E) V01–V83

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208) Which of these is used only in the hospital inpatient setting?

A) CPT codes
B) HCPCS codes
C) ICD-10-CM
D) ICD-10-PCS
E) ICD-9-CM Volume I

209) A code in which two diagnoses are included in one code is known as a(n) __________.

A) preliminary code
B) mixed code
C) multiple code
D) dual code
E) combination code

210) A condition that is of sudden onset or that suddenly becomes much worse is considered
a(n) __________.

A) chronic condition
B) subchronic condition
C) acute condition
D) intermittent condition
E) erratic condition

211) A condition that is long-standing is considered a(n) __________.

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A) chronic condition
B) subchronic condition
C) acute condition
D) intermittent condition
E) erratic condition

212) Denise is being seen today because of blurry vision and pain in both eyes. The physician
documents that diabetes has damaged the blood vessels in Denise's eyes, resulting in diabetic
retinopathy. How will this diagnosis be coded?

A) The retinopathy is coded first, followed by the diabetes.

B) The diabetes is coded first, followed by the retinopathy.
C) Only the diabetes should be coded.
D) Only the retinopathy should be coded.
E) The symptoms of blurry vision and pain should be coded.

213) Diagnosis-related groups, or DRGs, are based on all of the following except
__________.

A) significant procedures performed

B) principal diagnosis
C) secondary diagnoses
D) length of hospital stay
E) age, sex, and discharge status of the patient

214) About how many codes does the ICD-10-CM contain?

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A) 14,200
B) 38,700
C) 56,900
D) 62,400
E) 70,000

215) How many characters are present in ICD-10 codes?

A) 1 to 3
B) 3 to 5
C) 3 to 7
D) 5 to 7
E) 7 to 10

216) What character is used as a placeholder for a nonexistent digit in ICD-10 when a 6th or
7th digit is required for code specificity?

A) 0
B) 9
C) x
D) y
E) z

217) Which ICD-10 convention describes a condition that is not part of the condition
represented by the code, but if the patient actually has both conditions, both may be coded?

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A) Includes
B) Excludes1
C) Excludes2
D) Code Also
E) See Also

218) Which of the following statements is not correct about coding HIV positivity?

A) Requesting a confirmatory serology or culture for HIV is sufficient to code HIV

positivity.
B) When HIV symptoms are not present and serology is inconclusive, code R75 is
assigned.
C) Patients who are HIV positive but are currently asymptomatic are assigned code
Z21.
D) The provider must state "known HIV" or "positive HIV" in order to code HIV
positivity.
E) Patients who have developed an HIV-related illness should be assigned code B20.

219) The first step in the process of assigning a proper code for a neoplasm in ICD-10 is to
consult which of the following?

A) Appendix C of ICD-10-CM
B) The Tabular List
C) The Table of Neoplasms
D) Chapter 2, "Neoplasms"
E) Chapter 20, "External causes of morbidity"

220) In ICD-10, which has combination codes that include the type of diabetes, what code is
used if the type of diabetes is not documented in the medical record and the practitioner cannot
be questioned?

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A) Use the ICD-10 code for diabetes instead

B) Use the code for type 1 diabetes mellitus
C) Use the code for type 2 diabetes mellitus
D) Use a code that specifies insulin use
E) Use add-on codes to show unspecified diabetes

221) In ICD-10, which chapter contains codes to identify who, what, when, and where an
accident or injury occurred?

A) Chapter 17: Congenital malformations, deformations, and chromosomal

abnormalities
B) Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings; not
elsewhere classified
C) Chapter 19: Injury, poisoning, and certain other consequences of external causes
D) Chapter 20: External causes of morbidity
E) Chapter 21: Factors influencing health status and contact with health services

222) In ICD-10, in which chapter would a code for an injury diagnosis be found?

A) Chapter 17
B) Chapter 18
C) Chapter 19
D) Chapter 20
E) Chapter 21

223) How many chapters are contained in the ICD-10 coding book?

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A) 18
B) 19
C) 20
D) 21
E) 22

224) In ICD-10, which chapter would include the diagnosis codes for congenital
malformations, deformations, and chromosomal abnormalities?

A) 17
B) 18
C) 20
D) 21
E) 22

225) A plus sign (+) is used for __________ codes, indicating procedures that are carried out
in addition to a main procedure.

226) A(n) __________ plan is a strategy for finding, correcting, and preventing fraudulent
medical office practices.

227) The CPT contains codes that represent medical __________, such as surgery and
diagnostic tests, and medical services, such as an examination to evaluate a patient's condition.

228) __________ codes are the most frequently used of all CPT codes because they are used
by all practitioners in any medical specialty.

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229) A(n) __________ patient is one that has been seen by any providers in the same specialty
of the medical practice within the past three years.

230) The period of time that is covered for follow-up care after surgery is called the
__________ period.

231) The use of a(n) __________ with a CPT code shows that some special circumstance
applies to the service or procedure the practitioner performed.

232) The CPT considers a patient __________ if that person has not received professional
services from the practitioner within the last three years.

233) You will locate procedure codes in the __________ manual.

234) The extent of the __________ conducted is one of the key factors that determine the level
of service based on guidelines in the E/M section of the CPT.

235) The __________ of the medical decision making is a key factor in determining the level
of E/M codes selected.

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236) The extent of the patient __________ taken is a key factor in determining the level of
E/M codes selected.

237) The HCPCS __________ codes are more commonly known as CPT codes.

238) An example of an HCPCS Level __________ code is E0781, for an ambulatory infusion
pump.

239) HCPCS Level II codes are called __________ codes and cover supplies and DME.

240) The __________ coding system has two levels and is used for coding services for
Medicare patients.

241) Each procedure or service performed on or for a patient during a patient encounter is
reported on healthcare claims using a(n) __________ code.

242) Similar care that is being provided to the same patient by more than one practitioner is
known as __________ care.

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243) The fraudulent practice of coding a procedure or service at a higher level than that
provided to receive a higher level of reimbursement is known as code creep, overcoding,
overbilling, or __________.

244) Care provided to unstable, critically ill patients that require constant bedside attention is
known as __________ care.

245) Any code that includes more than one procedure in its description is considered a(n)
__________ code.

246) When an insurance carrier bases reimbursement on a code level lower than the one
submitted by the provider, this is called __________.

247) One of the elements of a physical exam is the __________ exam, which can include any
of the following: BP sitting or lying, pulse, respirations, temperature, height, weight, and general
appearance.

248) When coding E/M from the CPT manual, you must first know whether the patient is new
or __________ and where the services took place.

249) G0008 is an example of a __________ level II code.

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250) To ensure reimbursement at the highest allowed level, CPT codes must __________.

A) include codes and modifiers that reflect the services performed

B) include only the modifiers
C) include all of the unbundled procedures
D) reflect a procedure or service higher than what was actually performed
E) reflect a procedure or service lower than what was actually performed

251) The most frequently used CPT codes are the __________.

A) anesthesiology codes
B) evaluation and management codes
C) surgery codes
D) pathology and laboratory codes
E) radiology codes

252) For reporting an evaluation and management code, CPT considers a patient to be “new” if
the patient has not received professional services from any provider in the medical practice
within the past __________ year(s).

A) one
B) two
C) three
D) four
E) five

253) When unbundling is done intentionally to receive more payment than is allowed, the
claim is likely to be considered __________.

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A) ethical
B) invalid
C) noncompliant
D) fraudulent
E) erroneous

254) The Healthcare Common Procedure Coding System (HCPCS) was originally developed
for use in coding services, such as durable medical equipment, for__________.

A) Blue Cross
B) HMOs
C) Medicare patients
D) Medicaid patients
E) managed care patients

255) Analysis of the connection between the diagnostic and procedural information on a claim
is called __________.

A) code verification
B) code analysis
C) claim processing
D) code linkage
E) claim association

256) An act of deception used to take advantage of another person or entity is called
__________.

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A) liability
B) coercion
C) slander
D) fraud
E) defamation

257) A healthcare provider who practices under false qualifications or credentials is guilty of
__________.

A) slander
B) defamation
C) assault
D) libel
E) fraud

258) Medical offices usually have a(n) __________ to help minimize the risk of fraud by
discovering and correcting coding and billing problems.

A) quality assurance program

B) billing software program
C) financial management plan
D) compliance plan
E) external auditor

259) Having a medical practice compliance plan in place __________.

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A) eliminates the risk of an audit

B) ensures adherence to state regulations
C) shows a "good-faith" effort to be compliant with coding regulations
D) simplifies the tasks of the medical assistant
E) replaces the insurance company's compliance checks

260) A medical provider bills separately for a comprehensive metabolic panel and a
quantitative glucose test, which is normally included in the metabolic panel. This is an example
of which of the following fraudulent coding and billing practices?

A) Reporting services that were not performed.

B) Reporting services at a higher level than was carried out.
C) Performing procedures not related to the patient's condition.
D) Billing separately for services that are bundled in a single procedure code.
E) Reporting the same service twice.

261) When a patient has no symptoms of a disease and the provider performs the tests for that
disease at the patient's request, the provider has committed which of these fraudulent coding and
billing practices?

A) Reporting services that were not performed.

B) Reporting services at a higher level than was carried out.
C) Performing procedures not related to the patient's condition.
D) Billing separately for services that are bundled in a single procedure code.
E) Reporting the same service twice.

262) Billing for a moderate level evaluation and management service when only a simple BP
check and injection were carried out is an example of __________.

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A) Reporting services that were not performed

B) Reporting services at a higher level than was carried out
C) Performing procedures not related to the patient's condition
D) Billing separately for services that are bundled in a single procedure code
E) Reporting the same service twice

263) There is a question concerning a claim for a procedure submitted last year. Where will
you look to double-check the codes in question?

A) the current CPT

B) last year's CPT
C) HCPCS Level I codes
D) HCPCS Level II codes
E) ICD-10-CM

264) A plus sign (+) is used to indicate __________.

A) modifiers
B) primary codes
C) stand-alone codes
D) V codes
E) add-on codes

265) Modifiers to CPT codes indicate __________.

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A) that additional codes are needed

B) that some special circumstance applies to the service
C) synonyms
D) inclusions
E) exclusions

266) National codes issued by CMS that cover many supplies and durable medical equipment
are __________.

A) CPT modifiers
B) HCPCS Level I codes
C) HCPCS Level III
D) ICD-9-CM codes
E) ICD-10-CM codes

267) Inaccuracy in linking diagnostic codes and procedural codes will result in all of the
following except __________.

A) exclusion from payers' programs

B) denied claims
C) reduced payments
D) internal coding audits
E) prison sentences

268) The CPT is updated and new codes are provided for use beginning __________.

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A) on the first day of each month

B) semiannually on January 1 and July 1
C) quarterly on the first day of January, April, July, and September
D) annually on January 1
E) annually on July 1

269) Which of the following is not one of the six main sections in the CPT manual?

A) Anesthesiology
B) Physical Therapy
C) Pathology and Laboratory
D) Surgery
E) Evaluation and Management

270) In order to find information regarding prefixes and suffixes used in the CPT coding
manual, you would look in the __________.

A) Evaluation and Management section of the manual

B) general index for the manual
C) Introduction to the manual
D) office procedures manual
E) beginning of each section of the manual

271) Which of the following best describes the CPT code format?

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A) 3- to 5-character alphanumeric codes

B) 3- to 7-character alphanumeric codes
C) 4-digit numeric codes
D) 5-character alphabetic codes
E) 5-digit numeric codes

272) To complete the description for a CPT code that has an indented description, you should
__________.

A) refer to the next CPT code for further information

B) refer to the description for the previous CPT code to complete the description
C) use the index to find the main CPT code to be combined with this one
D) try to think of another way to describe the procedure being coded
E) refer to the previous year's CPT manual for guidance

273) When coding CPT procedures, an add-on code will describe __________.

A) special circumstances that apply to a procedure

B) surgical or other supplies that were used during a procedure
C) other procedures done in addition to a main procedure
D) medications used during a procedure
E) the type of anesthetic that was used during a procedure

274) If a code description has changed since the last revision of the CPT manual, what symbol
is placed next to the CPT code?

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A) green arrows
B) lightning bolt
C) red dot
D) blue triangle
E) pound (#) sign

275) What symbol appears next to codes that are new since the last CPT revision?

A) red dot
B) pound (#) sign
C) circle with diagonal line
D) blue triangle
E) lightning bolt

276) What symbol appears next to a code that appears out of numerical sequence?

A) red dot
B) blue triangle
C) lightning bolt
D) pound (#) sign
E) green arrows

277) A modifier indicates that __________.

A) special circumstances apply to the procedure

B) surgical or other supplies were used during the procedure
C) other procedures were done in addition to the main procedure
D) medications were used during the procedure
E) an anesthetic was used during the procedure

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278) Where in the CPT manual will information about the proper use of modifiers be found?

A) Introduction
B) Appendix A
C) Appendix B
D) Appendix C
E) Appendix D

279) Where in the CPT manual can you find a complete listing of all add-on codes?

A) Introduction
B) Appendix A
C) Appendix B
D) Appendix C
E) Appendix D

280) Dr. Moore is scheduled to perform a routine removal of a mole from Ralph's left shoulder
under local anesthesia. Dr. Moore has injected the local anesthetic and is about to begin the
procedure when Ralph suddenly has a panic attack and states, "I just can't handle this!" Dr.
Moore halts the procedure. When you code for this procedure, which of the following modifiers
will you use?

A) 23: Unusual Anesthesia

B) 47: Anesthesia by Surgeon
C) 52: Reduced Services
D) 53: Discontinued Procedure
E) 56: Preoperative Management Only

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281) Dr. Breckell is scheduled to perform a cyst removal on Haley's right hand. After he
begins the procedure, he notices that the cyst is much larger than anticipated and is involved with
nerves and ligaments in the right thumb. Complete cyst removal takes 30 minutes longer than
expected. Which modifier would you use to describe this special circumstance?

A) 22: Increased Procedural Services

B) 26: Professional Component
C) TC: Technical Component
D) 50: Bilateral Procedure
E) 51: Multiple Procedures

282) An example of a Category II code is a code used for __________.

A) weight reduction counseling

B) annual physical examinations
C) fracture management
D) total replacement heart systems
E) pain management

283) Which of the following items is not required for a service to be considered a
consultation?

A) request from another practitioner

B) documentation of the findings
C) record of recommendations
D) revision of the initial diagnosis
E) report to the referring practitioner

284) Counseling codes are used only if __________.

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A) counseling is provided during a complete physical examination

B) the patient is referred to a third party for counseling
C) a complete history and physical exam does not occur
D) counseling is provided by a practitioner assistant or nurse practitioner
E) the patient specifically requests a counseling referral

285) Which of the following is not a potential reason for downcoding?

A) The insurance carrier does not cover the services included on the claim.
B) The coding system used by the insurer does not match that used by the provider.
C) A workers' compensation carrier converts a CPT code to the lowest-paying code in
the system.
D) The payer discovers that documentation does not back up the level of code used.
E) The provider uses a HCPCS code the insurer does not recognize.

286) For coding purposes, which of the following is not a level of patient history?

A) problem-focused
B) expanded problem-focused
C) detailed
D) expanded detailed
E) comprehensive

287) For coding purposes, which of the following is not a complexity level for medical
decision making?

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A) straightforward MDM
B) general-purpose MDM
C) low-complexity MDM
D) moderate-complexity MDM
E) high-complexity MDM

288) Nathan is in the medical office today complaining of a sore throat and fever. After ruling
out strep throat, the practitioner diagnoses a common cold and tells Nathan to take over-the-
counter medications for symptom relief. In which category does Nathan’s chief complaint fall?

A) minimal complaint
B) self-limited complaint
C) low-severity complaint
D) moderate-severity complaint
E) high-severity complaint

289) Which of the following statements about surgical coding for the musculoskeletal system
is not true?

A) Fracture repair assumes and includes cast application.

B) If a diagnostic procedure becomes a therapeutic procedure, only the therapeutic
procedure is coded.
C) Cast application is coded only when the practitioner applying the cast did not
initially treat the fracture.
D) A fracture treatment is closed unless stated otherwise.
E) Musculoskeletal subheadings begin with the foot and toes and work their way up to
the head.

290) Which subsection of the surgery section include procedures on the spleen and bone
marrow?

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A) Cardiovascular System
B) Digestive System
C) Hemic/Lymphatic Systems
D) Endocrine System
E) Laboratory Procedures

291) How many codes are required for giving a patient an injection of a vaccine?

A) depends on who is giving the injection

B) 1
C) 2
D) 3
E) depends on the type of vaccine

292) When coding a surgical code, where should you look to be sure you find the correct
code?

A) Go directly to the E/M section in the front of the CPT manual.

B) Use the alphabetic listing of procedures at the back of the CPT manual.
C) Consult the Introduction to the CPT manual.
D) Use the numeric index to find the code.
E) Use the superbill that describes the patient encounter.

293) You have consulted the index in the CPT and discovered that a dressing for a burn is
found in procedure codes 16010–16030. To correctly code the dressing for the burn, you should
__________.

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A) check each code in the range to choose the correct code

B) use the codes 16010 and 16030
C) use the code 16010
D) choose any code within this code range
E) use the code 16030

294) After you decide on the appropriate CPT code(s) for a procedure, you should
__________.

A) consult Appendix C in the CPT to find examples of each code type

B) consult Appendix D in the CPT to determine which add-ons to use
C) consult Appendix A in the CPT to check for applicable modifiers
D) consult Appendix 2 of the HCPCS manual for applicable modifiers
E) code the procedure; no further action is necessary

295) Which of the following best describes HCPS Level II codes?

A) The codes have five characters: numbers, letters, or a combination of both.

B) The codes have six characters, including two initial letters followed by four
numbers.
C) The codes have five numeric digits.
D) The codes have six alphabetic characters (letters).
E) The codes have five alphabetic characters (letters).

296) A patient comes to the office for an annual physical and at the end of the examination the
patient complains of low back pain that has been bothering him for a few weeks. Which modifier
should be used with the E/M code for the low back pain to explain the need for two E/M codes at
the same visit?

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A) 22
B) 23
C) 24
D) 25
E) 26

297) In order for a service to be considered a consultation, the service must meet the 3Rs.
Which of the following are the correct 3Rs?

A) release, record, report

B) request, record, report
C) release, request, record
D) request, review, report
E) request, review, record

298) A maximum of up to __________ modifiers can be assigned per CPT procedure code?

A) 1
B) 2
C) 3
D) 4
E) as many as necessary

299) The money the medical practice must pay out to run the practice is called accounts
__________.

300) The term for income, or money, owed to the practice is called accounts __________.

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301) The process of classifying and reviewing past-due accounts by age from the first date of
billing is called __________.

302) If practitioners allow patients to pay for services over time, they are extending
__________ to the patient.

303) A credit __________ is a company that provides information about the creditworthiness
of a person seeking credit.

304) A common billing system that bills each patient only once a month but spreads the work
of billing over the entire month, sending statements to groups of patients every few days, is
called __________ billing.

305) A federal Truth in Lending Statement, which is a written description of the agreed terms
of payment, is also called a(n) __________ statement.

306) A(n) __________ account uses the last date of payment or charge for each illness as the
starting date for determining the time limit on that specific debt.

307) A(n) __________ account is an account with only one charge, usually for a small
amount.

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308) Bills sent to patients that contain an itemized accounting of services performed, an
indication of payments received from the patient or the patient's insurance, and an amount due to
the practice are called __________.

309) The statute of __________ is the state law that sets a time limit on when someone can
legally file a collection suit on a past-due account.

310) A(n) __________, or encounter form, includes the charges for each service rendered on
that day, a request for payment or insurance copayment, and all the information for submitting an
insurance claim.

311) A(n) __________ account is one in which the provider and patient sign an agreement
stating that the patient will pay the bill in a certain number of installments. If more than four
installments are involved, this account is governed by the Truth in Lending Act.

312) Free treatment for __________ cases must be undertaken carefully and is given at the
provider’s discretion.

313) A patient who moves without leaving a forwarding address and does not contact your
office to make arrangements for payment of services he has received is known as a(n)
__________.

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314) When a patient pays using a(n) __________ card, the money is immediately moved from
the patient's bank account to the medical practice account.

315) Another term for a bilateral agreement is __________ agreement.

316) Most medical offices collect __________ from patients who belong to managed care
organizations at the time of the office visit.

317) Most medical offices have a(n) __________ with the office name on it for patients who
pay by check to ensure that the name of the practice is spelled correctly on the check.

318) The person who has financial responsibility for a patient is known as the __________.

319) Large practices often use a(n) __________ billing service for both their insurance and
patient billing procedures.

320) The Telephone Consumer Protection Act of 1991 protects telephone subscribers from
unwanted telephone solicitation, which is commonly known as __________ .

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321) An overpayment on a patient’s account results in a negative number, or __________
balance.

322) Another term for a statement of income and expense is __________ statement.

323) The __________ appears as a fraction on the upper edge of all printed checks and
identifies the geographic area and specific bank on which the check is drawn.

324) Goods or properties that have a dollar value, such as the medical practice building, bank
accounts, office equipment, and accounts receivable, are called __________.

325) The process of communicating the income and expenses of a business and its financial
health is known as __________.

326) A(n) __________ statement shows how much revenue is available to cover expenses, to
invest, or to take as profit.

327) A(n) __________ check is a check issued on bank paper and signed by a bank
representative; it is usually purchased by people who do not have checking accounts.

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328) A(n) __________ check is a payer's check written and signed by the payer; the bank
withdraws the money from the payer's account and guarantees that the check will be paid when
submitted.

329) After receiving a check, immediately __________ it to prevent the check from being
cashed if it is lost or stolen.

330) The process of keeping a daily log of the patient charges and payments received from
patients each day is called __________.

331) A(n) __________ check states that it is void after a certain amount of time and is
sometimes used for payroll.

332) A(n) __________ is a kind of certificate of guaranteed payment that can be purchased
from banks and post offices and from some convenience stores.

333) In order to be considered __________, or legally transferable from one person to another,
a check has to be written and signed by the payer and include the amount of money to be paid.

334) One of the basic records of the single-entry system is the patient __________ cards,
which show how much each patient owes.

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335) The person to whom a check is written is the __________.

336) In order to be considered negotiable, a check must be signed by the __________.

337) The __________ system allows you to write each transaction once while recording it on
four different accounting forms.

338) A(n) __________ gives a person the legal right to handle financial matters for another
person who is unable to do so.

339) Once a month, when the practice receives the monthly checking account statement from
the bank, the statement should be compared with the office's financial records to ensure that they
are consistent and accurate. This process is called __________.

340) You should not accept a(n) __________ check that is made out to the patient rather than
to the practice unless it is from a health insurance company.

341) __________, or watching for changes in disbursements, is important because it helps

control expenses.

342) A practitioner may use __________ checks when attending an out-of-town conference or
whenever using a personal check or carrying a lot of cash is not appropriate.

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343) Most practices may use checks from a standard checkbook or __________ checks, which
often come in a three-ring binder and provide a stub for recordkeeping.

344) The part of the accounting process known as __________ is the systematic recording of
business transactions.

345) When performing bookkeeping procedures, you should strive for 100% __________,
because an undetected error at the first link will be carried through all the other links in the
chain.

346) Electronic bookkeeping systems contain built-in tax tables that calculate tax __________
for you.

347) The portion of a company's assets that are paid for is the company's __________.

348) The amount of money owed on a company asset is a(n) __________.

349) When posting a payment from a collection agency, post the payment from the agency in
the paid column and place the agency's fee in the __________ column.

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350) A(n) __________ banking system speeds up many banking tasks by performing
calculations automatically.

351) When a practice's income exceeds its expenses, the practice has a(n) __________; this
also is known as "being in the black."

352) When a practice's expenses exceed its income, the practice has a(n) __________; this
also is known as "being in the red."

353) Payment by credit card for a medical practice __________.

A) decreases the cash flow in the office

B) increases the time spent on paperwork
C) requires extra staff to process credit card charges
D) provides prompt payment from the credit card company
E) increases the complexity of preparing statements

354) Which of the following is a diplomatic way to ask a patient for payment?

A) "I need $74 for today's visit."

B) "For today's visit, the total charge is $74. How would you like to pay?"
C) "That will be $74. What is your check number?"
D) "We need a $74 payment by cash, check, or credit card."
E) "You will need to pay the $74 you owe before you can see the provider."

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355) On average how much will a medical practice generally receive if the provider charges
$100 for services and the patient pays with a credit card?

A) $100
B) $95–$99
C) $90–$94
D) $86–$89
E) $82–$85

356) If a medical practice accepts credit card payments, the American Medical Association
(AMA) suggests the use of which guideline?

A) Set the fees higher for patients who pay by credit card.
B) Do not encourage patients to use credit cards for payment.
C) Advertise outside the office that the practice accepts credit cards.
D) Allow only a select group of patients to use credit cards for payment.
E) Tell patients they may only use credit cards if they do not have cash.

357) If your medical practice does not have an authorization device for credit card payment,
__________.

A) omit this step completely if you have seen the patient before
B) it is sufficient to imprint the credit card voucher with the patient's credit card
C) call the credit card company for authorization
D) insist that the patient pay by cash or check
E) ask the patient for verification that the payment will go through

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358) Elena is a pregnant 16-year-old patient whose parents are divorced. She has legally left
her mothers' home and set up housekeeping with her boyfriend, Alan. They plan to be married
soon, but in the meantime, Elena shows you proof that she is "emancipated." Who is responsible
for payment for Elena's treatment?

A) Elena
B) Alan
C) Elena's mother
D) Elena's father
E) Alan's parents

359) The most appropriate way to determine which parent has consent ability and payment
responsibility for a minor child is to __________.

A) ask the parent who is with the child at the time of the appointment who has financial
responsibility
B) ask the parent who makes the appointment about financial responsibility before
making the appointment
C) check with the court system to see who was awarded custody
D) assume that the parent who brings the child for treatment has consent ability and
payment responsibility
E) require a letter from one of the parents guaranteeing payment

360) To which of the following patients would a medical provider most likely render treatment
as a professional courtesy?

A) cancer patients
B) elderly patients
C) children
D) other healthcare professionals
E) any patient who cannot pay

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361) Which of the following information should be included on a statement?

A) the patient's income

B) the balance from the previous month and an itemized list of charges
C) the patient's credit card information
D) the patient's occupation and place of employment
E) the provider's credentials

362) A superbill __________.

A) includes the charges and procedure codes for each service rendered on that day
B) is the original record of the provider’s services and charges for those services
C) bills each patient only once a month but spreads the work of billing over the month
D) is a signed agreement between the provider and the patient for payment
E) consists of a copy of the patient's ledger card that is mailed to the patient

363) When do most smaller practices send out their statements?

A) daily
B) weekly
C) at the end of the month
D) whenever the medical assistant has time to prepare the statements
E) patients are allowed to request a billing time that is convenient for them

364) A common billing system that bills each patient only once a month but spreads the work
of billing over the month is __________.

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A) using superbills
B) cycle billing
C) employing collection agencies
D) independent billing services
E) open-book accounting

365) Which of the following is true regarding a statement?

A) It is the usual fee a provider charges for a service.

B) It is paperwork sent to patients to inform them of payment or balance due.
C) It provides a price list for the medical practice.
D) It is a billing system that bills each patient once a month but staggers the due dates.
E) It provides a reminder from the medical office that the patient is due for a yearly
exam.

366) An account that is open to charges made occasionally as needed is called a(n)
__________.

A) single-entry account
B) open-book account
C) account payable
D) written-contract account
E) collection account

367) A written-contract account is __________.

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A) one that is open to charges made occasionally

B) an account with only one charge
C) one in which the practitioner and patient sign an agreement for payment installments
D) the total of the outstanding balance on the patient ledger cards
E) one in which the practitioner is requested by the courts to examine a specific patient

368) A person who is in town on vacation goes to a medical provider with symptoms of food
poisoning. The type of account to set up for this patient is a(n) __________.

A) open-book account
B) single-entry account
C) account payable
D) written-contract account
E) collection account

369) Which of the following is an accurate statement about open-book accounts?

A) They are regulated by the Truth in Lending Act.

B) They are accounts with only one charge.
C) The patient and provider sign an agreement for payment in more than one
installment.
D) The last date of payment or charge for each illness is used as the starting date for
determining the time limit on that specific debt.
E) The statute of limitations does not apply to open-book accounts.

370) Most of a practitioner’s long-standing patients have which type of account?

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A) single-entry account
B) accounts payable account
C) written-contract account
D) collection account
E) open-book account

371) Which of the following is appropriate when placing an initial call to a patient about
collections?

A) Call the patient at work.

B) Assume that the patient forgot to pay or was temporarily unable to pay.
C) Ask the patient why the bill has not been paid.
D) Tell the patient that if payment is not received promptly, the account will be turned
over to a collection agency.
E) Make the initial call if payment has not been received after 15 days.

372) An initial letter of inquiry is generally sent when an account is __________ days past
due.

A) 15
B) 30
C) 60
D) 90
E) 120

373) If an account is __________ days past due, send a letter explaining that unless you hear
from the patient by a specific date, the account will be given to a specific collection agency for
collection.

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A) 15
B) 30
C) 60
D) 90
E) 120

374) A collection letter containing stronger wording that asks the patient to specify when the
amount will be paid and to contact the office to make payment arrangements may be sent when
an account is __________ days past due.

A) 15
B) 30
C) 60
D) 90
E) 120

375) A letter that has a friendly, "we want to help" tone and gives the patient options but
makes it clear that the patient must take some sort of action, is most appropriately sent when the
account is __________ days past due.

A) 15
B) 30
C) 60
D) 90
E) 120

376) The process of classifying and reviewing past-due accounts from the first date of billing
is a(n) __________.

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A) invoice
B) age analysis
C) statement
D) superbill
E) collection letter.

377) Which of the following governs the methods that can be used to collect unpaid debts?

A) Truth in Lending Act

B) Fair Debt Collection Practices Act
C) Fair Credit Reporting Act
D) Telephone Consumer Protection Act
E) Equal Credit Opportunity Act

378) Which of the following also is called Public Law 95-109?

A) Fair Debt Collection Practices Act

B) Truth in Lending Act
C) Equal Credit Opportunity Act
D) Fair Credit Reporting Act
E) Telephone Consumer Protection Act

379) Which of the following requires credit bureaus to supply correct and complete
information to businesses for use in evaluating a person's application for credit, insurance, or a
job?

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A) Fair Debt Collection Practices Act

B) Truth in Lending Act
C) Equal Credit Opportunity Act
D) Fair Credit Reporting Act
E) Telephone Consumer Protection Act

380) Which of the following requires debt collectors to treat debtors fairly and without
collection tactics such as harassment, false statements, threats, and unfair practices?

A) Fair Debt Collection Practices Act

B) Truth in Lending Act
C) Equal Credit Opportunity Act
D) Fair Credit Reporting Act
E) Telephone Consumer Protection Act

381) Which of the following requires creditors to provide applicants with accurate and
complete credit costs and terms?

A) Fair Debt Collection Practices Act

B) Truth in Lending Act
C) Equal Credit Opportunity Act
D) Fair Credit Reporting Act
E) Telephone Consumer Protection Act

382) Which of the following prevents creditors from discriminating against applicants on the
basis of age, sex, race, religion, marital status, or income?

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A) Fair Debt Collection Practices Act

B) Truth in Lending Act
C) Equal Credit Opportunity Act
D) Fair Credit Reporting Act
E) Telephone Consumer Protection Act

383) Which of the following is a guideline for making a call requesting payment from a
patient?

A) Pose as a government official to convince the patient to pay.

B) Tell other people in the office about it and ask for suggestions.
C) Threaten to turn the account over to a collection agency, even if you do not plan to
do so.
D) Call the patient after 8 a.m. or before 9 p.m.
E) Refuse to talk to anyone except the patient, not even the patient's attorney.

384) Which of the following protects telephone subscribers from unwanted telephone
solicitations?

A) Fair Debt Collection Practices Act

B) Truth in Lending Act
C) Equal Credit Opportunity Act
D) Fair Credit Reporting Act
E) Telephone Consumer Protection Act

385) Which of the following should be a factor when you select an outside collection agency?

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A) Select an agency that will use harsh collection practices.

B) Choose an agency only after a patient fails to respond to the final collection letter or
has twice broken a promise to pay.
C) Encourage the agency to sue the patient.
D) Permit the agency to handle all cases, regardless of special considerations.
E) Continue to ask the patient for payment even though the collection agency is
working on the account.

386) An accounts receivable policy __________.

A) collects payments for a provider who has a large number of patients who do not pay
their bills
B) protects patients from being sued by the provider for failure to pay
C) decreases the provider's overall cash flow
D) ensures that the practice will have sufficient income to cover expected expenses
E) ensures that patients will have sufficient funds to pay for services

387) If a practitioner decides not to extend credit to a patient, what must be done according to
the Fair Credit Reporting Act?

A) Call the patient and tell him his bill must be paid in full immediately.
B) Inform the patient in writing why credit was denied.
C) Explain to the patient that you will be unable to extend credit.
D) Avoid discussing the issue of credit with the patient to avoid embarrassment.
E) Report the patient's lack of creditworthiness to the state's credit monitoring service.

388) A written agreement of the terms of payment between the patient and the practitioner is
a(n) __________.

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A) credit statement
B) disclosure statement
C) superbill
D) statement of account
E) accounts receivable statement

389) A payment arrangement in which the provider decides a patient will be billed every
month for the full amount owed and should make whatever payment is possible each month is
a(n) __________.

A) mutual agreement
B) written-contract agreement
C) open-book account
D) unilateral agreement
E) hardship agreement

390) A characteristic of a mutual agreement is that __________.

A) the patient is billed for payment in full monthly, but may make whatever payment is
possible
B) it is never regulated by the Truth in Lending Act
C) the provider and the patient agree on how much each month's payment will be
D) finance charges are always applied
E) it is generally set up by a collection agency

391) Criteria for hardship cases include patients who __________.

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A) refuse to pay the balance they owe

B) may be poor, underinsured, or elderly and on a limited income
C) have moved without leaving a forwarding address
D) have not received an invoice
E) receive professional courtesy from the medical office

392) An appropriate way to handle a patient relocation and address change is to __________.

A) stop trying to contact the patient after two unsuccessful tries

B) write off the charges as a hardship case
C) ask a third party for the patient's new address
D) turn the account over to a collection agency immediately
E) send a statement to the patient's relatives for payment

393) Which of the following information about a patient should a medical assistant provide to
the collection agency?

A) patient's income
B) date of the last payment or charge on the account
C) patient's educational level
D) impression of the patient's ability to pay
E) names of other providers the patient has seen

394) When is it appropriate for a medical provider to assess finance charges or late charges on
past-due accounts?

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A) when the provider feels it is necessary

B) after the patient has ignored two bills
C) only when the patient is notified in advance
D) after the patient has verbalized a lack of intent to pay
E) after the account has been sent to a collection agency

395) Which of the following states that creditors may not discriminate against an applicant
because he or she receives public assistance?

A) Equal Credit Opportunity Act

B) Fair Credit Reporting Act
C) Fair Debt Collection Practices Act
D) Truth in Lending Act
E) Telephone Consumer Protection Act

396) According to the Equal Credit Opportunity Act, how much will a practice have to pay if a
credit applicant joins and wins a class action lawsuit against the practice?

A) $100,000
B) $150,000
C) $250,000
D) 1/4% of the practice's net worth
E) up to $500,000 or 1% of the practice's net worth

397) Adrian is a patient whose parents were killed in a skiing accident a few months ago.
Adrian was involved in an automobile accident this morning. He refused ambulance transport
and a friend brought him to your office because he needed only minor wound care. He turned 21
last week, so he is legally an adult. He tells you he has no insurance and doesn't know how he
will pay for his care. Adrian might be a candidate for __________.

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A) Medicaid
B) Medicare
C) a hardship case
D) a collection agency
E) county assistance

398) When you ask Mrs. Redding how she would like to pay the $48 she owes for today's
services, she hands you a credit card. When you look at the card, you realize that the card
expired two months ago. Which of the following would be your best response to Mrs. Redding?

A) "I'm sorry, Mrs. Redding, but this card has expired. Do you have another card we
might use?"
B) "Mrs. Redding, I can't use this card because it expired two months ago."
C) "Why are you trying to pay us with an expired credit card?"
D) "Mrs. Redding, this card has expired; would you like me to bill you instead?"
E) "If I put the charge through on this expired card, the credit card company will be
furious."

399) Mrs. Patterson brings her 17-year-old daughter Kelly in for a prenatal exam. When you
inform Mrs. Patterson of the amount owed for today, she exclaims, "Oh, no! Kelly moved out
last week and is staying with the rascal that did this to her. She can pay for her own care!" What
should you do?

A) Explain to Mrs. Patterson that she is still responsible because her daughter is a
minor.
B) Ask for legal evidence that Kelly is an emancipated minor.
C) Require Kelly to pay the entire amount due.
D) Call Kelly's father to see if he will pay the bill.
E) Call Kelly's boyfriend and tell him that he is responsible for the bill.

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400) You are working at a walk-in outpatient clinic. A young woman who appears to be in her
20s comes in with a large cut on her left arm. When you ask for her insurance information, she
says, "I don't need insurance. My father runs this clinic. He'll treat me for free." What should you
do?

A) Require the woman to provide proof of insurance before being treated.

B) Write "professional courtesy" on the patient's chart.
C) Ask to see her identification to prove that she is the provider's daughter.
D) Send a statement for services to the provider's home address.
E) Check with the provider or office manager.

401) Which of the following accounts payable is typically the largest in a medical office?

A) payment for supplies and equipment

B) payroll
C) taxes owed to federal, state, and local agencies
D) licensing for physicians and staff
E) payment for practice-related products and services

402) Any payment the medical office makes for goods or services is called __________.

A) accounts receivable
B) a disbursement
C) a counter check
D) a limited check
E) a voucher check

403) One of the most common or numerous disbursements is payment for __________.

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A) equipment
B) rent
C) office supplies
D) utilities
E) dues

404) What are business checks with stubs attached called?

A) counter checks
B) voucher checks
C) limited checks
D) traveler's checks
E) certified checks

405) A type of check that states it is void after a certain time limit is a __________ check.

A) voucher
B) cashier's
C) counter
D) traveler's
E) limited

406) Which type of check is usually used for payroll in the medical office?

A) voucher
B) limited
C) counter
D) cashier's
E) traveler's

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407) Which type of check is purchased from a bank, written on the bank's own checking
account, and signed by a bank official?

A) certified
B) traveler's
C) cashier's
D) voucher
E) counter

408) A standard personal or business check that the bank verifies and then sets aside the funds
to guarantee payment is which type of check?

A) traveler's
B) voucher
C) limited
D) certified
E) counter

409) A special bank check that allows the depositor to withdraw funds from his or her account
only is called a __________ check.

A) counter
B) certified
C) voucher
D) traveler's
E) limited

410) Which of the following checks are preprinted and might be used by a practitioner to pay
for out-of-town conference expenses?

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A) counter
B) certified
C) voucher
D) traveler's
E) limited

411) A practitioner may use a __________ check when he wants to withdraw money from the
bank account but forgot his checkbook.

A) traveler's
B) voucher
C) limited
D) certified
E) counter

412) Which type of checks are preprinted in $10, $20, $50, and $100 denominations?

A) traveler's
B) voucher
C) limited
D) certified
E) counter

413) Which type of check would state "Pay to the Order of Myself Only"?

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A) traveler's
B) voucher
C) limited
D) certified
E) counter

414) Today, a practice's financial summary is generally prepared by __________.

A) the provider
B) a senior accountant
C) practice management software
D) the practice's auditors
E) an attorney

415) Which of the following demonstrates the practice’s profitability?

A) tracking
B) statement of income and expense
C) cash flow statement
D) quarterly return
E) trial balance

416) Which of the following shows how much revenue is available to cover expenses, to
invest, or to take as profit?

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A) statement of income and expense

B) trial balance
C) tracking
D) cash flow statement
E) quarterly return

417) A medical provider or practice manager may periodically review which of the following
reports to ensure accuracy of the books?

A) accounts receivable
B) trial balance
C) statement of income and expense
D) cash flow statement
E) quarterly return

418) Which of the following are usually components of a practice's accounting system?

A) employment contracts
B) daily log and disbursements journal
C) W-4 forms from all employees
D) a 401(k) plan
E) electronic health records

419) The process of communicating the income and expenses of a business and its financial
health is known as __________.

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A) bookkeeping
B) journalizing
C) accounting
D) reconciliation
E) endorsement

420) The part of the accounting process that consists of the systematic recording of business
transactions is __________.

A) reconciliation
B) vouching
C) endorsement
D) bookkeeping
E) journalizing

421) Which of the following is not an advantage of using a computerized bookkeeping

system?

A) Built-in tax tables calculate tax liabilities.

B) The computer performs repetitive tasks.
C) The computer performs mathematical calculations.
D) The bookkeeping system is available even if the power goes out.
E) The computer produces reports automatically.

422) Another term for a write-it-once system is __________ system.

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A) voucher
B) electronic
C) journalizing
D) third-party
E) pegboard

423) A double-entry bookkeeping system is based on the principle that the company's assets
are equal to __________.

A) capital minus its liabilities

B) liabilities minus its capital
C) assets plus its liabilities
D) assets minus its liabilities
E) capital plus its liabilities

424) The process of recording services provided, the fees charged, and payments received in a
daily log is known as __________.

A) journalizing
B) endorsement
C) vouching
D) balancing
E) reconciling

425) At the beginning of each day, if you are using a pegboard system, what is the first thing
you should put on the pegboard?

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A) superbill
B) checks
C) daily log sheet
D) receipts
E) patient ledger cards

426) When you place a patient's ledger card on the pegboard, how should you position the
card?

A) Align the ledger card's first blank line with the carbon strip under the next available
superbill.
B) Align the top of the ledger card with the top of the daily log.
C) Align the bottom of the ledger card with the carbon strip under the next available
superbill.
D) Align the top of the next available superbill with the top of the ledger card.
E) Align the right side of the ledger card with the right side of the superbill.

427) If you receive payment from a patient by mail after the office visit, you should record it
__________.

A) on the daily log for the day of the patient's visit

B) on the patient's ledger card and the current day's daily log
C) directly onto the superbill
D) in the adjustment column
E) on the patient's ledger card only

428) When a patient has a credit balance, __________.

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A) the account should be sent to a collection agency

B) a statement should be sent asking the patient to submit the balance
C) the practice can deduct the amount from the patient's account
D) the patient can be allowed to pay it at the next office visit
E) the practice owes the patient money

429) When the office manager or practitioner decides that an account is uncollectable, he or
she will __________.

A) send the account to a collection agency

B) send the account to the state regulator's office
C) send one last notice to the patient to pay the amount due
D) adjust the amount due off the account
E) ask the patient to come to the office to discuss options

430) The part of a check that takes the form of a fraction and identifies the specific bank on
which a check is drawn is the __________.

A) memo line
B) routing number
C) ABA number
D) check number
E) MICR recording area

431) Which of the following is not a common type of endorsement?

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A) restrictive endorsement
B) qualified endorsement
C) blank endorsement
D) mechanical endorsement
E) special endorsement

432) An endorsement that consists simply of the payee's signature is a __________.

A) restrictive endorsement
B) qualified endorsement
C) blank endorsement
D) mechanical endorsement
E) special endorsement

433) A third-party endorsement also is known as a __________.

A) restrictive endorsement
B) qualified endorsement
C) blank endorsement
D) mechanical endorsement
E) special endorsement

434) An endorsement that specifies precisely how the check may be redeemed, such as only
for deposit in the practice's bank account, is a __________.

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A) restrictive endorsement
B) qualified endorsement
C) blank endorsement
D) mechanical endorsement
E) special endorsement

435) A type of endorsement often used by attorneys when they accept a check on behalf of a
client but have no personal claim on the transaction is __________.

A) restrictive endorsement
B) qualified endorsement
C) blank endorsement
D) mechanical endorsement
E) special endorsement

436) Charise was seen today for an ongoing infection. When she comes to the counter to check
out, you tell her that the charge for today is $54. Charise takes her $260 paycheck out of her
pocket and endorses it "Pay to the order of BWW Medical Associates," signs it "Charise
Williams," and hands it to you. What should you do?

A) Explain that office policy does not allow you to take third-party checks
B) Accept and record the check and give Charise $206 in change
C) Accept and record the check, but tell Charise that you cannot give her any change
D) Ask Charise to wait while you call her employer to confirm that the check is good
E) Tell Charise that she must pay cash for her visit

437) Jim Sanderson comes to the office today to pay the balance due on his statement. He
presents the statement, showing an amount due of $96.75, and a money order for $96.75. How
should this payment be handled?

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A) Explain that office policy allows you to accept only cash, check, or credit card.
B) Accept the money order and record it on the daily log and the patient's ledger card.
C) Complete the stub attached to the check and return the stub to Mr. Sanderson.
D) Ask Mr. Sanderson for a photo ID to prove that he purchased the money order.
E) Ask Mr. Sanderson to wait while you verify that the money order is valid.

438) The process of comparing the office financial records with the monthly statement from
the bank is known as __________.

A) journalizing
B) reconciliation
C) endorsement
D) vouching
E) certifying

439) You are reconciling the office checking account with the bank statement that arrived this
morning. After accounting for unrecorded deposits, checks, and debits, you find that the total in
your practice records is $11,760 and the bank's total is $12,160. What is the first thing you
should do?

A) Adjust the practice records to match the bank's total.

B) Call the bank and inform them of the error on the statement.
C) Review each item on the statement against your records to find the $400 difference.
D) Inform the provider that the books do not balance this month.
E) Ask the office manager to call the auditor to review the books.

440) Which of the following statements is true about electronic banking?

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A) The computer computes the new balance each time you record a check.
B) You will no longer be responsible for recording and depositing checks.
C) The computer used for banking must be locked up at the end of the day.
D) You must still reconcile the bank statement on paper.
E) Cash flow in the office becomes slower and more difficult.

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Answer Key

Test name: CH-16-20 Test Bank

1) efficient
2) matrix
3) legal
4) open-hours
5) stream
6) wave
7) cluster
8) advance
9) computerized
10) reminders
11) walk-in
12) no-show
13) overbooking
14) itinerary
15) agenda
16) minutes
17) locum tenens
18) online
19) release
20) pre-procedure
21) walk-in
22) preferences
23) matrix
24) A
25) C
26) E

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27) D
28) C
29) B
30) D
31) B
32) C
33) D
34) B
35) A
36) B
37) D
38) E
39) B
40) C
41) A
42) C
43) C
44) C
45) A
46) C
47) A
48) C
49) C
50) D
51) B
52) D
53) B
54) D
55) B
56) B

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57) D
58) D
59) C
60) B
61) C
62) C
63) E
64) E
65) C
66) D
67) A
68) C
69) B
70) A
71) A
72) B
73) B
74) A
75) A
76) B
77) C
78) B
79) B
80) B
81) exclusions
82) coinsurance
83) third-party
84) formulary
85) premium
86) benefits

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87) deductible
88) copayment
89) allowable
90) capitation
91) assignment
92) balance
93) clearinghouse
94) coordination
95) Medigap
96) elective
97) interchange
98) remittance
99) referrals
100) fee-for-service (or indemnity)
101) Medicare
102) HIPAA
103) compensation
104) children
105) direct
106) clean
107) register
108) necessity
109) PCMH
110) precertification
111) B
112) C
113) C
114) B
115) B
116) E

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117) A
118) C
119) C
120) D
121) C
122) B
123) D
124) A
125) A
126) B
127) C
128) E
129) A
130) D
131) C
132) C
133) D
134) B
135) A
136) E
137) C
138) B
139) C
140) D
141) C
142) D
143) C
144) B
145) B
146) E

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147) C
148) C
149) B
150) A
151) D
152) C
153) A
154) D
155) B
156) C
157) A
158) B
159) D
160) E
161) Alphabetic
162) rubrics
163) conventions
164) cross-reference
165) diagnosis
166) Tabular
167) morbidity
168) chief
169) subcategory
170) principal
171) DRGs
172) alphabetic
173) combination
174) malignant
175) etiology
176) diagnosis

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177) Classification
178) mortality
179) subterms
180) symptoms
181) secondary
182) specificity
183) A
184) B
185) C
186) D
187) B
188) D
189) B
190) D
191) B
192) C
193) C
194) B
195) A
196) C
197) C
198) E
199) A
200) E
201) D
202) E
203) D
204) C
205) E
206) D

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207) A
208) D
209) E
210) C
211) A
212) B
213) D
214) E
215) C
216) C
217) C
218) A
219) C
220) C
221) D
222) C
223) D
224) A
225) add-on
226) compliance
227) procedures
228) E/M
229) established
230) global
231) modifier
232) new
233) CPT
234) examination
235) complexity
236) history

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237) Level I
238) II
239) national
240) HCPCS
241) procedure
242) concurrent
243) upcoding
244) critical
245) bundled
246) downcoding
247) constitutional
248) established
249) HCPCS
250) A
251) B
252) C
253) D
254) C
255) D
256) D
257) E
258) D
259) C
260) D
261) C
262) B
263) B
264) E
265) B
266) C

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267) D
268) D
269) B
270) C
271) E
272) B
273) C
274) D
275) A
276) D
277) A
278) B
279) E
280) C
281) A
282) A
283) D
284) C
285) A
286) D
287) B
288) B
289) E
290) C
291) C
292) B
293) A
294) C
295) A
296) D

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297) B
298) D
299) payable
300) receivable
301) age analysis
302) credit
303) bureau
304) cycle
305) disclosure
306) open-book
307) single-entry
308) statements
309) limitations
310) superbill
311) written-contract
312) hardship
313) skip
314) debit
315) mutual
316) copayments
317) stamp
318) guarantor
319) independent
320) telemarketing
321) credit
322) profit-and-loss
323) ABA number
324) assets
325) accounting
326) cash flow

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327) cashier's
328) certified
329) endorse
330) journalizing
331) limited
332) money order
333) negotiable
334) ledger
335) payee
336) payer
337) pegboard
338) power of attorney
339) reconciliation
340) third-party
341) Tracking
342) traveler's
343) voucher
344) bookkeeping
345) accuracy
346) liabilities
347) capital
348) liability
349) adjustment
350) electronic
351) profit
352) loss
353) D
354) B
355) B
356) B

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357) C
358) A
359) D
360) D
361) B
362) A
363) C
364) B
365) B
366) B
367) C
368) B
369) D
370) E
371) B
372) C
373) E
374) D
375) C
376) B
377) B
378) A
379) D
380) A
381) B
382) C
383) D
384) E
385) B
386) D

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387) B
388) B
389) D
390) C
391) B
392) C
393) B
394) C
395) A
396) E
397) C
398) A
399) B
400) E
401) B
402) B
403) C
404) B
405) E
406) B
407) C
408) D
409) A
410) D
411) E
412) A
413) E
414) C
415) B
416) D

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417) B
418) B
419) C
420) D
421) D
422) E
423) E
424) A
425) C
426) A
427) B
428) E
429) D
430) C
431) D
432) C
433) E
434) A
435) B
436) A
437) B
438) B
439) C
440) A

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