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Medical Billing Certification Test Answers (new)

Here you will find most recent Upwork Test questions with updated answers of Medical Billing Certification Test for Upwork Medical Transcription and Medical Billing category.

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1. What are modifiers?

 Answers: • They are an indicator to show that a procedure is linked to more than one diagnosis

 2. Electronic Medical Claims (EMC) help to ___________.
 Answers: • All of the above

 3. The 'Group' in the 'Group Health Insurance Card' refers to the _________.
 Answers: • employer

 4. CPT Codes are updated ________.
 Answers: • once every 2 years

 5. What does the UB-04 form include?
 Answers: • National Provider Identifier

 6. What is contained in the release of information (ROI) form?
 Answers: • The details of the information being transmitted

 7. What is not a part of the diagnosis information?
 Answers: • Macro Code

 8. Which of the following are required to organize your office as a medical biller?
 Answers: • All of the above

 9. Which of the following is not a part of Patient Condition Information?
 Answers: • Name and UPIN of the physician that was referred

 10. What is a benefit?
 Answers: • It is what a feature does for a product

 11. Which of the following aspects does administrative safeguards focus on?
 Answers: • All of the above

 12. It is necessary to attach a document called _________ when submitting a secondary claim.
 Answers: • Explanation of Benefits

 13. If the patient deductible is $600, and the deductible met is $400, the coverage is 60/40 and the physician's charge is $95, how much should the patient pay?
 Answers: • $240

 14. Which of the following is not a feature of Managed Care Plans?
 Answers: • Eradicating unwanted services

 15. Why was the accountability component added to HIPAA?
 Answers: • To prevent health care fraud and abuse

 16. Why were security standards created in HIPAA?
 Answers: • To provide easy accessibility to electronically transmitted health information to all users

 17. What is a deductible?
 Answers: • The amount of out-of-pocket expenses that the insured/patient will have to incur in order for the policy to begin to pay at 100%

 18. What are the main benefits of electronic claims?
 Answers: • They provide a quicker means of reimbursement

 19. What is a covered entity?
 Answers: • The healthcare providers which are linked to PPOs

 20. Which date format is used on the CMS 1500 Form?
 Answers: • mm/dd/ccyy

 21. Which of the following is the first phase of the insurance claim life cycle?
 Answers: • Collecting claim data

 22. Which of these is not a kind of third-party reimbursement?
 Answers: • Managed care plans

 23. What is an accident rider?
 Answers: • A 100% coverage that is not subject to co-payment or deductible in the event that the patient seeks emergency treatment

 24. What does the bottom of the CMS 1500 Form report?
 Answers: • All of the above

 25. Which of the following information is needed to complete the CMS 1500 form?
 Answers: • All of the above

 26. Identify the order of events after a claim reaches the insurance carrier:
 1.Application of leftover deductible
 2.Examining the procedures performed and the 'medical necessity' on these procedures
 3.Application of 'allowable payments options' for every procedure performed
 4.Review of the claim for proper formatting and information
 Answers: • 3214

 27. What is the length of the standard CPT codes?
 Answers: • 7

 28. What is the need for insurance verification?
 Answers: • To determine the accuracy of the patient information and the insurance card

 29. What is not one of the eligibility criteria for Medicare?
 Answers: • You should have retired on Social Security, Railroad Retirement, or federal government retirement programs

 30. Which of the following does the acronym HIPAA stand for?
 Answers: • Health Insurance Portability and Accountability Act of 1996

 31. How is the patient identified in case of Champva?
 Answers: • SSN

 32. What is needed to file Worker's Compensation and Auto Insurance Claims?
 Answers: • Claim Number

 33. Which are the disclosures exempted from minimum necessary?
 Answers: • Disclosure of de-identified information

 34. Which of these is not one of the co-operating parties which maintains and upgrades ICD-9-CM codes?
 Answers: • HCFA

 35. The component 'National Identifier Standards' fall under which of the following components of HIPAA?
 Answers: • Accountability

 36. In which of the following methods will you bill your clients for giving your services as a medical biller?
 Answers: • By billing on a percentage of the claims submitted

 37. What do the CPT codes refer to?
 Answers: • The procedures performed by a physician or a practitioner

 38. Which is a more efficient and less time consuming method to submit your claims?
 Answers: • All of the above

 39. Fill up the blank:

 National Provider Identifier is a _____ digit number.
 Answers: • 10

 40. What is the way to determine the primary and secondary policy if a child is covered under both parent's policies?
 Answers: • Application of the "insurance rule"

 41. What is a write off?
 Answers: • It is the denial of a claim

 42. Which of the following correctly defines the Encounter Document?
 Answers: • It is a form consisting of patient demographics, patient condition and guarantor information

 43. Which of these is not a type of insurance coverage?
 Answers: • Group Health/Medical Insurance

 44. What things should you emphasize on while selecting an attorney when starting your own medical billing business?
 Answers: • He should be able to develop a Compliance Plan in accordance with HIPAA protocols

 45. If the patient deductible is $700, and the deductible met is $685, the coverage is 80/20 and the physician's charge is $75, how much should the patient pay?
 Answers: • $15

 46. Which of the following is not necessarily a function performed by a medical biller?
 Answers: • Abstracting and coding of services rendered from a patient's medical records

 47. What is the role of a clearing house while submitting claims electronically?
 Answers: • A clearing house performs an initial computerized review of the claim submitted and sends the claim to the insurance carrier

 48. Which body is responsible for implementing the Privacy Rules
 Answers: • The American Medical Association

 49. Which of these does not cover preventive care services?
 Answers: • PPOs

 50. Why was HIPAA enacted into a law?
 Answers: • To ensure that individuals moving from one health plan to another does not get covered under the conditions of the already existing plan

 51. Who among the following can also be a guarantor?
 Answers: • The physician

 52. Which of the following is not a coding convention?
 Answers: • Connecting Words

 53. _____is an agreement made between the insurance company and the insured to send payments directly to the physician.
 Answers: • Coordination of Benefits

 54. What is the full form of AIDA?
 Answers: • Attention, Interest, Desire And Action

 55. Which of these is not a suitable marketing strategy for medical billing business?
 Answers: • Door-to-door marketing

 56. State whether true or false:

 HIPAA provides protections for both Group Health Plans and Individual Coverage.
 Answers: • True

 57. Which of the following components of HIPAA have been put into effect?
 Answers: • Portability and Accountability

 58. State whether true or false:

 Ideal practice management software should have good reporting and multi-tasking capabilities.
 Answers: • True

 59. In which box are the CPT codes entered on the CMS-1500 Form?
 Answers: • Box 24A

 60. Which of the following is the code for anesthesia (type of service code)?
 Answers: • 99