Fordney's Medical Insurance and Billing
by Linda M. Smith CPC CPC-1 CEMC CMBS (Editor)
16th Edition
,TABLE OF CONTENTS
UNIT 1 Career Role and Responsibilities
1. Role of an Insurance Billing Specialist
2. Privacy, Security, and HIPAA
3. Compliance, Fraud, and Abuse
UNIT 2 Introduction to Health Insurance
4. Basics of Health Insurance
5. The Blue Plans, Private Insurance, and Managed Care Plans
6. Medicare
7. Medicaid and Other State Programs
8. TRICARE and Veterans’ Health Care
9. Workers’ Compensation
10. Disability Income Insurance and Disability Benefit Programs
UNIT 3 Documentation and Coding for Professional Services
11. Medical Documentation and the Electronic Health Record
12. Diagnostic Coding
13. Procedural Coding
UNIT 4 Claims Submission in the Medical Office
14. The Paper Claim CMS-1500
15. The Electronic Claim
UNIT 5 The Claim Follow-Up and Payment Process
16. Receiving Payments and Insurance Problem Solving
17. Collection Strategies
,UNIT 6 Health Care Facility Billing
18. Introduction to Health Care Facilities and Ambulatory Surgery Centers
19. Billing for Health Care Facilities
UNIT 7 Employment
20. Seeking a Job and Attaining Professional Advancement
, Test Bank: Fordney's Medical Insurance and Billing
16th Edition by Linda M. Smith
CHAPTER 1: ROLE OF THE INSURANCE BILLING SPECIALIST
Multiple Choice Questions
1. The primary role of the insurance billing specialist is to:
A) Diagnose patient illnesses
B) Submit accurate claims and ensure timely reimbursement
C) Perform clinical procedures
D) Manage the physician's personal finances
Answer: B
Rationale: The insurance billing specialist is responsible for accurately submitting claims and following
up to ensure proper reimbursement for services rendered.
2. Which of the following is NOT a typical duty of an insurance billing specialist?
A) Verifying patient insurance eligibility
B) Posting payments to patient accounts
C) Prescribing medications
D) Appealing denied claims
Answer: C
Rationale: Prescribing medications is a clinical function performed by licensed healthcare providers, not
administrative billing staff.
3. The insurance billing specialist must have knowledge of which of the following?
by Linda M. Smith CPC CPC-1 CEMC CMBS (Editor)
16th Edition
,TABLE OF CONTENTS
UNIT 1 Career Role and Responsibilities
1. Role of an Insurance Billing Specialist
2. Privacy, Security, and HIPAA
3. Compliance, Fraud, and Abuse
UNIT 2 Introduction to Health Insurance
4. Basics of Health Insurance
5. The Blue Plans, Private Insurance, and Managed Care Plans
6. Medicare
7. Medicaid and Other State Programs
8. TRICARE and Veterans’ Health Care
9. Workers’ Compensation
10. Disability Income Insurance and Disability Benefit Programs
UNIT 3 Documentation and Coding for Professional Services
11. Medical Documentation and the Electronic Health Record
12. Diagnostic Coding
13. Procedural Coding
UNIT 4 Claims Submission in the Medical Office
14. The Paper Claim CMS-1500
15. The Electronic Claim
UNIT 5 The Claim Follow-Up and Payment Process
16. Receiving Payments and Insurance Problem Solving
17. Collection Strategies
,UNIT 6 Health Care Facility Billing
18. Introduction to Health Care Facilities and Ambulatory Surgery Centers
19. Billing for Health Care Facilities
UNIT 7 Employment
20. Seeking a Job and Attaining Professional Advancement
, Test Bank: Fordney's Medical Insurance and Billing
16th Edition by Linda M. Smith
CHAPTER 1: ROLE OF THE INSURANCE BILLING SPECIALIST
Multiple Choice Questions
1. The primary role of the insurance billing specialist is to:
A) Diagnose patient illnesses
B) Submit accurate claims and ensure timely reimbursement
C) Perform clinical procedures
D) Manage the physician's personal finances
Answer: B
Rationale: The insurance billing specialist is responsible for accurately submitting claims and following
up to ensure proper reimbursement for services rendered.
2. Which of the following is NOT a typical duty of an insurance billing specialist?
A) Verifying patient insurance eligibility
B) Posting payments to patient accounts
C) Prescribing medications
D) Appealing denied claims
Answer: C
Rationale: Prescribing medications is a clinical function performed by licensed healthcare providers, not
administrative billing staff.
3. The insurance billing specialist must have knowledge of which of the following?
