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Fordney’s Medical Insurance Test Bank (17th Ed): 600+ Q&A on HIPAA, Medicare, Coding & Revenue Cycle Management

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Master the complexities of medical insurance billing and revenue cycle management with this comprehensive test bank for Fordney’s Medical Insurance, 17th Edition. Designed for students, instructors, and professionals preparing for certification exams (such as the CMRS or CPC), this resource provides a robust collection of over 600 practice questions that mirror real-world scenarios and official curriculum standards. This test bank covers every critical domain of the field, including: Foundations of Insurance Billing: Professional vs. facility billing, ethics, medical etiquette, and legal doctrines like respondeat superior. HIPAA Compliance: Privacy Rule, Security Rule, Protected Health Information (PHI), covered entities, and breach notification. Fraud & Abuse: Key legislation (False Claims Act, Stark Law), auditing, monitoring, upcoding, and DRG creep. Public Health Programs: Detailed breakdowns of Medicare (Parts A, B, C, D, MBI numbers, RBRVS, PPS), Medicaid (MSP, CHIP, EPSDT), TRICARE (Prime, Select, DEERS), and Workers’ Compensation. Private & Managed Care: HMOs, PPOs, capitation, fee-for-service, and coordination of benefits (COB). Diagnostic & Procedural Coding: ICD-10-CM conventions, CPT guidelines (E/M codes, modifiers, global packages), and HCPCS Level II. Claims Processing: CMS-1500 form completion, electronic claims (EDI, 837P), clearinghouses, and appeals (redetermination, QIC, ALJ). Revenue Cycle & Collections: Accounts receivable (A/R), aging reports, payment posting, compliance plans, and collection strategies (FDCPA). Each question includes the correct answer, difficulty level, and learning objective reference, making it an ideal tool for exam prep, study groups, or self-assessment.

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Institution
Fordney’s Medical Insurance
Course
Fordney’s Medical Insurance

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, Chapter 01: Role of an Insurance Billing Specialist

MULTIPLE CHOICE

1. The primary goal of an insurance billing specialist is:

a. to manage the health care organization’s billing office

b. to ensure the cash flow of a health care organization through revenue cycle management

c. to send bills to patients for services they receive

d. to post payments received from patients and insurance carriers

CORRECT ANSWER: B DIF: Moderate OBJ: 2



2. Facility billing includes charging for medical services provided by:

a. physicians

b. laboratory services

c. ambulance services

d. ambulatory surgical centers

CORRECT ANSWER: D DIF: Easy OBJ: 2



3. A claims assistance professional

a. works for the consumer.

b. works for the health care organization.

c. works for an insurance company.

d. works for the federal government.

CORRECT ANSWER: A DIF: Easy OBJ: 2



4. What is ―cash flow‖ in a medical practice?

a. The actual money available to a medical practice

b. The amount of money received by a medical practice in 1 day

,c. The amount of money received by a medical practice in 1 month

d. The amount of outstanding money on the accounts receivable

CORRECT ANSWER: A DIF: Moderate OBJ: 2



5. Which level of education is generally required for one who seeks employment as an insurance coder?

a. College diploma

b. High school diploma

c. Completion of an accredited program for coding certification

d. No specific level of education is required

CORRECT ANSWER: C DIF: Easy OBJ: 4



6. The amount of money an insurance billing specialist earns is dependent on which of the following
factors?

a. Knowledge

b. Experience

c. Size of employing institution

d. All are correct

CORRECT ANSWER: D DIF: Moderate OBJ: 5



7. A self-employed medical insurance biller who does independent contracting is responsible for

a. advertising.

b. billing.

c. accounting.

d. All are correct.

CORRECT ANSWER: D DIF: Hard OBJ: 2

, 8. Medical etiquette refers to

a. consideration for others.

b. moral principles or practices.

c. laws.

d. the Oath of Hippocrates.

CORRECT ANSWER: A DIF: Moderate OBJ: 9



9. The process of shortening words and using abbreviations that do not follow standard grammar, spelling
and punctuation when writing electronic mail communications is referred to as:

a. emoticons

b. abbreviations

c. text speak

d. short text

CORRECT ANSWER: C DIF: Easy OBJ: 9



10. Professional ethics include

a. state laws.

b. federal laws.

c. standards of conduct.

d. civil torts.

CORRECT ANSWER: C DIF: Moderate OBJ: 9



11. The earliest written code of ethical principles for the medical profession is the

a. Oath of Hippocrates.

b. Socratic oath.

c. Code of Hammurabi.

d. Medicolegal oath.

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Institution
Fordney’s Medical Insurance
Course
Fordney’s Medical Insurance

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