Medical Office Concepts Final Exam
Review Questions with Complete
Solutions
Breach - ✔✔Which term refers to the acquisition, access, use or disclosure
of unsecured PHI in a manner not permitted under the HIPAA Privacy Rule,
thus compromising the security or privacy of the PHI
X-12 837 Health Care Claim - ✔✔Most physician practices are required to
use this HIPAA-standard electronic claim format called
ICD - ✔✔Which of the following refers to diagnostic codes
ERA - ✔✔An electronic document that lists patients, dates of service,
charges, and the amount paid or denied by the insurance carrier is the
at either check-in or check-out - ✔✔When are copayments routinely
collected
business associate - ✔✔An individual or entitiy that creates, receives,
maintains, or transmits PHI on behalf of a covered entity and may also
include subcontractors of an entity is known as
1
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
, accountable care organization - ✔✔A network of doctors and hospitals that
shares responsibility for managing the quality and cost of care provided to
a group of patients is known as
audit - ✔✔A formal examination or review undertaken to determine whether
a healthcare organization's staff members comply with regulations is known
as an
diagnosis code - ✔✔The patient's primary complaint (the illness or
condition that is the reason for the visit)
codes on payment transactions match the claim, payment listed for each
procedure is expected, any unpaid charges explained - ✔✔Each remittance
advice is compared against the claim to check that
individuals, secretary of health and human services, and the media - ✔✔If
a breach of unsecured health information affects more than 500 individuals,
HIPAA breach notification rule requires covered entities and their business
associates to notify
fee schedule - ✔✔A_________is a listing of standard charges for
procedures and the amount the provider bills for the provided services.
adjudication - ✔✔What is a series of steps designed to determine whether
a claim should be paid
2
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
Review Questions with Complete
Solutions
Breach - ✔✔Which term refers to the acquisition, access, use or disclosure
of unsecured PHI in a manner not permitted under the HIPAA Privacy Rule,
thus compromising the security or privacy of the PHI
X-12 837 Health Care Claim - ✔✔Most physician practices are required to
use this HIPAA-standard electronic claim format called
ICD - ✔✔Which of the following refers to diagnostic codes
ERA - ✔✔An electronic document that lists patients, dates of service,
charges, and the amount paid or denied by the insurance carrier is the
at either check-in or check-out - ✔✔When are copayments routinely
collected
business associate - ✔✔An individual or entitiy that creates, receives,
maintains, or transmits PHI on behalf of a covered entity and may also
include subcontractors of an entity is known as
1
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
, accountable care organization - ✔✔A network of doctors and hospitals that
shares responsibility for managing the quality and cost of care provided to
a group of patients is known as
audit - ✔✔A formal examination or review undertaken to determine whether
a healthcare organization's staff members comply with regulations is known
as an
diagnosis code - ✔✔The patient's primary complaint (the illness or
condition that is the reason for the visit)
codes on payment transactions match the claim, payment listed for each
procedure is expected, any unpaid charges explained - ✔✔Each remittance
advice is compared against the claim to check that
individuals, secretary of health and human services, and the media - ✔✔If
a breach of unsecured health information affects more than 500 individuals,
HIPAA breach notification rule requires covered entities and their business
associates to notify
fee schedule - ✔✔A_________is a listing of standard charges for
procedures and the amount the provider bills for the provided services.
adjudication - ✔✔What is a series of steps designed to determine whether
a claim should be paid
2
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
