MEDCERTS: MCBC KNOWLEDGE REVIEW
ASSESSMENT
What regulation addresses outpatient billing for nonphysician providers? - Answer -
Incident-to billing
What is entered in Block 1 on the CMS-1500 claim form? - Answer -Type of insurance
What is the full title of the HCPCS manual? - Answer -Healthcare Common Procedure
Coding System
ICD-10-CM coding compliance includes accurate transformation of __________ into
numbers - Answer -Diagnoses
Where might an insurance specialist find Medicare's rules and regulations published? -
Answer -Federal Register
Which methods are most commonly used first by a practice to attempt to get a patient's
payment on overdue accounts? - Answer -Letters and calls
Which is a patient bill that includes dates of service, services provided, charges, and
what the patient owes to the practice? - Answer -Statement
Medicare uses the Medicare Physician Fee Schedule (MPFS) based on which of the
following? - Answer -RBRVS
The Resource-Based Relative Value Scale (RBRVS) is a system used to determine
reimbursement rates for medical services in the United States. It considers factors such
as physician work, practice expenses, and malpractice expenses to assign a relative
value to each service.
What does the suffix "-rrhea" mean? - Answer -Flow
Which are paper-based claim guidelines for outpatient billing? - Answer -All of the
above - Use original red form, Use CMS-1500, Print in black ink
CPT codes are assigned to procedures provided to patients. What is a cholecystectomy
procedure? - Answer -Removal of gallbladder
Which HIPAA provision requires access to healthcare portability and renewability? -
Answer -Title I
Which is a medical decision making complexity level used in CPT coding? - Answer -All
of the above - Low, Moderate, High
, For privacy, what is the recommendation if there is a window in the reception area? -
Answer -Keep it closed
A patient is diagnosed with pneumothorax, which is a(n) __________. - Answer -
Collapsed lung
When a patient describes the development of an illness from its onset and symptoms
when seen by a physician, which is being documented? - Answer -History of present
illness (HPI)
Which reimbursement payment method is based on a group of physicians within a
geographic area? - Answer -(UCR): Usual, Customary, and Reasonable: represents
the typical or average cost for a particular service or product in a specific geographic
area.
What type of letter is sent to a patient if the physician chooses to no longer care for the
patient? - Answer -Dismissal
What task is being performed by the insurance specialist using an insurance aging
report for claims more than 30 days old? - Answer -Follow up
Which type of managed care plan has the least flexibility? - Answer -HMO: Health
Maintenance Organization
-Require a PCP
-Need a referral to see a specialist
-No non-out-of-network benefits
-No non-out-of-network coverage
What may accompany a remittance advice? - Answer -Payment
If a claim is rejected, which could be a reason? - Answer -All of the above - Submitted
after time limit, Incorrect patient information, Incorrect code linkage
Which type of audit is conducted after receiving the remittance advice? - Answer -
Retrospective
Which federal provision provides incentives for electronic health records utilization? -
Answer -Meaningful use
If the physician-patient relationship is terminated due to nonpayment of an account,
what must be sent? - Answer -Dismissal letter
Which criteria is required for Medicare eligibility? - Answer -All of the above - Age 65
and older, Disabled, End-stage kidney disease
ASSESSMENT
What regulation addresses outpatient billing for nonphysician providers? - Answer -
Incident-to billing
What is entered in Block 1 on the CMS-1500 claim form? - Answer -Type of insurance
What is the full title of the HCPCS manual? - Answer -Healthcare Common Procedure
Coding System
ICD-10-CM coding compliance includes accurate transformation of __________ into
numbers - Answer -Diagnoses
Where might an insurance specialist find Medicare's rules and regulations published? -
Answer -Federal Register
Which methods are most commonly used first by a practice to attempt to get a patient's
payment on overdue accounts? - Answer -Letters and calls
Which is a patient bill that includes dates of service, services provided, charges, and
what the patient owes to the practice? - Answer -Statement
Medicare uses the Medicare Physician Fee Schedule (MPFS) based on which of the
following? - Answer -RBRVS
The Resource-Based Relative Value Scale (RBRVS) is a system used to determine
reimbursement rates for medical services in the United States. It considers factors such
as physician work, practice expenses, and malpractice expenses to assign a relative
value to each service.
What does the suffix "-rrhea" mean? - Answer -Flow
Which are paper-based claim guidelines for outpatient billing? - Answer -All of the
above - Use original red form, Use CMS-1500, Print in black ink
CPT codes are assigned to procedures provided to patients. What is a cholecystectomy
procedure? - Answer -Removal of gallbladder
Which HIPAA provision requires access to healthcare portability and renewability? -
Answer -Title I
Which is a medical decision making complexity level used in CPT coding? - Answer -All
of the above - Low, Moderate, High
, For privacy, what is the recommendation if there is a window in the reception area? -
Answer -Keep it closed
A patient is diagnosed with pneumothorax, which is a(n) __________. - Answer -
Collapsed lung
When a patient describes the development of an illness from its onset and symptoms
when seen by a physician, which is being documented? - Answer -History of present
illness (HPI)
Which reimbursement payment method is based on a group of physicians within a
geographic area? - Answer -(UCR): Usual, Customary, and Reasonable: represents
the typical or average cost for a particular service or product in a specific geographic
area.
What type of letter is sent to a patient if the physician chooses to no longer care for the
patient? - Answer -Dismissal
What task is being performed by the insurance specialist using an insurance aging
report for claims more than 30 days old? - Answer -Follow up
Which type of managed care plan has the least flexibility? - Answer -HMO: Health
Maintenance Organization
-Require a PCP
-Need a referral to see a specialist
-No non-out-of-network benefits
-No non-out-of-network coverage
What may accompany a remittance advice? - Answer -Payment
If a claim is rejected, which could be a reason? - Answer -All of the above - Submitted
after time limit, Incorrect patient information, Incorrect code linkage
Which type of audit is conducted after receiving the remittance advice? - Answer -
Retrospective
Which federal provision provides incentives for electronic health records utilization? -
Answer -Meaningful use
If the physician-patient relationship is terminated due to nonpayment of an account,
what must be sent? - Answer -Dismissal letter
Which criteria is required for Medicare eligibility? - Answer -All of the above - Age 65
and older, Disabled, End-stage kidney disease
