AMCA BILLING & CODING TEST
What type of insurance allows treatment virtually anywhere with a high deductible that policy holders
are willing to pay?
a. COBRA
b. EPO
c. PPO
d. HMO - ANSWER-C
Veterans with service related disabilities are eligible for case under which of the following programs:
a. CHAMPUS
b. Medicare
c. CHAMPVA
d. TRICARE - ANSWER-C
_______________________ is usually sponsored and partially paid by an employer.
a. TRICARE
b. Private Insurance
c. Group Health Insurance
d. Worker's Aide - ANSWER-C
______________________ are used to report encounters for circumstances other than a disease or
injury in the ICD-10-CM.
a. A codes
b. V codes
c. Z codes
d. E codes - ANSWER-D
The abbreviation PMPM stands for:
a. Per member per month
b. Provider membership per management
c. Provider management provider manual
d. Pre menstrual after midnight - ANSWER-A
Schedule of benefits means:
a. Coordination of benefits
b. HMO
c. Medical service covered under the insured's policy
d. Managed care organization - ANSWER-C
Medicare is funded by:
a. State Funds
b. Federal Funds
c. Employers
d. The patient - ANSWER-B
Physicians establish a list of their usual fees for:
a. The charges they have written off
b. The procedures and services they frequently perform
c. Workers' Compensation patients
d. Their Medicare patients - ANSWER-B
The insurance carrier is allowed to use nay method to determine the amount for a service, also known
as the:
a. Allowed amount
, b. Fee schedule
c. Deductible
d. Insurance premium - ANSWER-B
Which of the following statements is true under the doctrine of respondeat superior?
a. The billing and coding specialist is superior to other members of the medical staff
b. The billing and coding specialist is responsible for any errors made by the medical staff
c. The physician is responsible for any errors made by the medical staff
d. The person who has been employed for the longest period of time is responsible for any errors
made by the medical staff - ANSWER-C
HIPAA, stands for which of the following?
a. Health Insurance Portability and Accountability Act
b. Health Insurance Privacy Assessment and Agreement
c. Health Insurance Privacy and Agreements
d. Health Insurance Practices and Agreements - ANSWER-A
Information given by a patient to medical personnel that cannot be disclosed without consent
constitutes:
a. Judgment
b. Duty of care
c. Privileged communication
d. Negligence - ANSWER-C
Why is a superbill/encounter form an important document in the office?
a. It is used when considering purchasing medical billing software
b. It has information needed for vendors
c. It ensures the correct spelling of the patient's name
d. It ensures the correct patient data information and procedure codes - ANSWER-D
Which of the following facilities does not use CMS-1500 forms?
a. ASC (Ambulatory Surgery Center)
b. Nursing Home
c. Acute care
d. Dialysis clinic - ANSWER-D
Physicians usually submit claims for patients and receive payments directly for the payers. The policy
holder authorizes this by signing and dating a:
a. Accept assignment
b. Schedule of benefits
c. Assignment of benefits
d. Encounter form - ANSWER-C
Under the HIPAA Privacy Rule, providers do not need specific authorization in order to release a
patients PHI for TPO purposes. What does TPO stand for?
a. Treatment, patient protection, operations
b. Treatment, payment and health care operations
c. Type of payment, patient and observation
d. Type of insurance, payment, and health care operations - ANSWER-B
If both parents cover dependents on their plan, the child's primary insurance is usually determined by
the birthday rule. What is meant by the birthday rule?
a. If the mother is older than the father than she is primary
b. The parent whose birthday is earlier in the calendar year is the primary
c. The father is usually older than the mother so he is the primary
d. The parent whose birthday is closest to the child's birthday is the primary - ANSWER-B
What type of insurance allows treatment virtually anywhere with a high deductible that policy holders
are willing to pay?
a. COBRA
b. EPO
c. PPO
d. HMO - ANSWER-C
Veterans with service related disabilities are eligible for case under which of the following programs:
a. CHAMPUS
b. Medicare
c. CHAMPVA
d. TRICARE - ANSWER-C
_______________________ is usually sponsored and partially paid by an employer.
a. TRICARE
b. Private Insurance
c. Group Health Insurance
d. Worker's Aide - ANSWER-C
______________________ are used to report encounters for circumstances other than a disease or
injury in the ICD-10-CM.
a. A codes
b. V codes
c. Z codes
d. E codes - ANSWER-D
The abbreviation PMPM stands for:
a. Per member per month
b. Provider membership per management
c. Provider management provider manual
d. Pre menstrual after midnight - ANSWER-A
Schedule of benefits means:
a. Coordination of benefits
b. HMO
c. Medical service covered under the insured's policy
d. Managed care organization - ANSWER-C
Medicare is funded by:
a. State Funds
b. Federal Funds
c. Employers
d. The patient - ANSWER-B
Physicians establish a list of their usual fees for:
a. The charges they have written off
b. The procedures and services they frequently perform
c. Workers' Compensation patients
d. Their Medicare patients - ANSWER-B
The insurance carrier is allowed to use nay method to determine the amount for a service, also known
as the:
a. Allowed amount
, b. Fee schedule
c. Deductible
d. Insurance premium - ANSWER-B
Which of the following statements is true under the doctrine of respondeat superior?
a. The billing and coding specialist is superior to other members of the medical staff
b. The billing and coding specialist is responsible for any errors made by the medical staff
c. The physician is responsible for any errors made by the medical staff
d. The person who has been employed for the longest period of time is responsible for any errors
made by the medical staff - ANSWER-C
HIPAA, stands for which of the following?
a. Health Insurance Portability and Accountability Act
b. Health Insurance Privacy Assessment and Agreement
c. Health Insurance Privacy and Agreements
d. Health Insurance Practices and Agreements - ANSWER-A
Information given by a patient to medical personnel that cannot be disclosed without consent
constitutes:
a. Judgment
b. Duty of care
c. Privileged communication
d. Negligence - ANSWER-C
Why is a superbill/encounter form an important document in the office?
a. It is used when considering purchasing medical billing software
b. It has information needed for vendors
c. It ensures the correct spelling of the patient's name
d. It ensures the correct patient data information and procedure codes - ANSWER-D
Which of the following facilities does not use CMS-1500 forms?
a. ASC (Ambulatory Surgery Center)
b. Nursing Home
c. Acute care
d. Dialysis clinic - ANSWER-D
Physicians usually submit claims for patients and receive payments directly for the payers. The policy
holder authorizes this by signing and dating a:
a. Accept assignment
b. Schedule of benefits
c. Assignment of benefits
d. Encounter form - ANSWER-C
Under the HIPAA Privacy Rule, providers do not need specific authorization in order to release a
patients PHI for TPO purposes. What does TPO stand for?
a. Treatment, patient protection, operations
b. Treatment, payment and health care operations
c. Type of payment, patient and observation
d. Type of insurance, payment, and health care operations - ANSWER-B
If both parents cover dependents on their plan, the child's primary insurance is usually determined by
the birthday rule. What is meant by the birthday rule?
a. If the mother is older than the father than she is primary
b. The parent whose birthday is earlier in the calendar year is the primary
c. The father is usually older than the mother so he is the primary
d. The parent whose birthday is closest to the child's birthday is the primary - ANSWER-B
