All Chapters Included
,Table of content
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
Chapter 01: Role of an Insurance Billing Specialist
Smith: Fordney’s Medical Insurance and Billing, 16th Edition
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
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
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.
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
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
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
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.
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.
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
Answer: C DIF: Easy OBJ: 9
10. Professional ethics include
a. state laws.
b. federal laws.
c. standards of conduct.
d. civil torts.
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.
Answer: C DIF: Easy OBJ: 9
12. What is the name of the modern code of ethics that the American Medical Association
(AMA) adopted in 1980?
a. The Modern Standards of Conduct Code
b. The Principles of Medical Ethics
c. The Oath of Hippocrates
d. The American Medical Association Code of Ethics
Answer: B DIF: Easy OBJ: 9
13. Reporting incorrect information to government-funded programs is
a. unethical.
b. illegal.
c. abuse.