student assignment pack 1 - u.s. career...

StudentAssignment

Pack 1

e0201405AS01C-34

Medical Billing Specialist

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Copyright © 2014, Weston Distance Learning, Inc. All Rights Reserved. e0201405AS01C-34

FOR MORE INFORMATION CONTACT:

U.S. Career InstituteFort Collins, CO 80525

www.uscareerinstitute.edu

Student Assignment Pack 1

Instructions for Quizzes1. Be sure you’ve mastered the Lessons and Practice Exercises that this Quiz covers.2. Mark your answers on the Quiz, and make sure to check your answers by reviewing the Lessons.3. When you’re finished, decide how you will submit your answers and then follow the correct

instructions below. You may only submit your answers for a Quiz once. Important: When submitting your Quiz, be sure to include your name, address, student ID number and course code. Incomplete information may result in your Quiz not being processed.

Scanner Quiz InstructionsFor a Quiz that contains only multiple-choice questions, please select the method of submission:

● Online: Submit your answers online and receive your grade immediately by submitting them to the student site, www.uscareerinstitute.edu.

● Phone: Call the Quiz Line at 1-877-599-5857 and give your answers over the phone to receive your grade immediately.

● Mail: Scanner Answer Sheets and envelopes are included with each Assignment Pack. Transfer your Quiz answers to the Scanner Answer Sheet, using only blue or black ink. Mail your Scanner Answer Sheet using the enclosed envelope.

Instructor-Graded Quiz InstructionsFor the quickest response to instructor-graded Quizzes, simply e-mail your completed Quiz as an attachment to your instructor at [email protected]. In most cases, you will receive the graded Quiz back via e-mail within three business days.

To ensure your instructor can grade your Quiz electronically, please create documents using one of the following preferred software programs: Microsoft® Word, Microsoft® Works or WordPerfect®. Make sure to include your name, student ID, course code and Quiz number in the subject line of your e-mail. Include your address in the e-mail. Finally, please note that these instructions only apply to handwritten Quizzes. Thank you and good luck!

For a Quiz that contains Instructor-graded questions, please select the method of submission:

● Online: Submit your answers online for an instructor to review and grade by submitting them to the student site, www.uscareerinstitute.edu.

● Mail or Fax: Answer Sheets and envelopes are included with each Assignment Pack. Transfer your Quiz answers to the Answer Sheet, using only blue or black ink. Mail your Cover Sheet and Answer Sheet using the enclosed envelope, or fax the forms to 1-877-599-5863.

After you have submitted your Quiz answers, you may begin the next lesson. You do not need to wait for your Quiz results to move on to the next lesson!

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Quiz 1: The World of Health CareThis is a Scanner Quiz that should be submitted according to the instructions at the beginning of this pack.

Select the best answer from the choices provided. Each item is worth 5 points.

1. Medical coding is the process of _____. a. identifying types of specialistsb. identifying patient complaints c. following up on insurance claimsd. translating narrative into numeric and/or alphanumeric codes

2. A(n) _____ setting may be a provider’s office or emergency department. a. inpatient b. urgent care c. rehabilitation d. outpatient

3. During residency, physicians might be asked to work _____ hours per week. a. 1000b. 85-100 c. 100-150 d. 200-250

4. The _____ assists the doctor by carrying out instructions under the doctor’s supervision. a. EMT b. paramedic c. nurse’s assistant d. physician assistant

5. _____ complete insurance forms and ensure proper reimbursement for patient encounters. a. Radiologic technologists b. Medical billing specialists c. Medical record technologistsd. Accounts receivable specialists

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6. Which of these lists correctly illustrates the order of training, from lowest to highest, of medical personnel? a. EMT, paramedic, physician b. paramedic, EMT, physician c. physician, EMT, paramedic d. EMT, physician, paramedic

7. EMT personnel _____ patients, while paramedics might begin to cure them. a. treat b. stabilize c. perform surgery on d. none of the above

8. The _____ organizes schedules and keeps appointments straight. a. nurse b. physician c. office manager d. laboratory technician

9. A(n) _____ listens to the provider’s dictation and types what she hears. a. medical billing specialist b. medical transcriptionist c. medical coding specialist d. office professional

10. The _____ reviews the medical report to determine the correct set of numbers that describe exactly what occurred during the patient’s visit.a. medical coding specialist b. medical transcriptionist c. medical billing specialist d. office professional

11. Claims that haven’t been paid yet are _____. a. a liability b. not codedc. denied d. outstanding

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12. _____ are normally supervised, and can perform some of the same functions as a doctor. a. Nurses b. Medical coders c. Nurse’s assistants d. Physician assistants

13. Anything the provider does to help the patient heal is called a _____. a. procedure b. diagnosis c. chief complaint d. sequence of events

14. To give yourself the best chance of gaining a new client, you must remember and practice professionalism, adaptability and _____. a. altruismb. presentation c. preoccupation d. insurance billing

15. Chief complaint means _____.a. why a patient is seeking treatmentb. how long the patient waited to be seenc. the complaint with the most letters in itd. what the nurse thinks is the worst symptom

16. A healthcare professional’s work attire should be _____.a. all whiteb. coverallsc. whatever style you like bestd. clean, wrinkle-free and professional

17. Two essential characteristics of a successful healthcare professional are _____.a. tenacity and toughnessb. warmth and confidencec. curiosity and free-spiritednessd. being argumentative and organizational

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18. Making lists to not forget tasks for the day is an example of _____.a. driveb. warmthc. confidenced. organization

19. Professionalism includes how you _____.a. talkb. dressc. interactd. all of the above

20. Which is not a responsibility of a nurse or nurse’s assistant? a. Stitching up a cutb. Cleaning up exam roomsc. Taking a patient’s temperatured. Talking to patients to ensure they are comfortable

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Quiz 2: Medical Insurance 101This is a Scanner Quiz that should be submitted according to the instructions at the beginning of this pack.


1. When an insurance carrier pays for medical treatment based on a policy, it is paying _____.a. HMOs b. benefits c. premiums d. a copayment

2. The _____ is a document that explains how much the insurance company paid on a claim. a. PPO b. insurance policy c. insurance statement d. explanation of benefits

3. A program that pays the medical bills for people with job-related injuries or illnesses is called _____. a. PPO b. Medicaid c. managed cared. workers’ compensation

4. The traditional insurance company paid out benefits based on a(n) _____ concept.a. HMO b. PPO c. managed care d. fee-for-service

5. Paying someone for services already performed is _____.a. reimbursementb. claims processingc. completing an encounterd. always an insurance company’s responsibility

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6. If preauthorization is required, but the insurance company is not notified, the insurance company _____.a. pays moreb. might reduce reimbursementc. bills the doctor for the cost of the extra paperwork involvedd. any of the above

7. The CPT and HCPCS manuals contain _____ codes. a. CMS b. diagnosis c. procedure d. temporary

8. Dr. Bryant charts that her patient, Sarah Morris, has a sprained ankle. The coding specialist will code this as a _____ code. a. CMS b. diagnosis c. procedure d. temporary

9. Codes that identify the physician’s opinion about what’s wrong with a patient are called _____ codes. a. HCPCS b. procedure c. diagnosis d. Medicare

10. _____ is the healthcare program for the Department of Defense.a. Medicaidb. TRICAREc. CHAMPVAd. Workers’ compensation

11. The life cycle of a medical bill begins with _____.a. the physician’s diagnosisb. making an appointmentc. a completed questionnaired. printing an encounter form

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12. ICD stands for _____.a. International Coding Decimalsb. International Coding Disordersc. Internal Classification of Disordersd. International Classification of Diseases

13. HCPCS stands for _____.a. Hired Care Primary Coding Systemb. Health Care Primary Coding Systemc. Honorary Coding Procedures Common Systemd. Healthcare Common Procedure Coding System

14. CPT stands for _____.a. Current Primary Testsb. Colorado Procedure Testsc. Current Procedural Terminologyd. Corporate Procedure Terminology

15. People under age 65 with certain disabilities are eligible for _____.a. Medicaidb. Medicarec. TRICAREd. group health insurance

16. A benefit to employees of a large company is _____.a. Medicareb. Medicaidc. TRICAREd. group health insurance

17. The total amount of bills at which point the copayment is dropped is called the _____.a. deductibleb. policy limitc. threshold limitd. allowable amount

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18. Medicare Part B pays for _____.a. hospital servicesb. pharmaceuticalsc. medical expensesd. skilled nursing facility care

19. Medicare Part A pays for _____.a. hospital servicesb. pharmaceuticalsc. medical expensesd. outpatient hospital treatment

20. Diagnosis codes are found in the _____ manual.a. CPTb. HCPCSc. ICD-10-CMd. ICD-10-PCS

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Quiz 3: Private Insurance and Managed CareThis is a Scanner Quiz that should be submitted according to the instructions at the beginning of this pack.

Match each term to the correct definition. Each item is worth 5 points.

1. _____ POS

2. _____ HMO

3. _____ PPO

4. _____ HSA


5. Which of the following is not found on the insurance identification card? a. Subscriber’s nameb. Group numberc. Physician addressd. Preauthorization phone number

6. A(n) _____ describes insurance benefits and coverage information.a. insurance policyb. benefit contractc. claimd. subscriber statement

7. Private health insurance _____.a. is federally fundedb. cannot raise ratesc. is federally administeredd. operates for profit

8. The identification card includes all except the _____.a. subscriber’s nameb. preauthorization informationc. group numberd. providers

a. A personal savings account that the participant owns and controls b. A group of providers and hospitals who give plan members

discounted health carec. Prepaid health plan in which individuals receive medical services

from participating providersd. Plan in which members choose their own medical care providers,

with care from a participating provider or facility resulting in increased benefits

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9. Managed care was started to help _____.a. deny benefitsb. improve medical researchc. fight rising healthcare costsd. organize insurance companies

10. If a nonparticipating physician treats an HMO patient, the patient’s insurance benefits _____.a. riseb. stay the samec. are reduced or deniedd. do not require a deductible

11. The most popular choice in managed care is the _____.a. HMOb. PPOc. PPGd. POS plan

12. PPO stands for _____.a. Primary Point of Serviceb. Preferred Provider Organizationc. Primary Physician Organizationd. Physician Provider Organization

13. The _____ is the doctor in charge of a particular patient in an HMO.a. PPOb. specialistc. primary physiciand. participating physician

14. One difference between HMOs and PPOs is that members of _____ can choose their own doctors and treatment facilities and still receive benefits.a. HMOsb. PPOsc. HMO fee-for-service plansd. the peer review organization

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15. Once a member meets the threshold limit, the PPO pays _____.a. 20 percent of every bill in a yearb. 20 percent of the covered chargesc. 100 percent of the covered chargesd. 100 percent of the disallowable charges

16. _____ coverage allows people the most freedom in choosing providers.a. HMOb. PPOc. Fee-for-serviced. Point of service

17. _____ strive to combine the best elements of both HMOs and PPOs.a. PPGsb. Physician Groupsc. Health Service Plansd. Point of Service Plans

18. _____ are managed care programs that the physicians own.a. HMOsb. PPOsc. Point of Service Plansd. Physician Provider Groups

19. _____ examine and ensure quality health care in managed care situations.a. Tracking teamsb. Preauthorization organizationsc. Peer review organizationsd. Utilization/preview wards

20. Which statement is not true of an HSA? a. HSAs are for those without insurance.b. Participants must be under the age of 65.c. Participants must have insurance with an HDHP.d. The HSA can pay for qualified medical expenses.

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Quiz 4: Medicaid, CHIP and MedicareThis is a Scanner Quiz that should be submitted according to the instructions at the beginning of this pack.


1. The process of a home state Medicaid program paying a claim for medical services that occur in another state is called _____.a. an appealb. reciprocityc. transferenced. preauthorization

2. The main purpose of CMS is to _____.a. replace HCFAb. administer healthcare benefits to its beneficiariesc. govern the Department of Health and Human Servicesd. purchase healthcare services for the Medicare and Medicaid programs

3. _____ programs must follow federal guidelines, but they vary somewhat from state to state.a. Medicareb. HMOc. Medicaidd. PPO

4. Which group of people are not eligible for Medicaid? a. Disabled workersb. Low-income people, families and children c. Children and adults with end-stage renal diseased. None of the above

5. Which of the following statements is true? a. Coinsurance is the amount Medicaid covers for services.b. Hemodialysis is a covered service that does not require Medicaid preauthorization.c. Emergency care requires Medicaid preauthorization.d. Minimum standards relate to certain aspects of care for Medicaid participants.

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6. Because each individual state runs Medicaid programs, the requirements for billing _____.a. vary from state to stateb. are the same for every statec. are dictated by the federal governmentd. are submitted to a federal agency and a state agency

7. Medicaid recipients include _____.a. the elderlyb. pregnant womenc. people with disabilitiesd. all of the above

8. If a Medicare patient fails to get proper preauthorization, the patient’s benefits will _____.a. increaseb. be reducedc. never be affectedd. always stay the same

9. _____ is the Medicaid review of a proposed treatment to determine whether the treatment is appropriate.a. An appealb. Reciprocityc. DHHS reviewd. Preauthorization

10. Medicaid _____ must be met but can be exceeded.a. mandatesb. requirementsc. minimum standardsd. maximum standards

11. Which statement is not true of CHIP? a. CHIP is federally funded.b. Children receive free preventative care with CHIP.c. CHIP is federally administered.d. Children up to age 19 may be eligible for CHIP.

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12. The _____ government administers Medicare.a. localb. statec. countyd. federal

13. Which of the following are not eligible for Medicare?a. Disabled workersb. Children and adults with end-stage renal diseasec. People under age 65 with certain disabilitiesd. All are eligible for Medicare.

14. The Medicare term _____ charge referred to whichever charge was the lowest of the following: customary charge, prevailing charge and actual charge.a. approvedb. acceptancec. case-by-cased. intermediary

15. Medicare Part A covers _____.a. mental health and hospital careb. hospital care and hospicec. ambulance services and hospiced. clinical research and mental health

16. _____ finance(s) Medicare Part A.a. Fiscal agentsb. The state governmentc. Monthly premiums paid by enrolleesd. Social Security payroll withholding tax paid by workers and their employers

17. Medicare Part B is financed by _____.a. fiscal agentsb. the state governmentc. monthly premiums paid by enrolleesd. Social Security payroll withholding tax paid by workers and their employers

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18. Fiscal agents are organizations under contract with the government to _____.a. deal with reciprocity situationsb. set rules for Medicare and Medicaidc. handle claims for services covered under Medicare Part Ad. handle claims for services covered under Medicare Part B

19. _____ insurance can be purchased to supplement Medicare insurance.a. Medigapb. Medicaidc. Medi-Medid. Medicare Part C

20. When a patient is eligible for both Medicare and Medicaid, you should submit claims to _____ first.a. Medigapb. Medicarec. Medicaidd. the secondary insurance carrier

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Quiz 5: Military, Workers’ Compensation and COBRAThis is an Instructor-graded Quiz that should be submitted according to the instructions at the beginning of this pack.

Select the best term(s) to complete each sentence. Not all terms will be used and some terms may be used more than once. Each item is worth 5 points.

18 months24 months196619731978 active-dutybeneficiariesBlack Lung BenefitsCHAMPVACOBRAConditionalDEERS

Double indemnityenhancedExtraFECAfiscal intermediaryjob-relatedlegal disabilitymedicalmilitary sponsormilitary waiver statementMiner’s Union Actnonavailability statement

occupationalpluspremiumPrimaryPrimeSocial Security Disabilitytemporary and permanentdisabilitiestertiaryTRICARETRICARE for Lifeworkers’ compensation

1. CHAMPUS was developed in the year _____ to control the rising costs of healthcare coverage and to standardize healthcare benefits.

2. _____ provides managed healthcare coverage for military service families.

3. The family members of uniformed service members are called _____.

4. _____ is the Department of Defense’s regionally handled managed-care program.

5. _____ requires the military sponsor to register the beneficiaries.

6. If a patient seeks treatment at a nonmilitary facility, TRICARE and CHAMPVA may require a(n) _____ from the military hospital.

7. TRICARE provides healthcare options for families of _____ or retired service members.

8. An organization that contracts with the government to handle TRICARE and CHAMPVA claims is called a(n) _____.

9. The TRICARE program that gives a discount on services and has a reduced cost-sharing fee is TRICARE _____.

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10. TRICARE _____ is the TRICARE program most like an HMO.

11. The program established to provide health care for families of veterans with service-connected disabilities is _____.

12. CHAMPVA was established in the year _____.

13. _____ was designed to provide health insurance to those who become unemployed.

14. FECA provides benefits for traumatic injuries and _____ illnesses.

15. The Federal Coal Mine Health and Safety Act is often known as the _____ Act.

16. COBRA coverage is available for _____.

17. _____ benefits are paid in the event of the death of a worker.

18. A(n) _____ disability involves a condition, such as a severe back injury, that disables a person.

19. Workers’ compensation is a primary carrier for _____ or on-the-job injuries.

20. For the Social Security Disability program, a _____ prevents the worker from doing any work.

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Fold on dotted line

This Space for Instructor Use

1. Fill in your student ID and your course code below.

STUDENT ID NUMBER COURSE CODE

2. Be sure your name and address are fi lled in below.3. Transfer your answers to this cover sheet.

NAME

ADDRESS

CITY STATE ZIP

U.S. Career Institute2001 Lowe StreetFort Collins, CO 80525

14-G

Grade: ___________

Medical Billing SpecialistQuiz 5

1. _____________________________________________

2. _____________________________________________

3. _____________________________________________

4. _____________________________________________

5. _____________________________________________

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6. _____________________________________________

7. _____________________________________________

8. _____________________________________________

9. _____________________________________________

10. _____________________________________________

11. _____________________________________________

12. _____________________________________________

13. _____________________________________________

14. _____________________________________________

15. _____________________________________________

16. _____________________________________________

17. _____________________________________________

18. _____________________________________________

19. _____________________________________________

20. _____________________________________________

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Quiz 6: Handling ClaimsThis is a Scanner Quiz that should be submitted according to the instructions at the beginning of this pack.

Select the best answer from the choices provided. Each item is worth 6.67 points

1. Numbers or alphanumeric characters based on the diagnosis made and procedures performed are called _____.a. codesb. checksc. HMOsd. terms

2. The diagnosis code is entered in field _____ of the CMS-1500 form.a. 66b. 67c. 21d. 24D

3. Codes that identify the physician’s opinion about what’s wrong with a patient are called _____ codes.a. procedureb. diagnosisc. HCPCSd. Medicare

4. ICD stands for _____.a. International Coding Decimalsb. International Coding Disordersc. International Classification of Diseasesd. Internal Classification of Disorders

5. If a patient is suffering from more than one symptom, the doctor will determine a _____, usually the main cause of the symptoms or the main health problem.a. primary diagnosisb. concurrent conditionc. concurrent diagnosisd. primary prognosis

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6. When you trace an insurance claim, you should send the _____ to the insurance company.a. name of the insuredb. date of servicec. procedures performedd. all of the above

7. If an insurance company denies a claim, the _____.a. decision is finalb. patient must file an appealc. patient can request a peer reviewd. decision can be appealed or reviewed by peers

8. An encounter form shows a patient was diagnosed with intermediate coronary syndrome. In which field will you enter the diagnosis code on the CMS-1500 claim form?a. 19b. 21c. 24Dd. 24E

9. A patient has a biopsy done on her lip. In which field will you enter the procedure code on the CMS-1500 claim form? a. 19b. 24Cc. 24Dd. 24E

10. As a billing specialist, you discover that Juanita Rodriguez’s insurance company has not reimbursed the doctor’s office for her bill, and 37 days have elapsed since you submitted the claim. You should _____ the insurance company.a. write a letter tob. callc. submit a second claim tod. any of the above

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11. Dr. White performs laboratory tests for his patient, Will Sears. The claims specialist will apply the _____ code to the claim form.a. modifierb. diagnosisc. procedured. CMS

12. Dr. Johnson charts that her patient, Sarah Gooding, has a sprained ankle. The billing specialist will apply the _____ code to the claim form.a. modifierb. diagnosisc. procedured. CMS

Match the coding term with its definition or description. Each item is worth 6.67 points.

13. _____ ICD

14. _____ CPT

15. _____ HCPCS

a. codes produced annually by the American Medical Association

b. pronounced “Hick-Picks”c. diagnosis codes

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Quiz 7: Introduction to Medical TerminologyThis is a Scanner Quiz that should be submitted according to the instructions at the beginning of this pack.

Select the best answer from the choices provided. Use your lesson materials and flashcards to answer these questions. Each item is worth 5 points.

1. Words are often made up of smaller _____.a. prefixesb. sentencesc. word partsd. medical terms

2. The foundation of a word is called a _____.a. suffixb. prefixc. root wordd. word’s base

3. Word parts can be called the _____ of words.a. laddersb. grammarc. root wordsd. building blocks

4. A word part that is attached to the end of a word is a ______.a. prefixb. suffixc. box card. combining vowel

5. A prefix is found at the _____ of a word.a. endb. middlec. beginningd. none of the above

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6. In many medical terms, the _____ joins a root word to a suffix.a. prefixb. apostrophec. locomotived. combining vowel

7. If driver means a person who drives, what would swimmer mean? a. To swim pastb. To swim againc. A person who swimsd. A person who drives and swims

8. Which of the following is a compound word? a. Loveb. Trustc. Bookletd. Bookshelf

9. A suffix is attached to the word part called the _____.a. endb. prefixc. adjectived. root word

10. A word that is made up of two or more root words is called a _____.a. double rootb. compound wordc. combining voweld. none of the above

11. In the term neo/nat/o/log/ist, the word part nat/ is a _____.a. suffixb. prefixc. root wordd. combining vowel

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12. In the term neo/nat/o/log/ist, the word part neo/ is a _____.a. suffixb. prefixc. root wordd. combining vowel

13. In the term dermat/o/logy, the word part /o/ is called a _____.a. suffixb. prefixc. root wordd. combining vowel

14. If reread means to read again, what does review mean? a. To view againb. To view backwardsc. To view and read togetherd. To view sometime in the past

15. _____ is the correct spelling of the term that means any disease of the muscles.a. Myopathyb. Myapathyc. Myapatheyd. Myopathey

Select the correct root word for each meaning. Each item is worth 5 points.

16. skulla. neur/ob. crani/oc. criani/od. cardi/o

17. livera. hist/ob. lith/oc. duct/od. hepat/o

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18. kidneya. ren/ob. col/oc. tens/od. enter/o

19. clota. muc/ob. myel/oc. therm/od. thromb/o

20. stomacha. arthr/ob. hydr/oc. gastr/od. enter/o

student assignment pack 1 - u.s. career...

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