If a child covered by both a primary and secondary insurance is charged $350.00 for a procedure. The primary insurance pays $275.00. How is the remaining balance paid?
The patient’s parents are responsible for the remaining balance.
The medical assistant submits a claim with the secondary insurance for $275.00.
The medical assistant submits a claim with the secondary insurance for $75.00.
The medical assistant submits a claim with the secondary insurance for $350.00.
True or false? Math skills are not important for the medical assistant because everything is done on the computer.
A payment system in which payments to providers are fixed and based on the number of enrollees over a period of time regardless of the type or numbers of services provided is called:
capitation
medigap
limiting fee
POS
True or false? Each insurance carrier will have its own negotiated fee schedule.
True or false? A medical office might have a separate fee schedule for patient’s paying out-of-pocket.
True or false? Unless prohibited by law, a medical office may have more than one fee schedule established by different insurance carriers.
True or false? During the patient interview, the medical assistant should document the patient’s statements into the progress note.
True or false? A professional appearance including clean scrubs, groomed hair, and appropriate makeup will contribute to the professionalism of the medical office and gain the patient’s trust.
In order to ensure that Casey is comfortable, the medical assistant should __________
maintain eye contact
keep the exam room door open
give Casey a hug
sit next Casey on the exam table
True or false? A day sheet tracks all of the patient transactions for one specific day in a medical office.
True or false? Only payments made at the medical office are recorded on the day sheet.
A medical assistant should record which of the following transactions on the day sheet?
An insurance payment received in the daily mail, a patient payment dropped off at the medical office, and a bankruptcy adjustment.
A bankruptcy adjustment.
A patient payment dropped off at the medical office.
An insurance payment received in the mail.
The total on the __________ should match the total on the bank deposit slip.
day sheet
superbill
claim
patient ledger
In alphabetic filing, a patient’s first name is the __________ filing unit.
FOURTH
SECOND
FIRST
THIRD
True or false? Correspondence with a patient does not need to be included in the patient’s medical record.
True or false? Workers’ compensation has its own fee schedule and a provider cannot bill a patient for the difference between their billed amount and workers’ compensation allowed amount.
What services does workers’ compensation pay for?
REHABILITATION
WAGE REPLACEMENT
DEATH BENEFITS
REHABILITATION, WAGE REPLACEMENT, DEATH BENEFITS
True or false? Services performed one month ago cannot be submitted for reimbursement.
When a patient gives permission for the insurance carrier to pay the provider directly, this is called:
managed care.
assignment of benefits.
resource utilization group.
third-party administrator.
True or false? The Explanation of Benefits (EOB) is not a bill, but a summary of the services submitted and insurance payments to the doctor’s office.
__________ plans reimburse physicians according to the procedures performed.
CAPITATION
CAPITA
DEDUCTIBLE
FEE FOR SERVICE
The cost-sharing measure in which the insured pays a percentage of the insurance carrier’s allowed amount is called:
CODEDUCTIBLE
COPAYMENT
COINSURANCE
COPREMIUM
When a patient is covered under more than one policy, __________ is used to ensure the claim is not paid to more than 100%.
AN ADJUSTMENT
CROSS-REFERENCE
BENEFIT OVERLAP
COORDINATION OF BENEFITS
True or false? Refunds owed to the patient can be provided as a standing credit balance or the medical assistant can issued a refund check to the patient.
True or false? All office equipment should be documented on the office inventory and checked for regular maintenance and repair so they are in proper working order for patient use.
True or false? It is important to know a patient’s insurance carrier before looking up the cost of a procedure in the fee schedule.
Posting information to the day sheet would be considered a __________ activity, whereas using the information from the day sheets and other forms to create a document that summarizes the medical office’s finances would be this type of activity: __________
accounting, bookkeeping
insurance, financial
financial, insurance
bookkeeping, accounting
Billing statements should be sent to patients:
biweekly
every 90 days
at the beginning and middle of the month
monthly
A financial statement that records the charges, receipts and services rendered on a given day is a:
balance sheet
petty cash fund
checkbook
Patient statements are generated:
quarterly
every two months
weekly
The abbreviation DOS stands for:
date of stamp
date of symptom
date of signature
date of service
Which of the following are CPT codes for the administration of the influenza vaccine?
G0008
90658, 90471, and G0008
90658
90471
The procedural code for Diagnostic Mammogram of both breasts is __________
77065
77056
77560
77650
True or false? The progress note is a summary of the procedures and diagnosis of the visit office.
True or false? OTC stands for over-the-counter.
A referral is:
required for all patients.
a request for a specialist opinion.
a transfer of specific care of the patient.
provided for certain procedures or hospital admissions
Mr. Caudill is feeling depressed about his new diagnosis. The medical assistant knows of another patient who was recently diagnosed with the same disorder and gives Mr. Caudill the patient’s phone number. Which of the following statements regarding the medical assistant’s actions are true:
The medical assistant violated Title One of HIPAA and could face disciplinary action.
The medical assistant did nothing wrong.
The medical assistant helped the patient network with others.
The medical assistant violated Title Two of HIPAA and could face disciplinary action.
What does the acronym SOAPE represent?
Shivering, outward, aching, pain, eventual
Sickness, observation, aching, pain, elevation
Subjective data, objective data, assessment, plan, and evaluation
Stomach, ovary, ankle, pancreas, ear
After a claim is processed, payment and the remittance advice (RA) are sent to the:
guarantor
patient
health plan
provider
True or false? The total amount of cash and checks needs to be documented at the bottom of the deposit slip.
Which of the following statements regarding EFT is false?
EFT allows payment to be automatically deposited into the provider account
EFT still has a corresponding remittance advice (RA).
EFT still requires the endorsement of a check
EFT still requires the endorsement of a check, allows payment to be automatically deposited, and still has a corresponding remittance advice (RA)
True or false? Checks are documented individually on a deposit slip.
All checks prepared for a deposit must be:
endorsed
photocopied
arranged in numerical order by check number
stamped "paid in full'
True or false? The medical assistant only needs to be aware of deposits and checks when reconciling a bank statement.
True or false? The medical assistant only needs to document checks received from insurance carriers on the bank deposit slip.
True or false? It is appropriate to charge a fee for NSF checks.
f a patient mails a check payment without having sufficient funds, the medical office could:
deduct the amount from the medical office’s checking account balance.
add the amount due back to the patient ledger.
document a description of the transaction in the patient ledger.
deduct the amount from the medical office’s checking account balance, add the amount due back to the patient ledger, or document a description%2
True or false? Postdated checks are not accepted as payment in the medical office.
NSF stands for:
non-sufficient funds
negative sum funds
neutrally subtracted funds
non-secure funds
What types of payment are most commonly used in the medical office?
cash
cash, personal check, or credit card
cash or personal check
cash, personal check, or third party check only
True or false? Cash and checks are listed separately on the deposit slip.
Bank deposit slips should be prepared:
by the physician only
daily
True or false? A patient’s outstanding balances are accounts payable.
True or false? The medical office may not impose a returned check fee for NSF checks because it is against insurance agreements.
True or false? It is acceptable to insist on cash only payments from patients with previous NSF checks.
True or false? Third party checks have a greater risk of being NSF.
If the patient writes “payment in full” and the account is not fully paid, the medical assistant should scratch the documentation from the check.
What precautions should be taken when accepting a check?
Do not accept third party checks.
Scan the check for accuracy.
Scan for accuracy, don't accept checks made out for more money than owed, and don't accept third party checks.
Do not accept checks made out for more money than owed.
Which detail should be documented on a check?
Payee name
Correct date
Payee name, correct date, and amount
Amount
True or false? The biller should not contact the patient about past due balances at their employment unless the work phone contact has been approved by the patient.
True or false? The Federal Trade Commission (FTC) enforces the Fair Debt Collection Practices Act (FDCPA). This act encourages debt collectors to use abusive, unfair, or deceptive practices to collect past due monies.
True or false? It is good practice to document the date and time you attempt to call patients about collections on accounts.
True or false? The Internet is a good resource when trying to collect money owed from a patient who has moved without leaving a forwarding address.
True or false? A blank prescription is documented as an in-office order in the Order Entry section of the patient record.
True or false? The medical assistant must document the date and time of a phone message in order to determine the average turnaround time to complete messages.
According to Amma Patel’s Phone Encounter, Ms. Patel called Walden-Martin: __________
two days ago.
yesterday.
this morning.
this afternoon.
True or false? It is not important to document the time Ms. Patel plans to pick up her prescription.
Which of the following orders can be generated by clicking the Add button beneath the Out-of-Office table?
Medication prescription
Requisition
Blank prescription
All of the above
You can access a specific patient encounter by selecting __________
Patient Demographics.
the Clinical Care module.
the Record dropdown menu.
an encounter listed in the Patient Dashboard.
The ICD-10 CM code for obesity is __________
E65.9.
E66.9.
E66.0.
E60.0.
True or False? The certified medical assistant is permitted to prepare a non-medical prescription, such as an order for a fitness center, for provider approval using a documented order in the patient record.
True or false? It is not necessary for the order to be documented in the patient record before the medical assistant can generate an order.
In order to document the University Laboratory results for Ms. Yan, the medical assistant should: __________
click on the Superbill.
document the results within the Phone Encounter only. No other documentation is necessary.
select “Diagnostic/Lab Results” from the Clinical Care info panel.
use the Order Entry record section in Clinical Care.
True or false? Z86.73 is part of the ICD-9 CM coding system.
ICD-10 CM code Z79.01 is used to identify which patient condition?
Transient Ischemic Attack (TIA)
Long Term Use of Anticoagulants
Traumatic Brain Injury (TBI)
CVA
True or false? The date field within the Diagnostic/Lab Results tab is the date the medical office receives the results.
True or false? The Problem List allows the user to enter both the ICD 9 CM code and ICD 10 code as part of the record.
The ICD-10 CM code for Personal History of CVA is Z86.73. This code is also used for which condition?
Pulmonary Embolism
Parkinson’s Disease
The ECG has a cost of $89.00. Where will the user obtain the charge for service to document on the Insurance Tracer?
Superbill
Completed Claim
Completed Claim, Superbill, and Fee Schedule
Fee Schedule
Which data elements are part of the Insurance Claim Tracer?
Date of service, date of claim submission, and procedure with charge
Date of Claim submission
Date of service
Procedure with charge
True or false? The policy ID of the patient account is not part of the Insurance Claim Tracer.
The Insurance Claim Tracer was generated: __________
because the original claim was denied.
as an alternative method of claim submission.
as a follow up to a claim yet to be paid.
as a method of adding additional services for reimbursement.
True or false? The date of service and date of claim are always different.
True or false? The Insurance Claim Tracer is generated from the Correspondence function of SimChart for the Medical Office.
The Insurance Claim Tracer is available in __________ .
Correspondence
the Superbill.
the Form Repository.
The status of the Ella Rainwater’s claim for this encounter is: __________
denied.
resubmitted.
submitted.
in progress.
The Alzheimer’s Disease handout is found under what category of the Patient Education record?
Health Promotion
Procedures
Diagnosis
Tests
True or false? Prior Authorization is located in the Form Repository.
Which field of the Prior Authorization form signifies the patient’s eligibility of managed care services?
Effective date
Authorization number
Procedure code
Expiration date
True or false? Prior authorization forms have both an effective and expiration date.
Which of the following is listed on the Prior Authorization form?
Procedure, diagnosis, and expiration date
Procedure