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Introduction to Professional Billing and Coding Careers.docx
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Introduction to Professional Billing and Coding Careers
MULTIPLE CHOICE
The percentage of all healthcare providers who are physicians and nurses is:
25%.
40%.
50%.
60%.
Answer: b
EMPLOYMENT DEMAND
The percentage of all healthcare providers who are allied health professionals is:
25%.
40%.
50%.
60%.
Answer: d
EMPLOYMENT DEMAND
The increased demand for medical billers, medical office assistants, and medical coders can be attributed to:
the growth of managed care.
physician practices having more responsibility for filing claims.
the need for additional staff to file claims and work to obtain timely payment.
all of the above.
Answer: d
EMPLOYMENT DEMAND
All of the following changes were a result of managed care EXCEPT:
physicians having to wait 30 days or longer for payment.
physicians having more responsibility for filing claims.
patients having to pay for services when rendered.
physicians having to add to their staff.
Answer: c
EMPLOYMENT DEMAND
Before the 1970s, a physician’s practice would grow based on:
advertising and referrals.
managed care contracts.
consultations.
hospital affiliations.
Answer: a
EMPLOYMENT DEMAND
Before the 1970s, a solo practice included all of the following staff members EXCEPT:
physician.
nurse.
certified medical biller.
receptionist.
Answer: c
EMPLOYMENT DEMAND
Managed care is a system in which physicians contract to participate in a health insurance network and healthcare delivery is
at the discretion of the physician.
provided only by in-network physicians.
based on the patient’s ability to pay.
monitored to control costs.
Answer: d
EMPLOYMENT DEMAND
It is common for small-group practices to outsource:
billing and accounts receivable.
insurance coverage verifications.
appointment scheduling and patient reminders.
medical records management.
Answer: a
FACILITIES
A practice with three physicians would generally be categorized as a:
solo practice.
private practice.
small-group practice.
large-group practice.
Answer: c
FACILITIES
A practice with 10 or more physicians would generally be categorized as a:
solo practice.
private practice.
small-group practice.
large-group practice.
Answer: d
FACILITIES
A group of physicians with different specialties may practice together at one outpatient facility known as a:
free clinic.
small-group practice.
multispecialty clinic.
private hospital.
Answer: c
FACILITIES
Most hospitals today are owned by a:
single, private owner.
nonprofit organization.
university.
corporation.
Answer: d
FACILITIES
All of the following are features of a patient account services (PAS) facility EXCEPT:
employing few staff members.
having multiple departments.
handling claims for hospitals within a state or region.
handling hospitals’ accounts receivable.
Answer: a
FACILITIES
A PAS facility may include all of the following departments EXCEPT:
Medical Records.
Government Billing.
Insurance Verification.
Appeals.
Answer: a
FACILITIES
A large-group practice is a specialized practice that is likely to:
employ more nurses than doctors.
include a physical therapist as part of the medical team.
employ in-house staff to handle claims and accounts receivable.
contract with an outside firm to handle claims and accounts receivable.
Answer: c
FACILITIES
A centralized billing office (CBO) typically contracts with a physician’s office to perform which of the following functions?
Scheduling patient appointments
Handling claims and/or accounts receivable
Verifying insurance coverage
Compiling and recording medical charts, reports, and correspondence
Answer: b
FACILITIES
A medical office assistant may handle all of the following duties in a medical office EXCEPT:
scheduling appointments.
compiling and recording medical records.
interpreting laboratory test results.
answering telephones.
Answer: c
JOB TITLES AND RESPONSIBILITIES
The responsibilities of a medical biller may include all of the following EXCEPT:
scheduling appointments.
submitting insurance claims.
entering patient charge information.
contacting insurance carriers about outstanding claims.
Answer: a
JOB TITLES AND RESPONSIBILITIES
A possible job title for a medical coder position would be:
admitting clerk.
administrative medical assistant.
medical receptionist.
health information technician.
Answer: d
JOB TITLES AND RESPONSIBILITIES
The healthcare professional who researches data in medical records to accurately document diagnoses and procedures to obtain maximum reimbursement for physicians is the:
medical office assistant.
medical collector.
medical coder.
payment poster.
Answer: c
JOB TITLES AND RESPONSIBILITIES
The healthcare professional who contacts patients or insurance carriers to collect money owed to the medical facility is the:
medical office assistant.
medical coder.
payment poster.
medical collector.
Answer: d
JOB TITLES AND RESPONSIBILITIES
The healthcare professional who is responsible for answering questions and explaining such topics as HIPAA privacy regulations, living wills, and do-not-resuscitate orders (DNRs) to patients and their family members is the:
medical collector.
insurance verification representative.
admitting clerk.
privacy compliance officer.
Answer: d
JOB TITLES AND RESPONSIBILITIES
The healthcare professional who contacts insurance carriers to verify benefit information for patients is the:
insurance verification representative.
admitting clerk.
payment poster.
medical collector.
Answer: a
JOB TITLES AND RESPONSIBILITIES
A registered health information technician (RHIT) may also be referred to as a(n):
payment poster.
medical records analyst.
medical collector.
insurance verification representative.
Answer: b
JOB TITLES AND RESPONSIBILITIES
Important skills required of a payment poster include all of the following EXCEPT:
data entry skills.
math skills.
tact and diplomacy.
working knowledge of insurance contracts.
Answer: c
JOB TITLES AND RESPONSIBILITIES
The duties and responsibilities of a medical coder may include all of the following EXCEPT:
greeting visitors and directing them to appropriate staff.
researching and reference checking of medical records.
accurately coding primary and secondary diagnoses.
using ICD-9-CM and CPT® coding books.
Answer: a
JOB TITLES AND RESPONSIBILITIES
The duties and responsibilities of a payment poster generally include:
greeting visitors and directing them to appropriate staff.
reading Explanation of Benefits documents issued by insurance carriers.
submitting claims to insurance carriers.
scheduling and confirming patients’ appointments.
Answer: b
JOB TITLES AND RESPONSIBILITIES
The duties and responsibilities of a medical collector may include:
contacting patients or insurance carriers to obtain payment of balances owed.
compiling medical charts, reports, and correspondence.
reviewing medical records for compliance with regulations.
accurately coding diagnoses and procedures.
Answer: a
JOB TITLES AND RESPONSIBILITIES
The duties and responsibilities of an insurance verification representative may include all of the following EXCEPT:
precertification and/or prior authorization of services.
researching and reference checking of medical records.
contacting insurance carriers to clarify or confirm benefit information for patients.
determining the patient’s financial responsibility prior to services rendered.
Answer: b
JOB TITLES AND RESPONSIBILITIES
The duties and responsibilities of an admitting clerk may include:
registering and greeting patients.
having patients complete paperwork.
dealing with patients who may be upset or irritable.
all of the above.
Answer: d
JOB TITLES AND RESPONSIBILITIES
The duties and responsibilities of a privacy compliance officer may include all of the following EXCEPT:
posting payments or making adjustments to patient accounts.
answering questions about privacy regulations.
explaining DNR orders to patients and their family members.
data entry of patient demographics.
Answer: a
JOB TITLES AND RESPONSIBILITIES
Benefits of professional memberships include all of the following EXCEPT:
opportunities for networking with other professionals in your field.
automatic job placement.
publications that keep you up to date on issues and developments in your field.
conferences and professional development opportunities.
Answer: b
PROFESSIONAL MEMBERSHIPS
Professional organization conferences can be held on the:
state level only.
national level only.
state and national level only.
state, national, or regional level.
Answer: d
PROFESSIONAL MEMBERSHIPS
To achieve certification as a National Certified Medical Office Assistant (NCMOA), you must have all of the following qualifications EXCEPT:
high-school diploma or equivalent.
graduation from an approved program of study or 1 year of experience.
evaluations of billing performance.
a passing grade on the NCMOA exam.
Answer: c
CERTIFICATIONS
Medical coding certifications include all of the following EXCEPT:
Certified Medical Billing Specialist (CMBS).
Certified Coding Associate (CCA).
Certified Professional Coder (CPC).
Certified Coding Specialist (CCS).
Answer: a
CERTIFICATIONS
The Certified Professional Coder (CPC) certification is designed to evaluate a medical coder’s knowledge of all of the following EXCEPT:
medical terminology.
math concepts.
coding concepts.
human anatomy.
Answer: b
CERTIFICATIONS
In order to receive the Certified Professional Coder (CPC) certification, you must:
have a college degree plus 1 year of experience.
have 2 years of work experience and pass the certification exam.
pass the certification exam within 12 months of obtaining your first job.
have 3 years of work experience and pass the certification exam.
Answer: b
CERTIFICATIONS
Coders without much job experience can receive the following certification:
National Certified Medical Office Assistant (NCMOA).
Certified Medical Administrative Assistant (CMAA).
Certified Coding Associate (CCA).
Certified Professional Coder (CPC).
Answer: c
CERTIFICATIONS
The Certified Coding Specialist (CCS) certification is awarded through the:
American Health Information Management Association.
American Academy of Professional Coders.
National Center for Competency Testing.
National Healthcareer Association.
Answer: a
CERTIFICATIONS
The Certified Medical Billing Specialist (CMBS) certification is awarded through the:
American Health Information Management Association.
Medical Association of Billers.
National Center for Competency Testing.
National Healthcareer Association.
Answer: b
CERTIFICATIONS
The Certified Professional Coder (CPC) certification is awarded through the:
American Academy of Professional Coders.
American Health Information Management Association.
National Center for Competency Testing.
National Healthcareer Association.
Answer: a
CERTIFICATIONS
The American Health Information Management Association awards the:
National Certified Medical Office Assistant (NCMOA) certificate.
Certified Medical Administrative Assistant (CMAA) certificate.
Certified Medical Billing Specialist (CMBS) certificate.
Certified Coding Associate (CCA) certificate.
Answer: d
CERTIFICATIONS
The National Center for Competency Testing awards the:
National Certified Medical Office Assistant (NCMOA) certificate.
Certified Medical Administrative Assistant (CMAA) certificate.
Certified Medical Billing Specialist (CMBS) certificate.
Certified Coding Associate (CCA) certificate.
Answer: a
CERTIFICATIONS
The Certified Coding Specialist–Physician (CCS-P) demonstrates expertise in all of the following areas EXCEPT:
group practices.
hospitals.
specialty clinics.
solo practice offices.
Answer: b
CERTIFICATIONS
Applicants who are successful in passing the Certified Professional Coder–Hospital (CPC-H) examination, but have not met the required coding work experience, will be awarded:
Certified Professional Coder–Hospital (CPC-H) certification.
Certified Professional Coder–Physician (CPC-P) certification.
Certified Coding Specialist (CCS) certification.
Certified Professional Coder–Hospital–Apprentice (CPC-H-A) certificate.
Answer: d
CERTIFICATIONS
If you work in a doctor’s office, a clinic, or a similar setting, to demonstrate your ability, you should consider obtaining the:
Certified Professional Coder–Hospital (CPC-H) certification.
Certified Coding Specialist–Physician (CCS-P) certification.
Certified Coding Associate (CCA) certification.
Certified Medical Administrative Assistant (CMAA) certification.
Answer: b
CERTIFICATIONS
The Registered Health Information Technician (RHIT) certification proves proficiency in all of the following EXCEPT:
patient record maintenance and management.
ICD-9-CM and CPT® coding.
medical record analysis.
familiarity with regulations regarding patient health information.
Answer: b
CERTIFICATIONS
A registered health information technician (RHIT) ensures the quality of medical records by verifying that all records are:
complete.
accurate.
compliant with healthcare regulations.
all of the above.
Answer: d
CERTIFICATIONS
A candidate for Certified Medical Billing Specialist (CMBS) certification is motivated to:
improve his or her medical billing knowledge.
assist providers in obtaining maximum reimbursement for services.
develop new coding and documentation skills.
do all of the above.
Answer: d
CERTIFICATIONS
The certification offered by the American Medical Billing Association (AMBA) to those who pass their exam is:
Certified Medical Billing Specialist.
Certified Coding Specialist.
Registered Health Information Technician
Certified Medical Reimbursement Specialist.
Answer: d
CERTIFICATIONS
FILL-IN-THE-BLANK
Because of __________, physicians became responsible for filing health insurance claims.
Answer: managed care
EMPLOYMENT DEMAND
__________ personnel make up 60% of all healthcare professionals.
Answer: Allied health
EMPLOYMENT DEMAND
A facility that handles hospitals’ claims and accounts receivable for a state or region is called a(n) __________.
Answer: patient account services (PAS) facility
FACILITIES
A physician who chooses not to handle billing and insurance claims within his or her facility may contract with a(n) __________.
Answer: centralized billing office (CBO)
FACILITIES
A(n) __________ practice usually consists of three to nine physicians of the same specialty.
Answer: small-group
FACILITIES
The front office staff member who primarily handles administrative duties is referred to as a(n) __________.
Answer: medical office assistant or administrative medical assistant
JOB TITLES AND RESPONSIBILITIES
A(n) __________ contacts patients or insurance carriers to collect money owed to the facility or practice.
Answer: medical collector
JOB TITLES AND RESPONSIBILITIES
The individual who contacts insurance carriers to verify benefits is referred to as a(n) __________.
Answer: insurance verification representative
JOB TITLES AND RESPONSIBILITIES
A coder without much job experience can demonstrate competency by obtaining certification as a(n) __________.
Answer: Certified Coding Associate (CCA)
CERTIFICATIONS
After 1 year of experience, a medical office assistant can take an exam through the National Center for Competency Testing and be certified as a(n) __________.
Answer: National Certified Medical Office Assistant (NCMOA)
CERTIFICATIONS
MATCHING
medical office assistant
medical biller
medical coder
registered health information technician
payment poster
medical collector
refund specialist
insurance verification representative
admitting clerk
privacy compliance officer
_____ The position whose duties include reading Explanation of Benefits documents from insurance carriers and posting payments or adjustments to the appropriate accounts.
Answer: e
JOB TITLES AND RESPONSIBILITIES
_____ The position that is responsible for registering and greeting patients.
Answer: i
JOB TITLES AND RESPONSIBILITIES
_____ The position that manages the coding of diagnoses, procedures, and services.
Answer: c
JOB TITLES AND RESPONSIBILITIES
_____ The position that contacts patients or insurance carriers to collect money owed to the medical facility.
Answer: f
JOB TITLES AND RESPONSIBILITIES
_____ The position that handles administrative duties and is responsible for making a physician’s office function smoothly.
Answer: a
JOB TITLES AND RESPONSIBILITIES
_____ The position that is responsible for answering questions or explaining such topics as privacy regulations and living wills to patients and their family members.
Answer: j
JOB TITLES AND RESPONSIBILITIES
_____ The position that obtains precertification and/or prior authorization of services.
Answer: h
JOB TITLES AND RESPONSIBILITIES
_____ The position that reviews records for completeness, accuracy, and compliance with regulations.
Answer: d
JOB TITLES AND RESPONSIBILITIES
_____ The position that submits insurance claims and enters patient data and charge information.
Answer: b
JOB TITLES AND RESPONSIBILITIES
_____ The position that analyzes patient accounts to discern whether or not a refund is required.
Answer: g
JOB TITLES AND RESPONSIBILITIES
TRUE/FALSE
_____ Allied health employees make up 40% of all healthcare professionals.
Answer: False
EMPLOYMENT DEMAND
_____ A small-group practice will frequently contract out its billing and accounts receivable.
Answer: True
FACILITIES
_____ A large-group practice will frequently contract out its billing and accounts receivable.
Answer: False
FACILITIES
_____ It is rare today to find a privately owned hospital.
Answer: True
FACILITIES
_____ The processing of hospital claims often takes place off site.
Answer: True
FACILITIES
_____ If you want a career that includes opportunities to advance, working for a patient account services (PAS) facility is not ideal.
Answer: False
FACILITIES
_____ A centralized billing office (CBO) specializes in hospital claims.
Answer: False
FACILITIES
_____ All facilities will have the same specific job description for a medical biller.
Answer: False
JOB TITLES AND RESPONSIBILITIES
_____ A medical receptionist is considered back office staff in a physician’s office.
Answer: False
JOB TITLES AND RESPONSIBILITIES
_____ Most of a medical collector’s job is performed on the telephone.
Answer: True
JOB TITLES AND RESPONSIBILITIES
_____ The position of refund specialist requires research and analytical skills.
Answer: True
JOB TITLES AND RESPONSIBILITIES
_____ The privacy compliance officer is responsible for answering questions about the Health Insurance Portability and Accountability Act (HIPAA).
Answer: True
JOB TITLES AND RESPONSIBILITIES
_____ Professional memberships can help you keep current with developments in your field.
Answer: True
PROFESSIONAL MEMBERSHIPS
_____ Certification for medical coding and billing is a requirement for employment in the field.
Answer: False
CERTIFICATIONS
_____ To become a Certified Medical Administrative Assistant (CMAA), you must be a graduate of a healthcare training program or have 1 or more years of full-time job experience.
Answer: True
CERTIFICATIONS
_____ To achieve certification as a Certified Medical Billing Specialist (CMBS), an individual must have 5 or more years of job experience.
Answer: False
CERTIFICATIONS
_____ A Certified Coding Associate (CCA) does not need much job experience.
Answer: True
CERTIFICATIONS
_____ The Certified Professional Coder (CPC) certificate requires 2 years of work experience.
Answer: True
CERTIFICATIONS
_____ The American Academy of Professional Coders has separate examinations and certifications for physician and hospital services.
Answer: True
CERTIFICATIONS
_____ A registered health information technician (RHIT) is not responsible for the quality of medical records.
Answer: False
JOB TITLES AND RESPONSIBILITIES
SHORT ANSWER
Explain how managed care has created a demand for trained and certified medical billers.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Answer: With managed care, it has become the physician’s responsibility to file claims and wait 30 days or longer for payment. Additional staff was needed to process claims in a timely fashion.
EMPLOYMENT DEMAND
Before the 1970s, how did a physician’s practice grow?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Answer: Physicians relied on advertising and referrals for additional business.
EMPLOYMENT DEMAND
Describe the characteristics of a small-group practice.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Answer: A small-group practice often consists of four or five physicians of the same specialty. It will frequently contract out its billing and accounts receivable.
FACILITIES
Describe the characteristics of a large-group practice.
______________________________________________________________________________________________________________________________________________________________________________________________________________________________
Answer: A large-group practice usually consists of 10 or more physicians and may be a specialized practice. It will typically handle its own billing and accounts receivable.
FACILITIES
Name two examples of hospital corporations.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Answer: Hospital Corporation of America (HCA) and Tenet Health Care Corporation.
FACILITIES
Describe the characteristics of a patient account services (PAS) facility.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Answer: A PAS handles claims and accounts receivable for hospitals in a state or region. There can be as many as 500 employees in multiple departments.
FACILITIES
Describe the characteristics of a centralized billing office (CBO).
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Answer: CBOs are businesses that contract with physicians to handle their claims and/or accounts receivable.
FACILITIES
What are some of the major job responsibilities of a medical office assistant?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Answer: A medical office assistant may perform duties such as scheduling and confirming appointments; compiling and recording medical charts, reports, and correspondence; answering telephones; greeting patients; and directing patients and visitors to appropriate staff.
JOB TITLES AND RESPONSIBILITIES
What are some of the major job responsibilities of a registered health information technician (RHIT)?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Answer: Some of the major job responsibilities of an RHIT include compiling, processing, and maintaining medical records in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements.
JOB TITLES AND RESPONSIBILITIES
Describe some of the benefits of professional memberships.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Answer: Professional memberships help you keep current with issues and developments in your field. They offer opportunities for networking and professional development through courses, seminars, and conferences.
PROFESSIONAL MEMBERSHIPS
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