#1
What is the primary function of medical billing?
To bill patients and insurance companies for healthcare services
ExplanationFacilitates reimbursement by invoicing patients and insurance for healthcare services.
#2
What is the purpose of a medical claim form?
To submit charges to insurance companies for reimbursement
ExplanationFacilitates reimbursement by submitting charges to insurance for coverage.
#3
Which of the following is NOT typically included in a medical claim?
Insurance premiums
ExplanationInsurance premiums are not part of the standard medical claim.
#4
Which government program provides healthcare coverage for individuals aged 65 and older in the United States?
Medicare
ExplanationMedicare offers healthcare coverage for individuals aged 65 and older.
#5
Which of the following is NOT a common type of healthcare provider?
Actuary
ExplanationAn actuary is not a healthcare provider.
#6
Which organization is responsible for assigning Current Procedural Terminology (CPT) codes?
American Medical Association (AMA)
ExplanationThe AMA is tasked with assigning CPT codes for medical procedures.
#7
What does the term 'ICD' stand for in medical billing?
International Classification of Diseases
ExplanationICD is the system used for classifying diseases and health problems.
#8
What is the purpose of a medical billing clearinghouse?
To process and format electronic claims before they are sent to insurance companies
ExplanationClearinghouses process and format electronic claims for efficient submission.
#9
What is the purpose of a National Provider Identifier (NPI) in medical billing?
To identify healthcare providers in the United States
ExplanationNPI uniquely identifies healthcare providers in the U.S.
#10
What does the term 'CMS' stand for in the context of medical billing?
Center for Medicare & Medicaid Services
ExplanationCMS oversees healthcare services for Medicare and Medicaid recipients.
#11
In medical billing, what is the term 'EOB' an abbreviation for?
Explanation of Benefits
ExplanationEOB provides details on what healthcare services were covered by insurance.
#12
What is the purpose of the Health Insurance Portability and Accountability Act (HIPAA) in medical billing?
To safeguard protected health information
ExplanationHIPAA ensures the protection of sensitive health information.
#13
What does 'EOC' stand for in medical billing?
Estimated Out-of-Pocket Costs
ExplanationEOC refers to the estimated out-of-pocket costs for patients.
#14
Which government agency oversees the regulation of electronic healthcare transactions in the United States?
Centers for Medicare & Medicaid Services (CMS)
ExplanationCMS oversees the regulation of electronic healthcare transactions in the U.S.
#15
What is a 'medical necessity' in the context of insurance billing?
The requirement that medical services provided be reasonable and necessary for the diagnosis or treatment of an illness or injury
ExplanationMedical necessity mandates services be reasonable and necessary for diagnosis or treatment.