#1
What is the primary purpose of medical insurance billing?
To process claims for reimbursement
ExplanationFacilitates reimbursement through claims processing.
#2
Which of the following is NOT typically included in a medical insurance claim?
Patient's medical history
ExplanationClaims usually exclude detailed patient medical history.
#3
In medical billing, what does the term 'EOB' stand for?
Explanation of Benefits
ExplanationEOB provides details on benefits and payments.
#4
What is a common reason for medical insurance claims to be denied?
Lack of medical necessity
ExplanationClaims are often denied due to insufficient medical necessity.
#5
Which of the following is NOT a typical step in the medical insurance billing process?
Pharmacy dispensing
ExplanationPharmacy dispensing is not a usual billing process step.
#6
What is a common consequence of improper medical coding in insurance claims?
Delayed reimbursement
ExplanationImproper coding often leads to delayed reimbursement.
#7
What is the primary purpose of a CMS-1500 form in medical billing?
To document patient demographics and insurance information
ExplanationCaptures patient and insurance details for billing purposes.
#8
What is the role of a clearinghouse in medical claim processing?
To review and correct errors in insurance claims
ExplanationClearinghouses ensure accuracy by reviewing and correcting claim errors.
#9
Which entity is responsible for setting medical billing and coding standards in the United States?
Centers for Medicare & Medicaid Services (CMS)
ExplanationCMS sets the standards for medical billing and coding in the US.
#10
What is the purpose of the CPT code set in medical billing?
To classify medical procedures and services
ExplanationClassifies procedures and services for billing purposes.
#11
Which department within a healthcare organization typically handles medical insurance billing and claim processing?
Revenue Cycle Management
ExplanationRevenue Cycle Management oversees billing and claim processing.
#12
What is a common reason for a claim to be rejected during the initial submission?
Incomplete insurance information
ExplanationClaims may be rejected if insurance information is incomplete.
#13
What is the purpose of the ICD-10-CM code set in medical billing?
To classify diseases and medical conditions
ExplanationClassifies diseases and conditions for standardized billing.
#14
Which federal law mandates the use of electronic transactions and code sets in healthcare?
HIPAA
ExplanationHIPAA mandates electronic transactions and code sets for healthcare.
#15
Which organization oversees the accreditation of coding education programs?
American Health Information Management Association (AHIMA)
ExplanationAHIMA oversees coding education program accreditation.