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Patient Encounter and Billing Information in Healthcare Quiz

#1

In healthcare, what does EHR stand for?

Electronic Health Record
Explanation

EHR stands for Electronic Health Record, a digital version of a patient's paper chart.

#2

Which government program provides healthcare coverage for individuals aged 65 and older in the United States?

Medicare
Explanation

Medicare provides healthcare coverage for individuals aged 65 and older in the United States.

#3

What does the acronym 'HIPAA' stand for in healthcare?

Health Insurance Portability and Accountability Act
Explanation

HIPAA stands for Health Insurance Portability and Accountability Act, which protects patient privacy and sets security standards for electronic health information.

#4

What does the acronym 'HMO' stand for in healthcare?

Healthcare Maintenance Organization
Explanation

HMO stands for Health Maintenance Organization, a type of managed care organization that provides healthcare services.

#5

What is the primary purpose of the CPT code in medical billing?

Describe medical procedures and services
Explanation

CPT codes describe medical procedures and services for billing purposes.

#6

What does the term 'co-payment' refer to in healthcare billing?

The amount the insured patient pays out of pocket for a specific service
Explanation

A co-payment is the amount the insured patient pays out of pocket for a specific healthcare service.

#7

What is the purpose of a 'superbill' in medical billing?

A summary of services provided and associated costs for billing
Explanation

A superbill provides a summary of services provided and associated costs for medical billing purposes.

#8

What is the purpose of a 'pre-authorization' process in healthcare billing?

Obtaining approval from insurance before certain medical services are provided
Explanation

The purpose of pre-authorization is to obtain approval from insurance before certain medical services are provided, ensuring coverage.

#9

What is the role of a 'billing specialist' in healthcare administration?

Processing insurance claims and invoices
Explanation

A billing specialist processes insurance claims and invoices as part of healthcare administration.

#10

What is the purpose of the 'Explanation of Benefits (EOB)' statement in healthcare billing?

Explaining the reasons for a denied insurance claim
Explanation

The EOB statement explains the reasons for a denied insurance claim, detailing what was covered and not covered.

#11

Which of the following is an example of a 'UB-04' form?

Hospital inpatient claim form
Explanation

A UB-04 form is used for hospital inpatient claims.

#12

What is the role of the 'ICD-10' code in healthcare coding and billing?

Classifying diseases and related health problems
Explanation

ICD-10 codes classify diseases and related health problems for coding and billing purposes.

#13

What is a 'clearinghouse' in the context of healthcare billing?

An organization that processes and submits claims to insurance carriers
Explanation

A clearinghouse is an organization that processes and submits claims to insurance carriers on behalf of healthcare providers.

#14

In healthcare, what does the term 'Deductible' refer to in insurance plans?

The amount a patient must pay out-of-pocket before the insurance coverage begins
Explanation

A deductible is the amount a patient must pay out-of-pocket before insurance coverage begins.

#15

What does the term 'CMS-1500' refer to in healthcare billing?

A billing form used for professional claims and services
Explanation

CMS-1500 is a billing form used for professional claims and services in healthcare billing.

#16

What is the role of a 'compliance officer' in healthcare organizations?

Ensuring adherence to laws and regulations in healthcare practices
Explanation

A compliance officer ensures adherence to laws and regulations in healthcare practices within organizations.

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