Chapter 01: Role of an Insurance Billing Specialist
Fordney: Insurance Handbook for the Medical Office, 14th Edition

MULTIPLE CHOICE

	1.	What does the abbreviation MSHP designate?
a.	Multiple service health care professional	
b.	Multiskilled health practitioner	
c.	Multiskilled health professional	
d.	Managed care solo health practice	

ANS:	B	DIF:	Moderate	REF:	p. 4	OBJ:	1

	2.	Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring
a.	specialized health care practitioners.	
b.	health care workers with college degrees.	
c.	multiskilled health care practitioners.	
d.	untrained health care practitioners.	

ANS:	C	DIF:	Moderate	REF:	p. 4	OBJ:	3

	3.	Administrative medical office responsibilities include
a.	laboratory analyses.	
b.	claims submission.	
c.	taking x-rays.	
d.	venipunctures.	

ANS:	B	DIF:	Easy	REF:	p. 4	OBJ:	3

	4.	A claims assistance professional
a.	works for the consumer.	
b.	helps patients file insurance claims.	
c.	neither a nor b.	
d.	both a and b.	

ANS:	D	DIF:	Easy	REF:	p. 4	OBJ:	1

	5.	What is “cash flow” in a medical practice?
a.	The actual money available to a medical practice	
b.	The amount of money received by a medical practice in 1 day	
c.	The amount of money received by a medical practice in 1 month	
d.	The amount of outstanding money on the accounts receivable	

ANS:	A	DIF:	Hard	REF:	p. 9	OBJ:	1

	6.	Front office medical duties have become increasingly important because
a.	diagnostic and procedure coding must be reviewed for its correctness and completeness.	
b.	the number of office visits for patients has increased.	
c.	the number of patients belonging to managed care plans has decreased.	
d.	the number of doctors has decreased.	

ANS:	A	DIF:	Moderate	REF:	p. 9	OBJ:	6

	7.	Which level of education is generally required for one who seeks employment as an insurance coder?
a.	College diploma.	
b.	High school diploma.	
c.	Completion of an accredited program for coding certification.	
d.	No specific level of education is required.	

ANS:	C	DIF:	Hard	REF:	p. 9	OBJ:	4

	8.	Which organization published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements for physician billing?
a.	American Management Association (AMA)	
b.	American Academy of Professional Coders (AAPC)	
c.	American Association of Medical Assistants (AAMA)	
d.	American Health Information Management Association (AHIMA)	

ANS:	D	DIF:	Hard	REF:	p. 12	OBJ:	4

	9.	The amount of money an insurance billing specialist earns is dependent on which of the following factors?
a.	Knowledge	
b.	Experience	
c.	Size of employing institution	
d.	All of the above	

ANS:	D	DIF:	Moderate	REF:	p. 12	OBJ:	5

	10.	A billing specialist is entrusted with
a.	holding patients’ medical information in confidence.	
b.	collecting monies.	
c.	being a reliable resource for co-workers.	
d.	all of the above.	

ANS:	D	DIF:	Moderate	REF:	p. 16	OBJ:	1

	11.	Medical etiquette refers to
a.	consideration for others.	
b.	moral principles or practices.	
c.	laws.	
d.	the Oath of Hippocrates.	

ANS:	A	DIF:	Moderate	REF:	p. 14	OBJ:	9

	12.	Medical ethics include
a.	state laws.	
b.	federal laws.	
c.	standards of conduct.	
d.	civil torts.	

ANS:	C	DIF:	Moderate	REF:	p. 16	OBJ:	1 | 9

	13.	The earliest written code of ethical principles for the medical profession is the
a.	Oath of Hippocrates.	
b.	Socratic oath.	
c.	Code of Hammurabi.	
d.	Medicolegal oath.	

ANS:	C	DIF:	Moderate	REF:	p. 16	OBJ:	9

	14.	What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980?
a.	The Modern Standards of Conduct Code	
b.	The Principles of Medical Ethics	
c.	The Oath of Hippocrates	
d.	The American Medical Association Code of Ethics	

ANS:	B	DIF:	Hard	REF:	p. 16	OBJ:	9

	15.	What should you do if you discover that a patient of your physician employer is under the care of another physician for the same ailment?
a.	Notify your physician.	
b.	Honor the patient’s choice and say nothing.	
c.	Notify the other physician.	
d.	None of the above.	

ANS:	A	DIF:	Hard	REF:	pp. 16-17	OBJ:	10

	16.	Reporting incorrect information to private insurance carriers is considered
a.	unethical.	
b.	poor etiquette.	
c.	criminal.	
d.	illegal.	

ANS:	A	DIF:	Hard	REF:	p. 17	OBJ:	10

	17.	Which code of ethics is most appropriate for an insurance billing specialist who handles medical records?
a.	The American Health Information Management Association (AHIMA) code of ethics	
b.	The American Association of Medical Assistants, Inc. (AAMA) code of ethics	
c.	The claims assistance professional (CAP) code of ethics	
d.	The Certified Coding Specialist (CCS) code of ethics	

ANS:	A	DIF:	Hard	REF:	p. 17	OBJ:	9

	18.	AHIMA publishes
a.	diagnostic and procedure coding competencies for outpatient services.	
b.	diagnostic coding and reporting requirements.	
c.	diagnostic medical terminology.	
d.	both a and b.	

ANS:	D	DIF:	Moderate	REF:	p. 12	OBJ:	4

	19.	A self-employed medical insurance biller who does independent contracting is responsible for
a.	advertising.	
b.	billing.	
c.	accounting.	
d.	all of the above.	

ANS:	D	DIF:	Moderate	REF:	p. 12	OBJ:	5

	20.	The Internet Healthcare Coalition has developed
a.	the AAMA Code of Ethics.	
b.	the eHealth Code of Ethics.	
c.	the AMA Code of Ethics.	
d.	the AHIMA Code of Ethics.	

ANS:	B	DIF:	Moderate	REF:	p. 17	OBJ:	4 | 9

	21.	Reporting incorrect information to government-funded programs is
a.	unethical.	
b.	illegal.	
c.	abuse.	
d.	fraud.	

ANS:	B	DIF:	Moderate	REF:	p. 17	OBJ:	4 | 10

	22.	Insurance specialist certificate programs include
a.	anatomy.	
b.	diagnostic coding.	
c.	computer technology.	
d.	all of the above.	

ANS:	D	DIF:	Moderate	REF:	p. 9	OBJ:	4

	23.	The doctrine stating that physicians are legally responsible for both their own conduct and that of their employees is known as
a.	respondeat superior.	
b.	let the master answer.	
c.	vicarious liability.	
d.	all of the above.	

ANS:	D	DIF:	Moderate	REF:	p. 17	OBJ:	10

	24.	The AHIMA Code of Ethics is appropriate for
a.	health information specialists.	
b.	coders.	
c.	insurance billing specialists.	
d.	all of the above.	

ANS:	D	DIF:	Easy	REF:	p. 17	OBJ:	9

	25.	Why are multiskilled health practitioners (MSHPs) in demand?
a.	They are cross-trained to provide more than one function.	
b.	They are often competent in more than one discipline.	
c.	They offer more flexibility to their employer.	
d.	All of the above.	

ANS:	D	DIF:	Moderate	REF:	p. 4	OBJ:	12

COMPLETION

	1.	The Greek physician known as the Father of Medicine devised the ____________________.

ANS:	Oath of Hippocrates

DIF:	Hard	REF:	p. 16	OBJ:	9

	2.	Standards of conduct by which an insurance billing specialist determines the propriety of his or her behavior in a relationship are known as medical ____________________.

ANS:	ethics

DIF:	Moderate	REF:	p. 16	OBJ:	9

	3.	The earliest written code of ethical principles of medicine is called the ____________________.

ANS:	Code of Hammurabi

DIF:	Hard	REF:	p. 16	OBJ:	9

	4.	In 1980 the AMA adopted a modern code of ethics called the ______________________________.

ANS:	Principles of Medical Ethics

DIF:	Hard	REF:	p. 16	OBJ:	9

	5.	It is ____________________ to report incorrect information to private insurance carriers because this can possibly damage the individual and the integrity of the database.

ANS:	unethical

DIF:	Hard	REF:	p. 17	OBJ:	9

	6.	To report incorrect information to a Medicare fiscal intermediary is ____________________.

ANS:	illegal

DIF:	Hard	REF:	p. 17	OBJ:	9

	7.	Physicians are paid on the basis of _________________________ units.

ANS:	relative value

DIF:	Moderate	REF:	p. 3	OBJ:	1

	8.	Respondeat superior, which literally means “let the master answer,” is also known as ____________________ liability.

ANS:	vicarious

DIF:	Hard	REF:	p. 17	OBJ:	10

	9.	All insurance billing specialists should check with their physician employers to see whether the specialist is included in the medical professional ____________________ insurance policy.

ANS:	liability

DIF:	Moderate	REF:	p. 17	OBJ:	10

	10.	An NPP is a ______________________________.

ANS:	non-physician practitioner

DIF:	Moderate	REF:	p. 3	OBJ:	10

	11.	Maintenance of health information records and distribution of mail to various departments in an office is done by a ____________________.

ANS:	file clerk

DIF:	Easy	REF:	p. 4	OBJ:	3

	12.	Obtaining and recording patient data using a questionnaire before that person’s first visit is known as ____________________.

ANS:	preregistration

DIF:	Easy	REF:	p. 3	OBJ:	6

MATCHING

Determine whether the following statements are (a) illegal, (b) unethical, or (c) both illegal and unethical. You may use the three choices as many times as needed.
a.	Illegal	
b.	Unethical	
c.	Both illegal and unethical	

	1.	Using code numbers to increase payment when case documentation does not warrant it.

	2.	Reporting incorrect information to Medicare.

	3.	Coding services that were not performed for payment.

	4.	Unbundling services when an available single code includes all services.

	5.	Reporting incorrect information to a private insurance carrier.

	6.	Assigning a code without documentation from the provider.

	7.	Coding a condition as primary when the majority of the treatment is for a preexisting condition.

	1.	ANS:	C	DIF:	Moderate	REF:	p. 17	OBJ:	9

	2.	ANS:	A	DIF:	Moderate	REF:	p. 17	OBJ:	9

	3.	ANS:	C	DIF:	Moderate	REF:	p. 17	OBJ:	9

	4.	ANS:	C	DIF:	Moderate	REF:	p. 17	OBJ:	9

	5.	ANS:	B	DIF:	Moderate	REF:	p. 17	OBJ:	9

	6.	ANS:	C	DIF:	Moderate	REF:	p. 17	OBJ:	9

	7.	ANS:	C	DIF:	Moderate	REF:	p. 17	OBJ:	9

TRUE/FALSE

	1.	It is commonplace to find administrative duties shared by a number of specialists in the physician’s office.

ANS:	T	DIF:	Easy	REF:	p. 4	OBJ:	2

	2.	The primary goal of an insurance claims assistance professional (CAP) is to assist the consumer in obtaining maximum benefits and to tell the patient what checks to write to providers to make sure there are no overpayments.

ANS:	T	DIF:	Moderate	REF:	p. 4	OBJ:	10

	3.	In a medical practice, front office duties have lost importance.

ANS:	F	DIF:	Easy	REF:	p. 9	OBJ:	1

	4.	Generally, a high school diploma is not required for an insurance billing specialist.

ANS:	F	DIF:	Easy	REF:	p. 9	OBJ:	4

	5.	Working in a physician’s office as an insurance billing specialist carries greater responsibilities than operating a self-owned insurance billing business.

ANS:	F	DIF:	Moderate	REF:	p. 12	OBJ:	1

	6.	Electronic claims submissions are a format of the past.

ANS:	F	DIF:	Easy	REF:	p. 13	OBJ:	1

	7.	It is acceptable practice for medical office personnel to use a patient’s first name when speaking to the patient about his or her insurance.

ANS:	F	DIF:	Easy	REF:	p. 15	OBJ:	11

	8.	The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the physician.

ANS:	F	DIF:	Moderate	REF:	p. 16	OBJ:	9

	9.	The Centers for Medicare and Medicaid Services, formerly known as the Health Care Financing Administration, adopted the Principles of Medical Ethics in 1980.

ANS:	F	DIF:	Hard	REF:	p. 16	OBJ:	9

	10.	Illegal coding practices are subject to penalties, fines, and/or imprisonment.

ANS:	T	DIF:	Easy	REF:	p. 16	OBJ:	10

	11.	At certain times medical office staff members are allowed to make critical remarks about a physician to a patient.

ANS:	F	DIF:	Moderate	REF:	p. 16	OBJ:	9

	12.	It is illegal to report incorrect information to government-funded programs such as Medicare, Medicaid, and TRICARE.

ANS:	T	DIF:	Easy	REF:	p. 17	OBJ:	9

	13.	The title used for medical billing personnel may depend on the region of the United States where they work.

ANS:	T	DIF:	Easy	REF:	p. 4	OBJ:	1

	14.	Medical billing employees should be able to perform a variety of administrative duties pertaining to the business office.

ANS:	T	DIF:	Easy	REF:	p. 4	OBJ:	3

	15.	Insurance companies never require the patient to submit the claim form.

ANS:	F	DIF:	Moderate	REF:	p. 9	OBJ:	1

	16.	Physicians are legally responsible for any actions of their employees performed within the context of their employment; therefore, an employee cannot be sued or brought to trial.

ANS:	F	DIF:	Moderate	REF:	p. 17	OBJ:	10

	17.	Rules of etiquette for e-mail and cell telephone calls fall under the Health Insurance Portability and Accountability Act.

ANS:	T	DIF:	Moderate	REF:	p. 15	OBJ:	9

	18.	A claims assistance professional (CAP) acts as an informal representative of patients and helps patients interpret insurance contracts.

ANS:	F	DIF:	Moderate	REF:	p. 4	OBJ:	10

	19.	In some states, giving an insured client advice on purchase or discontinuance of insurance policies is construed as being an insurance agent.

ANS:	T	DIF:	Easy	REF:	p. 10	OBJ:	10

	20.	An insurance billing specialist uses general skills in following an employer’s established policies when dealing with the health care contract.

ANS:	T	DIF:	Hard	REF:	p. 9	OBJ:	12

	21.	The best way for an insurance specialist to keep up to date in the profession is to read health care industry association publications, attend seminars on billing and coding, and participate in e-mail listserv discussions.

ANS:	T	DIF:	Easy	REF:	p. 19	OBJ:	12