How to use ElectroniClaim / MediSoft clearinghouse upload procedure
ElectroniClaim Upload Procedure

Practice Tests

Practice Test 1

(Lessons 1 - 4)

Multiple Choice Section. Select the best single answer for each of the following items. Upon completion, compare your answers with the correct responses on the answer page.

1. A document that is generated when a patient receives medical care

is called a ______________________.

a. Statement of Medical Transaction

b. Medical Bill

c. Generated User Interface Document

d. Patient-Doctor Relationship account

2. As a medical claims specialist, it is your responsibility to __________

for the doctors for whom you work.

a. change medical codes on the bill

b. buy lunch

c. submit insurance claims

d. both b and c are correct

3. A pre-printed form used by some doctors that contains the most

common procedures performed by that doctor is called a/an

_______________________.

a. Account Easing document

b. HCFA 1500 form

c. Encounter form

d. Insurance form

4. When processing a bill as a medical claims specialist, you should

always check ________________ to make sure it is correct.

    1. the name of the insurance company
    2. the name of the patient
    3. the patient’s social security number
    4. all of the above

 

5. If an insurance company pays 80% of a claim of $100, the

patient is responsible for ______% of the bill.

    1. 20
    2. 10
    3. 80
    4. both a and c are correct

6. The insurance company that is billed first is called the ____________

carrier.

    1. secondary
    2. primary
    3. aircraft
    4. first-payment

7. An "outstanding" claim is one that ________________________.

    1. the insurance company has paid
    2. has multiple charges
    3. is filled out correctly
    4. has not yet been paid yet

8. An error on the HCFA form will _______________ reimbursement.

    1. delay
    2. not affect
    3. speed up
    4. all of the above

9. The medical claims specialist is responsible for________________ .

    1. transcribing the doctor’s taped notes
    2. filling out and submitting insurance claim forms
    3. examining patients
    4. scheduling patients

 

10. Charges that exceed the reasonable and customary scale of a policy

are_________________ by the carrier.

    1. disallowed
    2. paid anyway
    3. always applied toward the deductible
    4. none of the above

11. Traditional Insurance companies paid out benefits based on a

_________________ concept.

    1. managed care
    2. HMO
    3. PPO
    4. fee-for-service

12. When you write a code on an insurance form, you are ___________

that entry.

    1. deleting
    2. coding
    3. highlighting
    4. eliminating

13. If pre-authorization is required, but the insurance company is not

notified, the insurance company _________________.

    1. does not care
    2. might reduce reimbursement
    3. pays the excess
    4. all of the above

14. CPT stands for:

    1. California Procedure Terminology
    2. Care Procedure Terminology
    3. Current Primary Terminology
    4. Current Procedure Terminology

 

15. The diagnosis code is entered on line _____ of the HCFA-1500 form.

    1. 31
    2. 1
    3. 21
    4. It is not entered on the HCFA form.

16. When you trace an insurance claim , you should send _________ to

the insurance company.

    1. the name of the insured
    2. the date of service
    3. all procedures performed
    4. all of the above

 

 

Practice Test 2

(Lessons 5 - 7)

Multiple Choice Section. Select the best single answer for each of the following items. Upon completion, compare your answers with the correct responses on the answer page.

1. Physicians who limit their practice to one organ system or area of

medicine are called ____________.

    1. facets
    2. opportunities
    3. specialties
    4. generalizations

2. As a reimbursement specialist, you have four main responsibilities:

gathering information, completing the insurance forms, __________

and secondary insurance billing.

    1. complaint filing
    2. patient scheduling
    3. doctor scheduling
    4. following up with insurance companies

3. When you work at home, you need to make sure you can be ______.

    1. distracted
    2. effective
    3. focused
    4. both b and c are correct

4. Modifiers are used to indicate __________ circumstances during a

procedure.

    1. usual
    2. repeat
    3. unusual
    4. specific

 

5. When more than on modifier is used, it is known as _____________.

    1. surgery modifiers
    2. an unlisted procedure
    3. multiple modifiers
    4. bundling

6. ______________ is a standard that considers what a typical doctor

charges for a service and what the majority of patients of a doctor pay

for a service to determine an acceptable cost for that service.

    1. Relative value
    2. Usual and customary
    3. Actual charge
    4. Medicaid

7. The number that represents what the doctor did during a session with

a patient is called the ____________________.

    1. terminology code
    2. diagnostic code
    3. procedure code
    4. DRG

8. Suspected conditions are also known as _________________.

    1. unconfirmed diagnoses
    2. ruled out diagnoses
    3. investigated diagnoses
    4. none of the above

 

 

 

Practice Test 3

(Lessons 8 - 10)

Multiple Choice Section. Select the best single answer for each of the following items. Upon completion, compare your answers with the correct responses on the answer page.

1. DRG stands for _______________________.

    1. Digital Related Groups
    2. Diagnostic Related Groups
    3. Determined Related Generalizations
    4. Diagnostic Retroactive Guarantees
  1. Medicaid is a _________ administered program financed by both the

state and federal government.

    1. state
    2. federally
    3. privately
    4. none of the above

3. According to the federal minimum standards, Medicaid must cover

__________ basic services.

    1. five
    2. eight
    3. nine
    4. three

4. To file a claim with Medicaid, you must use a ___________ form.

    1. HCFA-1200
    2. HCFA-1450
    3. HCFA-1500 or a close equivalent
    4. HCFA-1900 or a close equivalent

 

5. The __________ number is required on all Medicare claim forms.

    1. Unique Physician Identifier
    2. Medigap
    3. Automatic Claim
    4. Isolated Incident

6. When filing a claim for CHAMPUS or CHAMPVA, you must send the

claims ____________________.

    1. directly to the Department of Defense
    2. to a fiscal intermediary
    3. to the local military hospital
    4. to the automobile insurance company

7. To determine the DRG rate, which of the following factors must be

considered? ________

    1. the principal diagnosis
    2. the secondary diagnosis
    3. the age and sex of the patient
    4. all of the above

8. PEER review organizations review __________________.

    1. admissions
    2. procedures
    3. both of the above
    4. none of the above

 

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Last modified: September 1, 1999.

Answer for Practice Self-Tests

Practice Test 1

  1. B

  2. C

  3. C

  4. D

  5. A

  6. B

  7. D

  8. A

  9. B

  10. A

  11. D

  12. B

  13. B

  14. D

  15. C

16. D

 

Practice Test 2

  1. C

  2. D

  3. D

  4. C

  5. C

  6. B

  7. C

  8. A

Practice Test 3

  1. B

  2. A

  3. B

  4. C

  5. A

  6. B

  7. D

  8. C

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How to use ElectroniClaim

Send mail to sales@electroniclaim.com with questions or comments about this web site.
(Last modified: July 5, 1999)
Copyright © 2000 Electroniclaim