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Test answers for Medical Billing Certification 2020

(60) Last updated: January 22
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60 Answered Test Questions:

1. What are modifiers?


• They are used to add more information about a ICD-9 CM code

• They help in establishing "medical necessity"

• They are used to add more information about a CPT code

• They are an indicator to show that a procedure is linked to more than one diagnosis

2. Electronic Medical Claims (EMC) help to ___________.


• get the carrier more quickly than the paper claims

• pay more quickly than the paper claims

• notify more quickly in case the claim is rejected

• All of the above

3. The 'Group' in the 'Group Health Insurance Card' refers to the _________.


• employer

• the name of the insured

• the name of the insurance company

• third party administrator

4. CPT Codes are updated ________.


• once every 2 years

• annually

• whenever changes are necessary

• None of the above

5. What does the UB-04 form include?


• National Provider Identifier

• Taxonomy

• Guarantor Information

• Additional Codes

6. What is contained in the release of information (ROI) form?


• Name and signature of the patient

• The details of the information being transmitted

• The name of the medical biller

• None of the above

7. What is not a part of the diagnosis information?


• Macro Code

• Description

• Insurance Information

• Gender Specific Indication

• ICD9

8. Which of the following are required to organize your office as a medical biller?


• Computer

• CMS- 1500 forms

• Printed/ online coding resources

• Patient statement forms

• All of the above

9. Which of the following is not a part of Patient Condition Information?


• Name and UPIN of the physician that was referred

• Patient date of birth

• Diagnosis information

• Insured ID Number

10. What is a benefit?


• It is the function that a product performs

• It is what a feature does for a product

• It is the additional profits earned by a company

• It is the discount that a customer gets on a product

11. Which of the following aspects does administrative safeguards focus on?


• Administrative functions that ought to be applied to meet security standards

• Methods that should be applied to meet physical standards

• Administrative functions that prevent access to technical data

• All of the above

12. It is necessary to attach a document called _________ when submitting a secondary claim.


• Benefits of Explanation

• Certificate of Medical Necessity

• Explanation of Medical Necessity

• Explanation of Benefits

13. If the patient deductible is $600, and the deductible met is $400, the coverage is 60/40 and the physician's charge is $95, how much should the patient pay?


• $200

• $95

• $360

• $240

14. Which of the following is not a feature of Managed Care Plans?


• Charging a nominal fee from the members

• Eradicating unwanted services

• Charging a standard fee for healthcare provider and hospital services

• Itemizing each service and charging to the patient's account

15. Why was the accountability component added to HIPAA?


• To increase health care costs so that health care professionals earn more profits

• To prevent health care fraud and abuse

• To deny coverage to an individual who moves from one plan to another

• To ensure that individuals get renewed coverage if he moves from one plan to another

16. Why were security standards created in HIPAA?


• To provide easy accessibility to electronically transmitted health information to all users

• To provide a platform to safeguard only the electronic equipment and processes holding the health information

• To prevent unauthorized access of electronically stored and transmitted health information

• To safeguard electronically stored health information

17. What is a deductible?


• A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year

• The percentage that the policy will pay for a covered procedure

• The percentage that the policy will pay for diagnostic, lab and x-ray procedures

• The amount of out-of-pocket expenses that the insured/patient will have to incur in order for the policy to begin to pay at 100%

18. What are the main benefits of electronic claims?


• They provide a quicker means of reimbursement

• They facilitate quicker submission of claims

• They involve more paper work

• They lessen the interaction with the consulting physician

19. What is a covered entity?


• Any private organization or a government agency

• The organizations which maintain and upgrade ICD-9-CM codes

• The healthcare providers which are linked to PPOs

• The healthcare bodies covered by HIPAA

20. Which date format is used on the CMS 1500 Form?


• mm/dd/ccyy

• mm/dd/yy

• yy/mm/dd

• The date is not required

21. Which of the following is the first phase of the insurance claim life cycle?


• Entering the data about claim information

• Entering patient demographics in the claim form

• Collecting claim data

• Stating the name of the guarantor in the claim form

22. Which of these is not a kind of third-party reimbursement?


• Fee-for-service

• Capitation

• Episode of Care

• Managed care plans

23. What is an accident rider?


• A 100% coverage that is not subject to co-payment or deductible in the event that the patient seeks emergency treatment

• The amount of out-of-pocket expenses that the insured/patient will have to incur in order for the policy to begin to pay at 100%

• The remaining deductible amount not yet incurred by the insured party or family

• A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year

24. What does the bottom of the CMS 1500 Form report?


• Provider

• Procedure

• Diagnostic and Charge Information

• All of the above

• None of the above

25. Which of the following information is needed to complete the CMS 1500 form?


• Patient Information

• Insurance/Payment Information

• Guarantor Information

• Diagnostic Information (ICD-9 Codes)

• All of the above

26. Identify the order of events after a claim reaches the insurance carrier:
1.Application of leftover deductible
2.Examining the procedures performed and the 'medical necessity' on these procedures
3.Application of 'allowable payments options' for every procedure performed
4.Review of the claim for proper formatting and information


• 4231

• 4213

• 3421

• 3214

27. What is the length of the standard CPT codes?


• 7

• 4

• 5

• 2

28. What is the need for insurance verification?


• To determine the accuracy of the patient information and the insurance card

• To determine how the insurance will consider and/or pay for the services rendered

• To charge the patient for their portion appropriately

• To make the patient's information public

29. What is not one of the eligibility criteria for Medicare?


• You should be 65 or more than 65 years of age

• You should have retired on Social Security, Railroad Retirement, or federal government retirement programs

• It is meant for individuals who have been legally disabled for more than 2 years or who are suffering from end-stage renal disease

• You should be a resident of the United States

30. Which of the following does the acronym HIPAA stand for?


• Health Insurance Program and Accountability Act of 1996

• Health Insurance Portability and Accountability Act of 1996

• Health Insurance Portability, Accountability, and Administrative Act of 1995

• Health Insurance Portability and Administrative Act of 1995

31. How is the patient identified in case of Champva?


• VA File #

• Sponsor's SSN


• Medicare #

32. What is needed to file Worker's Compensation and Auto Insurance Claims?


• Patient Relationship to Insured

• Patient's Name

• Patient Address & Telephone Number

• Claim Number

33. Which are the disclosures exempted from minimum necessary?


• Permissive Disclosures

• Disclosure of Protected Health Information

• Disclosure of de-identified information

• None of the above

34. Which of these is not one of the co-operating parties which maintains and upgrades ICD-9-CM codes?


• World Health Organization(WHO)

• American Hospital Association (AHA)


• National Center for Health Statistics

35. The component 'National Identifier Standards' fall under which of the following components of HIPAA?


• Program

• Administrative Simplification

• Accountability

• Portability

36. In which of the following methods will you bill your clients for giving your services as a medical biller?


• By using a set fee

• By billing on a percentage of the claims submitted

• By percentage of collections

• All of the above

37. What do the CPT codes refer to?


• The disease that the patient is suffering from

• The diagnoses performed on the patient

• The procedures performed by a physician or a practitioner

• The names of the medicines prescribed by the practitioner

38. Which is a more efficient and less time consuming method to submit your claims?


• Through direct submissions

• Through HIPAA

• Through clearing houses

• All of the above

39. Fill up the blank:

National Provider Identifier is a _____ digit number.


• 8

• 9

• 10

• 4

40. What is the way to determine the primary and secondary policy if a child is covered under both parent's policies?


• Application of the "birthday rule"

• Application of the "insurance rule"

• The policy of both the mother and the father would be considered primary

• The policy of both the mother and the father would be considered secondary

41. What is a write off?


• It is a percentage of the charge or the dollar amount that the patient will pay to the provider for every encounter/visit

• It is the difference between the actual fee and the permitted fee

• It is the denial of a claim

• It is the ongoing fee paid to the insurance company by the insured

42. Which of the following correctly defines the Encounter Document?


• It is a form consisting of patient demographics, patient condition and guarantor information

• It is a form listing the present diagnosis and the past medical condition of the patient

• It is a form listing the insurance coverage information of a patient

• It is a form listing the services performed on a patient in a date of service

43. Which of these is not a type of  insurance coverage?


• Medicare

• Group Health/Medical Insurance

• Workers Compensation

• Campus

• Medical

44. What things should you emphasize on while selecting an attorney when starting your own medical billing business?


• You should look at his years of experience

• He should be able to develop a Compliance Plan in accordance with HIPAA protocols

• You should look at the attorney's ability to speak legal jargon with you

• You should look at his knowledge base about the entire legal system of your country

45. If the patient deductible is $700, and the deductible met is $685, the coverage is 80/20 and the physician's charge is $75, how much should the patient pay?


• $26

• $15

• $27

• $60

46. Which of the following is not necessarily a function performed by a medical biller?


• Performing insurance benefits verification and referral tasks

• Abstracting and coding of services rendered from a patient's medical records

• Submitting claims on Electronic Data Interchange (EDI)

• Mailing patient's billing statements

47. What is the role of a clearing house while submitting claims electronically?


• A clearing house acts as an intermediary between the billing center and the insurance carrier

• A clearing house allows the billing center to correct the errors in the rejected claim only once

• A clearing house posts the final payments to the referring physician's clinic

• A clearing house performs an initial computerized review of the claim submitted and sends the claim to the insurance carrier

48. Which body is responsible for implementing the Privacy Rules


• The Office of Civil Rights

• The American Medical Association

• World Health Organization

• All of the above

49. Which of these does not cover preventive care services?



• PPOs

• HMOs

• None of the above

50. Why was HIPAA enacted into a law?


• To implement portability requirements for individual and group health insurance plans

• To decrease administrative cost and burdens of the legal industry

• To ensure that individuals moving from one health plan to another does not get covered under the conditions of the already existing plan

• None of the above

51. Who among the following can also be a guarantor?


• The patient

• The physician

• The insurance company

• The medical biller

52. Which of the following is not a coding convention?


• Punctuation

• Articles

• Connecting Words

• Abbreviations

53. _____is an agreement made between the insurance company and the insured to send payments directly to the physician.


• Assignment of Benefits

• Coordination of Benefits

• Preauthorization

• Pre-Existing Conditions

54. What is the full form of AIDA?


• Attention, Interest, Desire And Action

• Action, Interest, Desire And Advertising

• Action, Interest, Desire And Attention

• None of the above

55. Which of these is not a suitable marketing strategy for medical billing business?


• Door-to-door marketing

• Cold Calling

• Mailing List

• Business Networking

56. State whether true or false:

HIPAA provides protections for both Group Health Plans and Individual Coverage.


• True

• False

57. Which of the following components of HIPAA have been put into effect?


• Portability and Administrative Simplification

• Portability and Accountability

• Accountability and Program

• Administrative Simplification and Program

58. State whether true or false:

Ideal practice management software should have good reporting and multi-tasking capabilities.


• True

• False

59. In which box are the CPT codes entered on the CMS-1500 Form?


• Box 24A

• Box 24D

• Box 24B

• Box 24C

60. Which of the following is the code for anesthesia (type of service code)?


• X*

• 99

• 07

• 15