NCMA Medical Office Administration and Billing

Question 1

What does ICD-10-CM stand for, and what is its primary purpose in medical billing?

Accepted Answer

International Classification of Diseases, 10th revision, Clinical Modification; used to classify and code diagnoses

Answer

International Clinical Diagnostic Manual, 10th revision; used for procedure billing

Answer

Integrated Coding and Diagnosis, version 10; used for hospital billing only

Answer

Insurance Claims Database, 10th edition; used by payers to process claims

Question 2

What is the purpose of the superbill (encounter form) in a medical office?

Accepted Answer

A comprehensive form listing services rendered, diagnoses, and charges used to generate insurance claims

Answer

A bill sent to the patient for outstanding balances

Answer

An authorization form required before procedures can be performed

Answer

A government-mandated form for reporting communicable diseases

Question 3

Which of the following best defines the term 'co-insurance' in health insurance?

Accepted Answer

The percentage of covered medical costs the patient pays after meeting the deductible

Answer

A flat fee paid by the patient at the time of service

Answer

The maximum amount a patient pays out-of-pocket per year

Answer

A secondary insurance plan that covers what the primary plan does not

Question 4

What is a Prior Authorization (PA) and when is it required?

Accepted Answer

Advance approval from the insurance company required before certain procedures, medications, or referrals can be covered

Answer

A patient's consent form signed before all procedures

Answer

A physician's license to perform specialized procedures

Answer

An authorization to access the patient's electronic medical record

Question 5

When scheduling patient appointments, which scheduling system gives each appointment a fixed time slot and tends to minimize waiting room time?

Accepted Answer

Stream (fixed interval) scheduling

Answer

Wave scheduling

Answer

Open booking

Answer

Modified wave scheduling

Question 6

A patient calls to schedule a procedure but their insurance has not yet responded to the prior authorization request. What is the most appropriate response?

Accepted Answer

Inform the patient that the authorization is pending, provide an estimated timeframe, and schedule only after authorization is received or based on physician guidance

Answer

Schedule the procedure anyway since the insurance will likely approve it

Answer

Tell the patient to call their insurance company themselves to follow up

Answer

Cancel the prior authorization request and have the patient pay out of pocket