NHI Medical Office Procedures & Billing 5 — Questions and Answers
Question 1: A physician sees a patient for a follow-up on hypertension and also addresses a new complaint of knee pain during the same visit. To bill both problems, the biller should use:
- Two separate claims on different dates
- A single claim with multiple diagnosis codes linked to appropriate procedure codes (Correct answer)
- Only the primary diagnosis on the claim
- A referral code for the secondary complaint
Correct answer: A single claim with multiple diagnosis codes linked to appropriate procedure codes
Multiple conditions addressed in the same visit are reported on a single claim with all relevant diagnosis codes linked to the appropriate procedure codes.
Question 2: The 'allowed amount' on an insurance payment represents:
- The total billed charge submitted by the provider
- The maximum amount the payer will reimburse for a given service (Correct answer)
- The amount the patient must pay out of pocket
- The provider's standard fee before any discount
Correct answer: The maximum amount the payer will reimburse for a given service
The allowed amount (also called the approved or contracted amount) is the maximum the payer will pay for a specific service under the provider's contract.
Question 3: A medical office that uses 'wave scheduling' typically:
- Books patients only on alternating days to manage provider workload
- Schedules multiple patients at the top of each hour, then none for the second half (Correct answer)
- Books appointments in 5-minute intervals throughout the day
- Reserves every other appointment slot for walk-in patients
Correct answer: Schedules multiple patients at the top of each hour, then none for the second half
Wave scheduling books several patients at the same start time each hour, allowing the provider to see them in order of arrival and accommodate variations in visit length.
Question 4: When a patient has both Medicare and Medicaid, Medicare is considered the:
- Secondary payer
- Primary payer (Correct answer)
- Supplemental payer
- Coordination payer
Correct answer: Primary payer
Medicare is always the primary payer for patients who have both Medicare and Medicaid; Medicaid pays secondary as the payer of last resort.
Question 5: Which of the following best describes 'upcoding' in medical billing?
- Correcting a previously submitted claim with a more accurate code
- Intentionally billing a higher-level code than the service rendered to increase payment (Correct answer)
- Using an unlisted code when no specific code exists
- Updating outdated codes to reflect current coding guidelines
Correct answer: Intentionally billing a higher-level code than the service rendered to increase payment
Upcoding is a fraudulent billing practice where a provider intentionally bills for a more expensive service than what was actually performed.
Question 6: A release of information form signed by a patient allows the medical office to:
- Collect payment directly from the patient's bank account
- Share protected health information with authorized parties (Correct answer)
- Photograph the patient for identification purposes
- Update the patient's insurance without verbal consent
Correct answer: Share protected health information with authorized parties
A signed release of information (ROI) form authorizes the medical office to disclose protected health information (PHI) to specified third parties.
Question 7: Which of the following is a key responsibility of a medical office manager related to billing?
- Personally treating patients when the physician is unavailable
- Overseeing the revenue cycle, including claims submission and collections (Correct answer)
- Prescribing medications on behalf of licensed providers
- Performing diagnostic tests to support billing documentation
Correct answer: Overseeing the revenue cycle, including claims submission and collections
A medical office manager is responsible for overseeing revenue cycle management, including monitoring claim submissions, denials, and collections to ensure financial health.
NHI Medical Office Procedures & Billing 5
A physician sees a patient for a follow-up on hypertension and also addresses a new complaint of knee pain during the same visit.
To bill both problems, the biller should use: