Weekly Quiz 7 Chapter 9 & 16

A  fraud.

B  conversion.

C  embezzlement.

D  retention.

A  180 days.

B  1 year.

C  3 years.

D  5 years.

A  Department of Labor.

B  carrier president.

C  carrier legal department.

D  Department of Insurance.

A  30 days.

B  120 days.

C  90 days.

D  60 days.

A  redetermination by the carrier.

B  review by the state insurance commissioner.

C  review by a qualified independent contractor.

D  review by an administrative law judge.

A  review by the state insurance commissioner.

B  review by an administrative law judge.

C  redetermination by the carrier.

D  review by a qualified independent contractor.

A  review by the state insurance commissioner.

B  review by a qualified independent contractor.

C  review by an administrative law judge.

D  redetermination by the carrier.

A  30 days after denial.

B  180 days after denial.

C  60 days after denial.

D  90 days after denial.

A  HIPAA.

B  Title XXI of the Social Security Act.

C  ERISA.

D  FECA.

A  a billing error was made by the medical office assistant.

B  the patient had a routine service covered by the policy.

C  the claim was for services related to an accident.

D  the carrier requested information from the patient that was not received.

A  sending a form letter.

B  rebilling the claim.

C  telephone or fax.

D  sending a copy of pertinent court decisions.

A  a modifier was used to indicate multiple procedures that the carrier bundled.

B  the patient had a routine service covered by the policy.

C  the claim was considered not medically necessary.

D  the carrier requested information from the patient that was not received.

A  from the patient medical record.

B  about why the patient cannot afford to pay more.

C  about payment from other carriers for the reported service.

D  about the physician’s financial situation.

A  newsletters from the carrier.

B  All of these.

C  an administrative manual.

D  phone calls to the carrier.

A  part of the plan.

B  part of the assessment.

C  objective information.

D  subjective information.

A  assessment information.

B  objective information.

C  subjective information.

D  the plan.

A  subjective information.

B  objective information.

C  the plan.

D  assessment information.

A  patient should be contacted to confirm the service was rendered.

B  physician should verbally verify that the service was provided.

C  medical office specialist should be contacted to modify the record.

D  service was not performed and cannot be billed.

A  claims processing.

B  medical transcription.

C  documentation.

D  encounter form completion.

A  explain in simple language why the insurance carrier denied payment.

B  use respect and care when explaining policy benefits.

C  if the denial was due to a need for additional information, submit the additional documentation immediately and let the patient know it has been done.

D  ask the patient to call the insurance carrier to try to get them to reconsider.

A  adjudication.

B  reconsideration.

C  appeal.

D  audit.

A  peer review.

B  utilization review.

C  appeal committee review.

D  routine examination of claims.

A  write off the entire amount.

B  submit the required information and follow up with the carrier.

C  bill the patient.

D  ask the patient to write a letter explaining the situation.

A  negotiate with the patient for partial payment.

B  bill the patient.

C  file an appeal with the insurance carrier.

D  write off the entire amount.

A  the patient was not eligible when the initial claim was filed.

B  the medical office specialist made a mistake on the claim.

C  charges on the original claim were not detailed.

D  some of the services provided to a patient were not billed on prior claims.

A  bundling.

B  upcoding.

C  unbundling.

D  downcoding.

A  False

B  True

A  a new patient office visit.

B  an established patient office visit.

C  subsequent in-hospital care.

D  critical care services.

A  CPT Guidelines.

B  CPT Appendix A.

C  CPT Appendix C.

D  CPT Index.

A  the presenting problems.

B  the possible management options.

C  All of these.

D  the diagnostic procedures.

A  minimal.

B  high.

C  moderate.

D  low.

A  must be part of the HPI.

B  can be stated or implied.

C  must be explicitly stated.

D  must be coded.

A  comprehensive exam.

B  problem-focused exam.

C  expanded problem-focused exam.

D  detailed exam.

A  tissue systems.

B  body organs.

C  body areas.

D  organ systems.

A  general organ system exam.

B  general multisystem exam.

C  multibody-area exam.

D  single organ system exam.

A  family history.

B  HPI.

C  social history.

D  past history.

A  comprehensive.

B  pertinent.

C  detailed.

D  complete.

A  brief or comprehensive.

B  brief or extended.

C  brief or detailed.

D  brief or complicated.

A  three HPI elements.

B  one HPI element.

C  four HPI elements.

D  two HPI elements.

A  quality.

B  severity.

C  associated signs and symptoms.

D  context.

A  severity.

B  timing.

C  quality.

D  duration.

A  history of present illness (HPI).

B  past, family, and social history (PFSH).

C  review of systems (ROS).

D  chief complaint (CC).

A  comprehensive.

B  detailed.

C  expanded problem focused.

D  problem focused.

A  unbundle the service.

B  pay the service as billed.

C  upcode the service.

D  deny payment.

A  extent of the exam documented.

B  complexity of the diagnosis.

C  complexity of the medical decision making.

D  extent of the history documented.

A  the provider.

B  all office staff.

C  the office manager.

D  the provider and the office manager.

A  bundling.

B  downcoding.

C  unbundling.

D  upcoding.

A  private payer.

B  All of these.

C  practice employee.

D  government investigator.

A  prospectively only.

B  either prospectively or retrospectively.

C  retrospectively only.

D  neither prospectively or retrospectively.

A  completeness of progress reports.

B  accurate coding and billing.

C  appropriate documentation of the visit.

D  the date of service and the patient’s insurance identification number.