Weekly Quiz 7 Chapter 9 & 16

A  fraud.

B  conversion.

C  retention.

D  embezzlement.

A  1 year.

B  180 days.

C  3 years.

D  5 years.

A  Department of Labor.

B  carrier legal department.

C  carrier president.

D  Department of Insurance.

A  120 days.

B  90 days.

C  30 days.

D  60 days.

A  review by a qualified independent contractor.

B  review by an administrative law judge.

C  redetermination by the carrier.

D  review by the state insurance commissioner.

A  review by an administrative law judge.

B  redetermination by the carrier.

C  review by the state insurance commissioner.

D  review by a qualified independent contractor.

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  60 days after denial.

B  180 days after denial.

C  90 days after denial.

D  30 days after denial.

A  HIPAA.

B  ERISA.

C  FECA.

D  Title XXI of the Social Security Act.

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

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

C  the claim was for services related to an accident.

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

A  rebilling the claim.

B  telephone or fax.

C  sending a form letter.

D  sending a copy of pertinent court decisions.

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

B  the claim was considered not medically necessary.

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

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

A  about why the patient cannot afford to pay more.

B  about payment from other carriers for the reported service.

C  from the patient medical record.

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  objective information.

B  subjective information.

C  part of the assessment.

D  part of the plan.

A  assessment information.

B  the plan.

C  subjective information.

D  objective information.

A  assessment information.

B  subjective information.

C  the plan.

D  objective information.

A  physician should verbally verify that the service was provided.

B  service was not performed and cannot be billed.

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

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

A  medical transcription.

B  encounter form completion.

C  claims processing.

D  documentation.

A  use respect and care when explaining policy benefits.

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

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

D  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.

A  reconsideration.

B  audit.

C  adjudication.

D  appeal.

A  appeal committee review.

B  utilization review.

C  routine examination of claims.

D  peer review.

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

B  bill the patient.

C  write off the entire amount.

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

A  file an appeal with the insurance carrier.

B  bill the patient.

C  negotiate with the patient for partial payment.

D  write off the entire amount.

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

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

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

D  charges on the original claim were not detailed.

A  upcoding.

B  downcoding.

C  unbundling.

D  bundling.

A  True

B  False

A  critical care services.

B  subsequent in-hospital care.

C  an established patient office visit.

D  a new patient office visit.

A  CPT Appendix A.

B  CPT Appendix C.

C  CPT Index.

D  CPT Guidelines.

A  the possible management options.

B  the presenting problems.

C  All of these.

D  the diagnostic procedures.

A  low.

B  moderate.

C  minimal.

D  high.

A  must be coded.

B  must be part of the HPI.

C  can be stated or implied.

D  must be explicitly stated.

A  problem-focused exam.

B  detailed exam.

C  comprehensive exam.

D  expanded problem-focused exam.

A  body areas.

B  body organs.

C  organ systems.

D  tissue systems.

A  single organ system exam.

B  multibody-area exam.

C  general organ system exam.

D  general multisystem exam.

A  social history.

B  family history.

C  HPI.

D  past history.

A  pertinent.

B  complete.

C  detailed.

D  comprehensive.

A  brief or extended.

B  brief or comprehensive.

C  brief or detailed.

D  brief or complicated.

A  three HPI elements.

B  two HPI elements.

C  one HPI element.

D  four HPI elements.

A  severity.

B  context.

C  associated signs and symptoms.

D  quality.

A  quality.

B  severity.

C  duration.

D  timing.

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

B  review of systems (ROS).

C  history of present illness (HPI).

D  chief complaint (CC).

A  comprehensive.

B  expanded problem focused.

C  detailed.

D  problem focused.

A  upcode the service.

B  deny payment.

C  pay the service as billed.

D  unbundle the service.

A  extent of the history documented.

B  complexity of the diagnosis.

C  extent of the exam documented.

D  complexity of the medical decision making.

A  the provider.

B  all office staff.

C  the provider and the office manager.

D  the office manager.

A  unbundling.

B  upcoding.

C  bundling.

D  downcoding.

A  All of these.

B  practice employee.

C  government investigator.

D  private payer.

A  either prospectively or retrospectively.

B  retrospectively only.

C  neither prospectively or retrospectively.

D  prospectively only.

A  appropriate documentation of the visit.

B  accurate coding and billing.

C  completeness of progress reports.

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