Weekly Quiz 7 Chapter 9 & 16

A  retention.

B  embezzlement.

C  conversion.

D  fraud.

A  5 years.

B  3 years.

C  180 days.

D  1 year.

A  Department of Insurance.

B  carrier president.

C  carrier legal department.

D  Department of Labor.

A  30 days.

B  90 days.

C  120 days.

D  60 days.

A  review by an administrative law judge.

B  review by a qualified independent contractor.

C  redetermination by the carrier.

D  review by the state insurance commissioner.

A  review by a qualified independent contractor.

B  review by an administrative law judge.

C  review by the state insurance commissioner.

D  redetermination by the carrier.

A  review by the state insurance commissioner.

B  redetermination by the carrier.

C  review by an administrative law judge.

D  review by a qualified independent contractor.

A  60 days after denial.

B  30 days after denial.

C  90 days after denial.

D  180 days after denial.

A  FECA.

B  HIPAA.

C  Title XXI of the Social Security Act.

D  ERISA.

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

B  the claim was for services related to an accident.

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

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

A  rebilling the claim.

B  telephone or fax.

C  sending a copy of pertinent court decisions.

D  sending a form letter.

A  the claim was considered not medically necessary.

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

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

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

A  about the physician’s financial situation.

B  about payment from other carriers for the reported service.

C  from the patient medical record.

D  about why the patient cannot afford to pay more.

A  All of these.

B  an administrative manual.

C  newsletters from the carrier.

D  phone calls to the carrier.

A  part of the assessment.

B  subjective information.

C  objective information.

D  part of the plan.

A  the plan.

B  assessment information.

C  objective information.

D  subjective information.

A  objective information.

B  assessment information.

C  the plan.

D  subjective information.

A  physician should verbally verify that the service was provided.

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

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

D  service was not performed and cannot be billed.

A  medical transcription.

B  documentation.

C  encounter form completion.

D  claims processing.

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

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

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  use respect and care when explaining policy benefits.

A  adjudication.

B  audit.

C  appeal.

D  reconsideration.

A  peer review.

B  appeal committee review.

C  routine examination of claims.

D  utilization review.

A  bill the patient.

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

C  write off the entire amount.

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

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

B  charges on the original claim were not detailed.

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

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

A  unbundling.

B  downcoding.

C  upcoding.

D  bundling.

A  False

B  True

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 Guidelines.

D  CPT Index.

A  All of these.

B  the presenting problems.

C  the diagnostic procedures.

D  the possible management options.

A  low.

B  moderate.

C  high.

D  minimal.

A  can be stated or implied.

B  must be coded.

C  must be part of the HPI.

D  must be explicitly stated.

A  problem-focused exam.

B  detailed exam.

C  expanded problem-focused exam.

D  comprehensive exam.

A  organ systems.

B  body organs.

C  body areas.

D  tissue systems.

A  single organ system exam.

B  general multisystem exam.

C  multibody-area exam.

D  general organ system exam.

A  past history.

B  social history.

C  HPI.

D  family history.

A  detailed.

B  pertinent.

C  complete.

D  comprehensive.

A  brief or complicated.

B  brief or detailed.

C  brief or extended.

D  brief or comprehensive.

A  one HPI element.

B  four HPI elements.

C  two HPI elements.

D  three HPI elements.

A  quality.

B  severity.

C  context.

D  associated signs and symptoms.

A  severity.

B  timing.

C  duration.

D  quality.

A  review of systems (ROS).

B  chief complaint (CC).

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

D  history of present illness (HPI).

A  problem focused.

B  comprehensive.

C  expanded problem focused.

D  detailed.

A  unbundle the service.

B  deny payment.

C  pay the service as billed.

D  upcode the service.

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 provider and the office manager.

D  the office manager.

A  downcoding.

B  upcoding.

C  unbundling.

D  bundling.

A  private payer.

B  practice employee.

C  All of these.

D  government investigator.

A  neither prospectively or retrospectively.

B  either prospectively or retrospectively.

C  prospectively only.

D  retrospectively 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.