Weekly Quiz 7 Chapter 9 & 16

A  embezzlement.

B  retention.

C  fraud.

D  conversion.

A  180 days.

B  1 year.

C  5 years.

D  3 years.

A  Department of Labor.

B  Department of Insurance.

C  carrier president.

D  carrier legal department.

A  30 days.

B  120 days.

C  90 days.

D  60 days.

A  review by a qualified independent contractor.

B  review by the state insurance commissioner.

C  redetermination by the carrier.

D  review by an administrative law judge.

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  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  180 days after denial.

B  60 days after denial.

C  30 days after denial.

D  90 days after denial.

A  FECA.

B  HIPAA.

C  ERISA.

D  Title XXI of the Social Security Act.

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

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

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

D  the claim was for services related to an accident.

A  rebilling the claim.

B  telephone or fax.

C  sending a form letter.

D  sending a copy of pertinent court decisions.

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

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

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

D  the claim was considered not medically necessary.

A  about why the patient cannot afford to pay more.

B  about the physician’s financial situation.

C  from the patient medical record.

D  about payment from other carriers for the reported service.

A  phone calls to the carrier.

B  All of these.

C  newsletters from the carrier.

D  an administrative manual.

A  part of the assessment.

B  part of the plan.

C  objective information.

D  subjective information.

A  objective information.

B  assessment information.

C  subjective information.

D  the plan.

A  the plan.

B  objective information.

C  assessment information.

D  subjective information.

A  service was not performed and cannot be billed.

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

C  physician should verbally verify that the service was provided.

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

A  claims processing.

B  documentation.

C  encounter form completion.

D  medical transcription.

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  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  explain in simple language why the insurance carrier denied payment.

A  appeal.

B  reconsideration.

C  audit.

D  adjudication.

A  appeal committee review.

B  peer review.

C  utilization review.

D  routine examination of claims.

A  bill the patient.

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

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

D  write off the entire amount.

A  write off the entire amount.

B  bill the patient.

C  negotiate with the patient for partial payment.

D  file an appeal with the insurance carrier.

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

B  charges on the original claim were not detailed.

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

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

A  upcoding.

B  downcoding.

C  unbundling.

D  bundling.

A  False

B  True

A  an established patient office visit.

B  subsequent in-hospital care.

C  critical care services.

D  a new patient office visit.

A  CPT Appendix C.

B  CPT Index.

C  CPT Appendix A.

D  CPT Guidelines.

A  the possible management options.

B  the diagnostic procedures.

C  All of these.

D  the presenting problems.

A  minimal.

B  high.

C  moderate.

D  low.

A  must be coded.

B  can be stated or implied.

C  must be explicitly stated.

D  must be part of the HPI.

A  problem-focused exam.

B  comprehensive exam.

C  expanded problem-focused exam.

D  detailed exam.

A  body areas.

B  organ systems.

C  tissue systems.

D  body organs.

A  general organ system exam.

B  general multisystem exam.

C  single organ system exam.

D  multibody-area exam.

A  social history.

B  family history.

C  HPI.

D  past history.

A  comprehensive.

B  detailed.

C  complete.

D  pertinent.

A  brief or detailed.

B  brief or extended.

C  brief or comprehensive.

D  brief or complicated.

A  one HPI element.

B  two HPI elements.

C  three HPI elements.

D  four HPI elements.

A  quality.

B  context.

C  associated signs and symptoms.

D  severity.

A  duration.

B  severity.

C  quality.

D  timing.

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

B  chief complaint (CC).

C  review of systems (ROS).

D  history of present illness (HPI).

A  detailed.

B  problem focused.

C  expanded problem focused.

D  comprehensive.

A  unbundle the service.

B  pay the service as billed.

C  upcode the service.

D  deny payment.

A  complexity of the diagnosis.

B  complexity of the medical decision making.

C  extent of the history documented.

D  extent of the exam documented.

A  the provider and the office manager.

B  the office manager.

C  all office staff.

D  the provider.

A  bundling.

B  downcoding.

C  upcoding.

D  unbundling.

A  All of these.

B  government investigator.

C  private payer.

D  practice employee.

A  neither prospectively or retrospectively.

B  either prospectively or retrospectively.

C  prospectively only.

D  retrospectively only.

A  accurate coding and billing.

B  appropriate documentation of the visit.

C  completeness of progress reports.

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