Final Exam

A  worker is also receiving Social Security disability benefits.

B  worker failed to follow safety procedures.

C  worker signed an acknowledgement of workplace hazards.

A  self-funded plans.

B  state workers’ compensation funds.

C  private insurance carriers.

D  federal programs.

A  Federal Employees’ Compensation Act.

B  Energy Employees Occupational Illness Compensation Program Act.

C  Longshore and Harbor Workers’ Compensation Act.

D  District of Columbia Workers’ Compensation Act.

A  District of Columbia Workers’ Compensation Act.

B  Occupational Safety and Health for Private Employers Act.

C  Federal Employees’ Compensation Act.

D  Energy Employees Occupational Illness Compensation Program Act.

A  Optional Standards for Health Act.

B  Occupational Safety and Health Administration.

C  Optional Safety and Health Act.

D  Occupational Standards for Health Administration.

A  $150 from the insurance carrier and $50 from the patient.

B  $120 from the insurance carrier and $30 from the patient.

C  $160 from the insurance carrier and $40 from the patient.

D  $120 from the insurance carrier and $80 from the patient.

A  the insurance carrier only.

B  the patient only.

C  the insurance carrier and the patient.

D  None of these.

A  file a complaint with the Centers for Medicare and Medicaid Services (CMS).

B  request assistance from the state insurance commissioner.

C  bill the patient for the remaining balance.

D  file a complaint with the Department of Health and Human Services (DHHS).

A  medically reasonable.

B  medically feasible.

C  medically appropriate.

D  medically necessary.

A  entering patient information data into the computer.

B  obtaining correct and complete patient information.

C  posting charges and diagnoses.

D  verifying patient insurance benefits.

A  Centers for Medicare and Medicaid Services (CMS).

B  Veterans Administration (VA) hospital network.

C  Department of Defense (DoD).

D  Veterans Administration (VA) Health Administration Center.

A  physician consulting manager.

B  preventive care manager.

C  primary care manager.

D  physician case manager.

A  $1,000 per beneficiary.

B  $1,000 per family.

C  $7,500 per beneficiary.

D  $7,500 per family.

A  June 30.

B  January 31.

C  September 30.

D  December 31.

A  CHAMPVA.

B  TRICARE Standard.

C  TRICARE for Life

D  TRICARE Prime.

A  necessary preauthorization was not obtained.

B  patient signed an advance beneficiary notice (ABN).

C  claim was not filed in a timely manner.

D  service was not medically necessary.

A  physical therapy services.

B  prescribed drugs.

C  transportation services.

D  early and periodic screening, diagnostic, and treatment services for children younger than age 21.

A  prenatal care.

B  well-child checkups.

C  emergency services.

D  preventive services.

A  Medicaid begins paying for services.

B  Medicare begins paying for services.

C  a deductible is paid.

D  a coinsurance amount applies.

A  each state government.

B  the federal government.

C  contracted insurance carriers.

D  the Centers for Medicare and Medicaid Services (CMS).

A  ambulance transportation.

B  clinical laboratory services.

C  routine foot care.

D  outpatient hospital services.

A  90 days.

B  30 days.

C  unlimited days if medically necessary.

D  60 days.

A  telemedicine.

B  hospice care.

C  home healthcare.

D  inpatient hospital care.

A  Department of Health and Human Services (DHHS).

B  Centers for Medicare and Medicaid Services (CMS).

C  Internal Revenue Service (IRS).

D  Social Security Administration (SSA).

A  disabled.

B  end-stage renal disease.

C  age 65 or older.

D  low income.

A  purple

B  black

C  red

D  blue

A  resource intensity.

B  treatment difficulty.

C  severity of illness.

D  discharge status.

A  capitation.

B  fee for service.

C  prospective payment system.

D  per diem.

A  prospective payment system.

B  per diem.

C  fee for service.

D  capitation.

A  surgery.

B  discharge

C  admission.

D  diagnosis.

A  CMS-1500 claim form

B  UB-04 claim form

C  Superbill

D  Verification of benefits form

A  every 2 years.

B  once per year.

C  every 3 years.

D  at every visit.

A  Assignment of benefits form

B  Patient information form

C  Release of information form

D  Explanation of benefits form

A  demographic information.

B  All of these.

C  insurance information.

D  employment information.

A  payments from insurance companies.

B  private donations.

C  payments from patients.

D  bank loans.

A  surgery.

B  medicine.

C  evaluation and management (E/M).

D  radiology.

A  upcoding.

B  bundling.

C  unbundling.

D  downcoding.

A  All of these.

B  assess the completeness of the medical record.

C  determine the accuracy of the physician’s documentation.

D  ensure compliance with HIPAA regulations.

A  It delays insurance payment.

B  It ensures compliance.

C  It increases the risk of errors.

D  It decreases the workload of the medical office specialist.

A  certification audits.

B  accreditation audits.

C  internal audits.

D  external audits.

A  authorized.

B  complete.

C  accurate.

D  clean.

A  two digits.

B  two letters.

C  two letters or two numbers.

D  two letters or one letter and one number.

A  ensuring the validity of profiles and fee schedules through standardized coding.

B  coordinating government programs by uniform application of Centers for Medicare and Medicaid Services (CMS) policies.

C  implementing standard fee structures for all providers across all plans.

D  allowing providers and suppliers to communicate their services in a consistent manner.

A  Healthcare Common Procedure Coding System.

B  Health Coding for Procedures and Claim Sets.

C  Healthcare Coding for Procedures and Claims Systems.

D  Healthcare Current Procedures Coding System.

A  Evaluation and Management

B  Anesthesia

C  Radiology

D  Surgery

A  denials of claims.

B  increased reimbursement.

C  claim-processing delays.

D  reduced reimbursement.

A  arthroscopy.

B  evaluation and management.

C  abdominal distention.

D  osteopathic manipulation.

A  assign the code.

B  look under a related procedure for more information.

C  refer to the patient chart for more information.

D  verify the code in the main text of the CPT book.

A  bill the patient.

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

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

D  write off the entire amount.

A  write off the entire amount.

B  bill the patient.

C  file an appeal with the insurance carrier.

D  negotiate with the patient for partial payment.

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

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

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

D  charges on the original claim were not detailed.

A  recommended practice.

B  fraudulent practice.

C  requirement.

D  sign of error on the part of the physician’s office.

A  modifier.

B  written explanation.

C  Category II CPT code.

D  Category III CPT code.

A  Surgery.

B  Evaluation and Management .

C  Anesthesia.

D  Medicine.

A  increased use of nonstandard CPT codes.

B  increased use of temporary codes for emerging technology.

C  use of local codes.

D  elimination of local, temporary codes.

A  4 digits.

B  5 digits.

C  6 digits.

D  3 digits.

A  Tabular List of Diseases and Injuries.

B  Neoplasm Table.

C  Table of Drugs and Chemicals.

D  External Causes Index.

A  complication codes.

B  outpatient codes.

C  co-existing condition codes.

D  inpatient codes.

A  All of these.

B  conduct studies of disease trends.

C  review costs and evaluate facilities.

D  forecast healthcare needs.

A  calling the insurance carrier.

B  reading and understanding the physician’s documentation.

C  filling out a claim form.

D  registering the patient.