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  federal programs.

B  self-funded plans.

C  private insurance carriers.

D  state workers’ compensation funds.

A  District of Columbia Workers’ Compensation Act.

B  Federal Employees’ Compensation Act.

C  Energy Employees Occupational Illness Compensation Program Act.

D  Longshore and Harbor Workers’ Compensation Act.

A  Occupational Safety and Health for Private Employers Act.

B  District of Columbia Workers’ Compensation Act.

C  Energy Employees Occupational Illness Compensation Program Act.

D  Federal Employees’ Compensation Act.

A  Occupational Standards for Health Administration.

B  Optional Standards for Health Act.

C  Optional Safety and Health Act.

D  Occupational Safety and 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 and the patient.

B  the insurance carrier only.

C  None of these.

D  the patient only.

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 appropriate.

B  medically feasible.

C  medically reasonable.

D  medically necessary.

A  obtaining correct and complete patient information.

B  posting charges and diagnoses.

C  verifying patient insurance benefits.

D  entering patient information data into the computer.

A  Centers for Medicare and Medicaid Services (CMS).

B  Department of Defense (DoD).

C  Veterans Administration (VA) Health Administration Center.

D  Veterans Administration (VA) hospital network.

A  preventive care manager.

B  physician consulting manager.

C  primary care manager.

D  physician case manager.

A  $1,000 per beneficiary.

B  $7,500 per family.

C  $7,500 per beneficiary.

D  $1,000 per family.

A  June 30.

B  September 30.

C  December 31.

D  January 31.

A  TRICARE for Life

B  CHAMPVA.

C  TRICARE Standard.

D  TRICARE Prime.

A  service was not medically necessary.

B  necessary preauthorization was not obtained.

C  patient signed an advance beneficiary notice (ABN).

D  claim was not filed in a timely manner.

A  prescribed drugs.

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

C  transportation services.

D  physical therapy services.

A  prenatal care.

B  preventive services.

C  emergency services.

D  well-child checkups.

A  a deductible is paid.

B  Medicaid begins paying for services.

C  a coinsurance amount applies.

D  Medicare begins paying for services.

A  contracted insurance carriers.

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

C  each state government.

D  the federal government.

A  ambulance transportation.

B  outpatient hospital services.

C  clinical laboratory services.

D  routine foot care.

A  90 days.

B  30 days.

C  unlimited days if medically necessary.

D  60 days.

A  inpatient hospital care.

B  telemedicine.

C  hospice care.

D  home healthcare.

A  Centers for Medicare and Medicaid Services (CMS).

B  Internal Revenue Service (IRS).

C  Department of Health and Human Services (DHHS).

D  Social Security Administration (SSA).

A  age 65 or older.

B  end-stage renal disease.

C  disabled.

D  low income.

A  purple

B  black

C  red

D  blue

A  discharge status.

B  resource intensity.

C  treatment difficulty.

D  severity of illness.

A  prospective payment system.

B  capitation.

C  per diem.

D  fee for service.

A  fee for service.

B  prospective payment system.

C  per diem.

D  capitation.

A  discharge

B  diagnosis.

C  admission.

D  surgery.

A  CMS-1500 claim form

B  Superbill

C  Verification of benefits form

D  UB-04 claim form

A  every 3 years.

B  once per year.

C  at every visit.

D  every 2 years.

A  Explanation of benefits form

B  Patient information form

C  Assignment of benefits form

D  Release of information form

A  demographic information.

B  All of these.

C  insurance information.

D  employment information.

A  bank loans.

B  payments from insurance companies.

C  payments from patients.

D  private donations.

A  medicine.

B  evaluation and management (E/M).

C  radiology.

D  surgery.

A  bundling.

B  downcoding.

C  unbundling.

D  upcoding.

A  determine the accuracy of the physician’s documentation.

B  ensure compliance with HIPAA regulations.

C  assess the completeness of the medical record.

D  All of these.

A  It ensures compliance.

B  It delays insurance payment.

C  It decreases the workload of the medical office specialist.

D  It increases the risk of errors.

A  external audits.

B  accreditation audits.

C  internal audits.

D  certification audits.

A  clean.

B  accurate.

C  authorized.

D  complete.

A  two letters.

B  two letters or one letter and one number.

C  two letters or two numbers.

D  two digits.

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

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

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

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

A  Health Coding for Procedures and Claim Sets.

B  Healthcare Coding for Procedures and Claims Systems.

C  Healthcare Common Procedure Coding System.

D  Healthcare Current Procedures Coding System.

A  Evaluation and Management

B  Radiology

C  Anesthesia

D  Surgery

A  reduced reimbursement.

B  denials of claims.

C  increased reimbursement.

D  claim-processing delays.

A  arthroscopy.

B  abdominal distention.

C  osteopathic manipulation.

D  evaluation and management.

A  assign the code.

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

C  look under a related procedure for more information.

D  refer to the patient chart for more information.

A  bill the patient.

B  write off the entire amount.

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

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  charges on the original claim were not detailed.

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

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

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

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

B  fraudulent practice.

C  recommended practice.

D  requirement.

A  written explanation.

B  Category II CPT code.

C  Category III CPT code.

D  modifier.

A  Surgery.

B  Anesthesia.

C  Evaluation and Management .

D  Medicine.

A  increased use of nonstandard CPT codes.

B  elimination of local, temporary codes.

C  increased use of temporary codes for emerging technology.

D  use of local codes.

A  3 digits.

B  5 digits.

C  4 digits.

D  6 digits.

A  External Causes Index.

B  Neoplasm Table.

C  Tabular List of Diseases and Injuries.

D  Table of Drugs and Chemicals.

A  co-existing condition codes.

B  outpatient codes.

C  complication codes.

D  inpatient codes.

A  All of these.

B  conduct studies of disease trends.

C  forecast healthcare needs.

D  review costs and evaluate facilities.

A  calling the insurance carrier.

B  filling out a claim form.

C  reading and understanding the physician’s documentation.

D  registering the patient.