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  Longshore and Harbor Workers’ Compensation Act.

B  District of Columbia Workers’ Compensation Act.

C  Energy Employees Occupational Illness Compensation Program Act.

D  Federal Employees’ Compensation Act.

A  Occupational Safety and Health for Private Employers Act.

B  Federal Employees’ Compensation Act.

C  District of Columbia Workers’ Compensation Act.

D  Energy Employees Occupational Illness Compensation Program Act.

A  Optional Safety and Health Act.

B  Occupational Safety and Health Administration.

C  Optional Standards for Health Act.

D  Occupational Standards for Health Administration.

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

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

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

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

A  the insurance carrier only.

B  the insurance carrier and the patient.

C  the patient only.

D  None of these.

A  request assistance from the state insurance commissioner.

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

C  bill the patient for the remaining balance.

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

A  medically necessary.

B  medically feasible.

C  medically appropriate.

D  medically reasonable.

A  verifying patient insurance benefits.

B  entering patient information data into the computer.

C  posting charges and diagnoses.

D  obtaining correct and complete patient information.

A  Veterans Administration (VA) hospital network.

B  Department of Defense (DoD).

C  Veterans Administration (VA) Health Administration Center.

D  Centers for Medicare and Medicaid Services (CMS).

A  physician consulting manager.

B  physician case manager.

C  preventive care manager.

D  primary care manager.

A  $7,500 per family.

B  $1,000 per beneficiary.

C  $7,500 per beneficiary.

D  $1,000 per family.

A  January 31.

B  December 31.

C  September 30.

D  June 30.

A  TRICARE for Life

B  TRICARE Standard.

C  TRICARE Prime.

D  CHAMPVA.

A  service was not medically necessary.

B  patient signed an advance beneficiary notice (ABN).

C  necessary preauthorization was not obtained.

D  claim was not filed in a timely manner.

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

B  transportation services.

C  prescribed drugs.

D  physical therapy services.

A  emergency services.

B  prenatal care.

C  preventive services.

D  well-child checkups.

A  a deductible is paid.

B  Medicare begins paying for services.

C  a coinsurance amount applies.

D  Medicaid begins paying for services.

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

B  the federal government.

C  contracted insurance carriers.

D  each state government.

A  ambulance transportation.

B  clinical laboratory services.

C  outpatient hospital services.

D  routine foot care.

A  30 days.

B  60 days.

C  unlimited days if medically necessary.

D  90 days.

A  inpatient hospital care.

B  home healthcare.

C  hospice care.

D  telemedicine.

A  Centers for Medicare and Medicaid Services (CMS).

B  Internal Revenue Service (IRS).

C  Social Security Administration (SSA).

D  Department of Health and Human Services (DHHS).

A  low income.

B  end-stage renal disease.

C  disabled.

D  age 65 or older.

A  purple

B  black

C  red

D  blue

A  discharge status.

B  treatment difficulty.

C  resource intensity.

D  severity of illness.

A  per diem.

B  prospective payment system.

C  capitation.

D  fee for service.

A  per diem.

B  fee for service.

C  prospective payment system.

D  capitation.

A  admission.

B  diagnosis.

C  discharge

D  surgery.

A  Verification of benefits form

B  UB-04 claim form

C  Superbill

D  CMS-1500 claim form

A  every 3 years.

B  every 2 years.

C  at every visit.

D  once per year.

A  Explanation of benefits form

B  Release of information form

C  Assignment of benefits form

D  Patient information form

A  insurance information.

B  All of these.

C  demographic information.

D  employment information.

A  bank loans.

B  payments from insurance companies.

C  payments from patients.

D  private donations.

A  surgery.

B  radiology.

C  evaluation and management (E/M).

D  medicine.

A  unbundling.

B  downcoding.

C  bundling.

D  upcoding.

A  ensure compliance with HIPAA regulations.

B  assess the completeness of the medical record.

C  All of these.

D  determine the accuracy of the physician’s documentation.

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  internal audits.

B  external audits.

C  accreditation audits.

D  certification audits.

A  accurate.

B  clean.

C  authorized.

D  complete.

A  two letters or one letter and one number.

B  two letters.

C  two letters or two numbers.

D  two digits.

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

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

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

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

A  Healthcare Current Procedures Coding System.

B  Healthcare Coding for Procedures and Claims Systems.

C  Healthcare Common Procedure Coding System.

D  Health Coding for Procedures and Claim Sets.

A  Evaluation and Management

B  Surgery

C  Radiology

D  Anesthesia

A  claim-processing delays.

B  reduced reimbursement.

C  denials of claims.

D  increased reimbursement.

A  abdominal distention.

B  arthroscopy.

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  write off the entire amount.

B  bill the patient.

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

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

A  negotiate with the patient for partial payment.

B  write off the entire amount.

C  file an appeal with the insurance carrier.

D  bill the patient.

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

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

C  charges on the original claim were not detailed.

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

A  fraudulent practice.

B  requirement.

C  recommended practice.

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

A  written explanation.

B  Category III CPT code.

C  Category II CPT code.

D  modifier.

A  Anesthesia.

B  Surgery.

C  Medicine.

D  Evaluation and Management .

A  increased use of temporary codes for emerging technology.

B  increased use of nonstandard CPT codes.

C  use of local codes.

D  elimination of local, temporary codes.

A  5 digits.

B  3 digits.

C  6 digits.

D  4 digits.

A  Neoplasm Table.

B  Tabular List of Diseases and Injuries.

C  External Causes Index.

D  Table of Drugs and Chemicals.

A  outpatient codes.

B  complication codes.

C  inpatient codes.

D  co-existing condition codes.

A  All of these.

B  forecast healthcare needs.

C  review costs and evaluate facilities.

D  conduct studies of disease trends.

A  calling the insurance carrier.

B  filling out a claim form.

C  registering the patient.

D  reading and understanding the physician’s documentation.