Final Exam

A  worker is also receiving Social Security disability benefits.

B  worker signed an acknowledgement of workplace hazards.

C  worker failed to follow safety procedures.

A  state workers’ compensation funds.

B  federal programs.

C  self-funded plans.

D  private insurance carriers.

A  Energy Employees Occupational Illness Compensation Program Act.

B  Federal Employees’ Compensation Act.

C  Longshore and Harbor Workers’ Compensation Act.

D  District of Columbia Workers’ Compensation Act.

A  District of Columbia Workers’ Compensation Act.

B  Federal Employees’ Compensation Act.

C  Energy Employees Occupational Illness Compensation Program Act.

D  Occupational Safety and Health for Private Employers 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 $80 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 patient only.

C  the insurance carrier and the patient.

D  None of these.

A  request assistance from the state insurance commissioner.

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

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

D  bill the patient for the remaining balance.

A  medically feasible.

B  medically reasonable.

C  medically appropriate.

D  medically necessary.

A  posting charges and diagnoses.

B  entering patient information data into the computer.

C  verifying patient insurance benefits.

D  obtaining correct and complete patient information.

A  Department of Defense (DoD).

B  Veterans Administration (VA) Health Administration Center.

C  Centers for Medicare and Medicaid Services (CMS).

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 family.

B  $7,500 per family.

C  $7,500 per beneficiary.

D  $1,000 per beneficiary.

A  September 30.

B  December 31.

C  June 30.

D  January 31.

A  TRICARE Standard.

B  TRICARE Prime.

C  CHAMPVA.

D  TRICARE for Life

A  claim was not filed in a timely manner.

B  necessary preauthorization was not obtained.

C  patient signed an advance beneficiary notice (ABN).

D  service was not medically necessary.

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

B  transportation services.

C  physical therapy services.

D  prescribed drugs.

A  emergency services.

B  preventive services.

C  well-child checkups.

D  prenatal care.

A  a deductible is paid.

B  a coinsurance amount applies.

C  Medicare begins paying for services.

D  Medicaid begins paying for services.

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

B  contracted insurance carriers.

C  the federal government.

D  each state government.

A  ambulance transportation.

B  clinical laboratory services.

C  routine foot care.

D  outpatient hospital services.

A  30 days.

B  unlimited days if medically necessary.

C  90 days.

D  60 days.

A  telemedicine.

B  hospice care.

C  inpatient hospital care.

D  home healthcare.

A  Department of Health and Human Services (DHHS).

B  Internal Revenue Service (IRS).

C  Centers for Medicare and Medicaid Services (CMS).

D  Social Security Administration (SSA).

A  end-stage renal disease.

B  low income.

C  age 65 or older.

D  disabled.

A  blue

B  black

C  red

D  purple

A  discharge status.

B  treatment difficulty.

C  resource intensity.

D  severity of illness.

A  prospective payment system.

B  fee for service.

C  capitation.

D  per diem.

A  capitation.

B  fee for service.

C  per diem.

D  prospective payment system.

A  surgery.

B  admission.

C  discharge

D  diagnosis.

A  CMS-1500 claim form

B  Verification of benefits form

C  Superbill

D  UB-04 claim form

A  every 3 years.

B  once per year.

C  at every visit.

D  every 2 years.

A  Patient information form

B  Explanation of benefits form

C  Assignment of benefits form

D  Release of information form

A  insurance information.

B  All of these.

C  employment information.

D  demographic information.

A  bank loans.

B  private donations.

C  payments from insurance companies.

D  payments from patients.

A  evaluation and management (E/M).

B  surgery.

C  medicine.

D  radiology.

A  upcoding.

B  unbundling.

C  bundling.

D  downcoding.

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 increases the risk of errors.

B  It ensures compliance.

C  It delays insurance payment.

D  It decreases the workload of the medical office specialist.

A  internal audits.

B  certification audits.

C  accreditation audits.

D  external audits.

A  accurate.

B  authorized.

C  complete.

D  clean.

A  two letters or two numbers.

B  two digits.

C  two letters.

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

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

A  Healthcare Current Procedures Coding System.

B  Health Coding for Procedures and Claim Sets.

C  Healthcare Coding for Procedures and Claims Systems.

D  Healthcare Common Procedure Coding System.

A  Evaluation and Management

B  Surgery

C  Radiology

D  Anesthesia

A  claim-processing delays.

B  reduced reimbursement.

C  increased reimbursement.

D  denials of claims.

A  arthroscopy.

B  abdominal distention.

C  evaluation and management.

D  osteopathic manipulation.

A  assign the code.

B  refer to the patient chart for more information.

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

D  look under a related procedure for more information.

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

B  bill the patient.

C  write off the entire amount.

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

A  file an appeal with the insurance carrier.

B  bill the patient.

C  negotiate with the patient for partial payment.

D  write off the entire amount.

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

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

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

D  charges on the original claim were not detailed.

A  recommended practice.

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

C  fraudulent practice.

D  requirement.

A  Category II CPT code.

B  Category III CPT code.

C  modifier.

D  written explanation.

A  Surgery.

B  Medicine.

C  Anesthesia.

D  Evaluation and Management .

A  increased use of temporary codes for emerging technology.

B  use of local codes.

C  increased use of nonstandard CPT codes.

D  elimination of local, temporary codes.

A  4 digits.

B  6 digits.

C  3 digits.

D  5 digits.

A  Tabular List of Diseases and Injuries.

B  Neoplasm Table.

C  External Causes Index.

D  Table of Drugs and Chemicals.

A  complication codes.

B  outpatient codes.

C  co-existing condition codes.

D  inpatient codes.

A  review costs and evaluate facilities.

B  forecast healthcare needs.

C  conduct studies of disease trends.

D  All of these.

A  calling the insurance carrier.

B  filling out a claim form.

C  reading and understanding the physician’s documentation.

D  registering the patient.