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  state workers’ compensation funds.

B  federal programs.

C  self-funded plans.

D  private insurance carriers.

A  Energy Employees Occupational Illness Compensation Program Act.

B  Longshore and Harbor Workers’ Compensation Act.

C  Federal Employees’ Compensation Act.

D  District of Columbia Workers’ Compensation Act.

A  Federal Employees’ Compensation Act.

B  District of Columbia Workers’ Compensation Act.

C  Occupational Safety and Health for Private Employers Act.

D  Energy Employees Occupational Illness Compensation Program Act.

A  Occupational Safety and Health Administration.

B  Optional Safety and Health Act.

C  Occupational Standards for Health Administration.

D  Optional Standards for Health Act.

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

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

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

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

A  the insurance carrier and the patient.

B  the insurance carrier only.

C  None of these.

D  the patient only.

A  bill the patient for the remaining balance.

B  request assistance from the state insurance commissioner.

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

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

A  medically necessary.

B  medically reasonable.

C  medically appropriate.

D  medically feasible.

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  Veterans Administration (VA) Health Administration Center.

B  Veterans Administration (VA) hospital network.

C  Department of Defense (DoD).

D  Centers for Medicare and Medicaid Services (CMS).

A  primary care manager.

B  preventive care manager.

C  physician consulting manager.

D  physician case manager.

A  $1,000 per beneficiary.

B  $7,500 per family.

C  $1,000 per family.

D  $7,500 per beneficiary.

A  December 31.

B  June 30.

C  January 31.

D  September 30.

A  CHAMPVA.

B  TRICARE Standard.

C  TRICARE Prime.

D  TRICARE for Life

A  necessary preauthorization was not obtained.

B  patient signed an advance beneficiary notice (ABN).

C  service was not medically necessary.

D  claim was not filed in a timely manner.

A  physical therapy services.

B  transportation services.

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

D  prescribed drugs.

A  emergency services.

B  preventive services.

C  prenatal care.

D  well-child checkups.

A  Medicaid begins paying for services.

B  a deductible is paid.

C  Medicare begins paying for services.

D  a coinsurance amount applies.

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

B  the federal government.

C  each state government.

D  contracted insurance carriers.

A  outpatient hospital services.

B  routine foot care.

C  clinical laboratory services.

D  ambulance transportation.

A  unlimited days if medically necessary.

B  90 days.

C  60 days.

D  30 days.

A  telemedicine.

B  inpatient hospital care.

C  hospice care.

D  home healthcare.

A  Department of Health and Human Services (DHHS).

B  Social Security Administration (SSA).

C  Centers for Medicare and Medicaid Services (CMS).

D  Internal Revenue Service (IRS).

A  low income.

B  end-stage renal disease.

C  disabled.

D  age 65 or older.

A  purple

B  red

C  black

D  blue

A  discharge status.

B  severity of illness.

C  resource intensity.

D  treatment difficulty.

A  prospective payment system.

B  per diem.

C  capitation.

D  fee for service.

A  prospective payment system.

B  fee for service.

C  capitation.

D  per diem.

A  surgery.

B  diagnosis.

C  discharge

D  admission.

A  UB-04 claim form

B  CMS-1500 claim form

C  Verification of benefits form

D  Superbill

A  at every visit.

B  once per year.

C  every 3 years.

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  demographic 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  surgery.

D  radiology.

A  bundling.

B  upcoding.

C  downcoding.

D  unbundling.

A  determine the accuracy of the physician’s documentation.

B  assess the completeness of the medical record.

C  All of these.

D  ensure compliance with HIPAA regulations.

A  It ensures compliance.

B  It delays insurance payment.

C  It increases the risk of errors.

D  It decreases the workload of the medical office specialist.

A  internal audits.

B  external audits.

C  certification audits.

D  accreditation audits.

A  authorized.

B  clean.

C  complete.

D  accurate.

A  two letters.

B  two letters or two numbers.

C  two letters or one letter and one number.

D  two digits.

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

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

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

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

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  Radiology

B  Anesthesia

C  Surgery

D  Evaluation and Management

A  reduced reimbursement.

B  denials of claims.

C  claim-processing delays.

D  increased reimbursement.

A  osteopathic manipulation.

B  arthroscopy.

C  abdominal distention.

D  evaluation and management.

A  look under a related procedure for more information.

B  assign the code.

C  refer to the patient chart for more information.

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

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

B  write off the entire amount.

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

D  bill the patient.

A  bill the patient.

B  negotiate with the patient for partial payment.

C  file an appeal with the insurance carrier.

D  write off the entire amount.

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

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

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

D  charges on the original claim were not detailed.

A  fraudulent practice.

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

C  requirement.

D  recommended practice.

A  modifier.

B  Category III CPT code.

C  Category II CPT code.

D  written explanation.

A  Evaluation and Management .

B  Surgery.

C  Medicine.

D  Anesthesia.

A  increased use of nonstandard CPT codes.

B  increased use of temporary codes for emerging technology.

C  elimination of local, temporary codes.

D  use of local codes.

A  5 digits.

B  4 digits.

C  6 digits.

D  3 digits.

A  Neoplasm Table.

B  External Causes Index.

C  Tabular List of Diseases and Injuries.

D  Table of Drugs and Chemicals.

A  co-existing condition codes.

B  outpatient codes.

C  inpatient codes.

D  complication codes.

A  conduct studies of disease trends.

B  All of these.

C  forecast healthcare needs.

D  review costs and evaluate facilities.

A  registering the patient.

B  calling the insurance carrier.

C  filling out a claim form.

D  reading and understanding the physician’s documentation.