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  private insurance carriers.

C  federal programs.

D  self-funded plans.

A  Longshore and Harbor Workers’ Compensation Act.

B  District of Columbia Workers’ Compensation Act.

C  Federal Employees’ Compensation Act.

D  Energy Employees Occupational Illness Compensation Program Act.

A  Energy Employees Occupational Illness Compensation Program Act.

B  District of Columbia Workers’ Compensation Act.

C  Occupational Safety and Health for Private Employers Act.

D  Federal Employees’ Compensation 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  None of these.

B  the insurance carrier and the patient.

C  the patient only.

D  the insurance carrier only.

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 necessary.

B  medically feasible.

C  medically reasonable.

D  medically appropriate.

A  posting charges and diagnoses.

B  verifying patient insurance benefits.

C  obtaining correct and complete patient information.

D  entering patient information data into the computer.

A  Department of Defense (DoD).

B  Centers for Medicare and Medicaid Services (CMS).

C  Veterans Administration (VA) hospital network.

D  Veterans Administration (VA) Health Administration Center.

A  physician consulting manager.

B  physician case manager.

C  preventive care manager.

D  primary care manager.

A  $1,000 per family.

B  $7,500 per beneficiary.

C  $1,000 per beneficiary.

D  $7,500 per family.

A  June 30.

B  December 31.

C  January 31.

D  September 30.

A  TRICARE Standard.

B  TRICARE for Life

C  CHAMPVA.

D  TRICARE Prime.

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  transportation services.

B  prescribed drugs.

C  physical therapy services.

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

A  well-child checkups.

B  preventive services.

C  prenatal care.

D  emergency services.

A  a deductible is paid.

B  Medicaid begins paying for services.

C  a coinsurance amount applies.

D  Medicare 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  routine foot care.

B  ambulance transportation.

C  clinical laboratory services.

D  outpatient hospital services.

A  60 days.

B  30 days.

C  90 days.

D  unlimited days if medically necessary.

A  hospice care.

B  home healthcare.

C  inpatient hospital care.

D  telemedicine.

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  disabled.

B  end-stage renal disease.

C  age 65 or older.

D  low income.

A  blue

B  red

C  black

D  purple

A  discharge status.

B  severity of illness.

C  treatment difficulty.

D  resource intensity.

A  per diem.

B  capitation.

C  fee for service.

D  prospective payment system.

A  fee for service.

B  capitation.

C  per diem.

D  prospective payment system.

A  diagnosis.

B  discharge

C  surgery.

D  admission.

A  Superbill

B  Verification of benefits form

C  UB-04 claim form

D  CMS-1500 claim form

A  once per year.

B  every 2 years.

C  at every visit.

D  every 3 years.

A  Patient information form

B  Release of information form

C  Assignment of benefits form

D  Explanation of benefits form

A  demographic information.

B  insurance information.

C  All of these.

D  employment information.

A  payments from patients.

B  private donations.

C  payments from insurance companies.

D  bank loans.

A  evaluation and management (E/M).

B  radiology.

C  medicine.

D  surgery.

A  upcoding.

B  bundling.

C  unbundling.

D  downcoding.

A  ensure compliance with HIPAA regulations.

B  assess the completeness of the medical record.

C  determine the accuracy of the physician’s documentation.

D  All of these.

A  It delays insurance payment.

B  It decreases the workload of the medical office specialist.

C  It increases the risk of errors.

D  It ensures compliance.

A  internal audits.

B  external audits.

C  accreditation audits.

D  certification audits.

A  accurate.

B  authorized.

C  complete.

D  clean.

A  two letters.

B  two letters or two numbers.

C  two digits.

D  two letters or one letter and one number.

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

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

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 Coding for Procedures and Claims Systems.

B  Healthcare Common Procedure Coding System.

C  Health Coding for Procedures and Claim Sets.

D  Healthcare Current Procedures Coding System.

A  Radiology

B  Anesthesia

C  Surgery

D  Evaluation and Management

A  increased reimbursement.

B  denials of claims.

C  claim-processing delays.

D  reduced reimbursement.

A  arthroscopy.

B  abdominal distention.

C  evaluation and management.

D  osteopathic manipulation.

A  look under a related procedure for more information.

B  assign the code.

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

D  refer to the patient chart for more information.

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

B  bill the patient.

C  write off the entire amount.

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

A  bill the patient.

B  write off the entire amount.

C  negotiate with the patient for partial payment.

D  file an appeal with the insurance carrier.

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

B  charges on the original claim were not detailed.

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

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

A  requirement.

B  fraudulent practice.

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

D  recommended practice.

A  Category III CPT code.

B  written explanation.

C  Category II CPT code.

D  modifier.

A  Evaluation and Management .

B  Anesthesia.

C  Surgery.

D  Medicine.

A  use of local codes.

B  increased use of temporary codes for emerging technology.

C  increased use of nonstandard CPT codes.

D  elimination of local, temporary codes.

A  3 digits.

B  4 digits.

C  6 digits.

D  5 digits.

A  External Causes Index.

B  Table of Drugs and Chemicals.

C  Tabular List of Diseases and Injuries.

D  Neoplasm Table.

A  inpatient codes.

B  co-existing condition codes.

C  outpatient codes.

D  complication codes.

A  review costs and evaluate facilities.

B  conduct studies of disease trends.

C  forecast healthcare needs.

D  All of these.

A  registering the patient.

B  reading and understanding the physician’s documentation.

C  filling out a claim form.

D  calling the insurance carrier.