Final Exam

A  worker signed an acknowledgement of workplace hazards.

B  worker failed to follow safety procedures.

C  worker is also receiving Social Security disability benefits.

A  self-funded plans.

B  federal programs.

C  private insurance carriers.

D  state workers’ compensation funds.

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  Occupational Safety and Health for Private Employers Act.

C  Federal Employees’ Compensation Act.

D  Energy Employees Occupational Illness Compensation Program Act.

A  Optional Standards for Health Act.

B  Occupational Standards for Health Administration.

C  Optional Safety and Health Act.

D  Occupational Safety and Health Administration.

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

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

C  $150 from the insurance carrier and $50 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  the patient only.

D  None of these.

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 appropriate.

B  medically feasible.

C  medically reasonable.

D  medically necessary.

A  obtaining correct and complete patient information.

B  verifying patient insurance benefits.

C  entering patient information data into the computer.

D  posting charges and diagnoses.

A  Veterans Administration (VA) Health Administration Center.

B  Department of Defense (DoD).

C  Centers for Medicare and Medicaid Services (CMS).

D  Veterans Administration (VA) hospital network.

A  physician consulting manager.

B  physician case manager.

C  primary care manager.

D  preventive care manager.

A  $7,500 per beneficiary.

B  $1,000 per family.

C  $1,000 per beneficiary.

D  $7,500 per family.

A  September 30.

B  January 31.

C  June 30.

D  December 31.

A  TRICARE for Life

B  TRICARE Standard.

C  CHAMPVA.

D  TRICARE Prime.

A  necessary preauthorization was not obtained.

B  patient signed an advance beneficiary notice (ABN).

C  claim was not filed in a timely manner.

D  service was not medically necessary.

A  physical therapy services.

B  prescribed drugs.

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

D  transportation services.

A  emergency services.

B  prenatal care.

C  preventive 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  the Centers for Medicare and Medicaid Services (CMS).

B  each state government.

C  the federal government.

D  contracted insurance carriers.

A  routine foot care.

B  ambulance transportation.

C  outpatient hospital services.

D  clinical laboratory services.

A  90 days.

B  60 days.

C  30 days.

D  unlimited days if medically necessary.

A  telemedicine.

B  home healthcare.

C  inpatient hospital care.

D  hospice care.

A  Social Security Administration (SSA).

B  Internal Revenue Service (IRS).

C  Centers for Medicare and Medicaid Services (CMS).

D  Department of Health and Human Services (DHHS).

A  age 65 or older.

B  disabled.

C  low income.

D  end-stage renal disease.

A  blue

B  purple

C  black

D  red

A  severity of illness.

B  treatment difficulty.

C  resource intensity.

D  discharge status.

A  capitation.

B  per diem.

C  fee for service.

D  prospective payment system.

A  prospective payment system.

B  capitation.

C  fee for service.

D  per diem.

A  admission.

B  surgery.

C  diagnosis.

D  discharge

A  UB-04 claim form

B  Verification of benefits form

C  Superbill

D  CMS-1500 claim form

A  every 3 years.

B  once per year.

C  every 2 years.

D  at every visit.

A  Patient information form

B  Assignment of benefits form

C  Release of information form

D  Explanation of benefits form

A  All of these.

B  insurance information.

C  employment information.

D  demographic information.

A  payments from patients.

B  private donations.

C  payments from insurance companies.

D  bank loans.

A  radiology.

B  medicine.

C  surgery.

D  evaluation and management (E/M).

A  upcoding.

B  unbundling.

C  bundling.

D  downcoding.

A  ensure compliance with HIPAA regulations.

B  All of these.

C  determine the accuracy of the physician’s documentation.

D  assess the completeness of the medical record.

A  It delays insurance payment.

B  It ensures compliance.

C  It increases the risk of errors.

D  It decreases the workload of the medical office specialist.

A  accreditation audits.

B  internal audits.

C  external audits.

D  certification audits.

A  authorized.

B  clean.

C  complete.

D  accurate.

A  two letters.

B  two digits.

C  two letters or one letter and one number.

D  two letters or two numbers.

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  Health Coding for Procedures and Claim Sets.

B  Healthcare Common Procedure Coding System.

C  Healthcare Current Procedures Coding System.

D  Healthcare Coding for Procedures and Claims Systems.

A  Radiology

B  Surgery

C  Evaluation and Management

D  Anesthesia

A  claim-processing delays.

B  increased reimbursement.

C  denials of claims.

D  reduced reimbursement.

A  arthroscopy.

B  abdominal distention.

C  osteopathic manipulation.

D  evaluation and management.

A  assign the code.

B  look under a related procedure for more information.

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

D  refer to the patient chart for more information.

A  bill the patient.

B  write off the entire amount.

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

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  charges on the original claim were not detailed.

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

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  recommended practice.

B  requirement.

C  fraudulent practice.

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

A  Category III CPT code.

B  written explanation.

C  Category II CPT code.

D  modifier.

A  Surgery.

B  Evaluation and Management .

C  Medicine.

D  Anesthesia.

A  use of local codes.

B  elimination of local, temporary codes.

C  increased use of nonstandard CPT codes.

D  increased use of temporary codes for emerging technology.

A  6 digits.

B  5 digits.

C  4 digits.

D  3 digits.

A  Table of Drugs and Chemicals.

B  Neoplasm Table.

C  External Causes Index.

D  Tabular List of Diseases and Injuries.

A  complication codes.

B  outpatient codes.

C  co-existing condition codes.

D  inpatient codes.

A  forecast healthcare needs.

B  review costs and evaluate facilities.

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.