Final Exam

A  worker failed to follow safety procedures.

B  worker signed an acknowledgement of workplace hazards.

C  worker is also receiving Social Security disability benefits.

A  private insurance carriers.

B  self-funded plans.

C  state workers’ compensation funds.

D  federal programs.

A  Longshore and Harbor Workers’ Compensation Act.

B  Energy Employees Occupational Illness Compensation Program Act.

C  District of Columbia Workers’ Compensation Act.

D  Federal Employees’ Compensation Act.

A  District of Columbia Workers’ Compensation Act.

B  Energy Employees Occupational Illness Compensation Program Act.

C  Occupational Safety and Health for Private Employers Act.

D  Federal Employees’ Compensation 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  $160 from the insurance carrier and $40 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  $150 from the insurance carrier and $50 from the patient.

A  None of these.

B  the insurance carrier only.

C  the patient only.

D  the insurance carrier and the patient.

A  bill the patient for the remaining balance.

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

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

D  request assistance from the state insurance commissioner.

A  medically appropriate.

B  medically necessary.

C  medically reasonable.

D  medically feasible.

A  obtaining correct and complete patient information.

B  posting charges and diagnoses.

C  entering patient information data into the computer.

D  verifying patient insurance benefits.

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  preventive care 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  June 30.

C  December 31.

D  January 31.

A  TRICARE for Life

B  TRICARE Standard.

C  TRICARE Prime.

D  CHAMPVA.

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  transportation services.

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

C  prescribed drugs.

D  physical therapy services.

A  emergency services.

B  well-child checkups.

C  prenatal care.

D  preventive services.

A  a coinsurance amount applies.

B  Medicare begins paying for services.

C  Medicaid begins paying for services.

D  a deductible is paid.

A  contracted insurance carriers.

B  each state government.

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

D  the federal government.

A  clinical laboratory services.

B  routine foot care.

C  ambulance transportation.

D  outpatient hospital services.

A  90 days.

B  60 days.

C  30 days.

D  unlimited days if medically necessary.

A  inpatient hospital care.

B  home healthcare.

C  telemedicine.

D  hospice care.

A  Centers for Medicare and Medicaid Services (CMS).

B  Department of Health and Human Services (DHHS).

C  Social Security Administration (SSA).

D  Internal Revenue Service (IRS).

A  low income.

B  disabled.

C  end-stage renal disease.

D  age 65 or older.

A  purple

B  blue

C  black

D  red

A  treatment difficulty.

B  discharge status.

C  severity of illness.

D  resource intensity.

A  prospective payment system.

B  per diem.

C  fee for service.

D  capitation.

A  capitation.

B  fee for service.

C  per diem.

D  prospective payment system.

A  discharge

B  surgery.

C  diagnosis.

D  admission.

A  CMS-1500 claim form

B  UB-04 claim form

C  Verification of benefits form

D  Superbill

A  once per year.

B  at every visit.

C  every 3 years.

D  every 2 years.

A  Explanation of benefits form

B  Patient information form

C  Release of information form

D  Assignment of benefits form

A  All of these.

B  insurance information.

C  demographic information.

D  employment information.

A  private donations.

B  payments from patients.

C  bank loans.

D  payments from insurance companies.

A  surgery.

B  radiology.

C  medicine.

D  evaluation and management (E/M).

A  bundling.

B  unbundling.

C  downcoding.

D  upcoding.

A  ensure compliance with HIPAA regulations.

B  All of these.

C  assess the completeness of the medical record.

D  determine the accuracy of the physician’s documentation.

A  It increases the risk of errors.

B  It ensures compliance.

C  It decreases the workload of the medical office specialist.

D  It delays insurance payment.

A  external audits.

B  accreditation audits.

C  internal audits.

D  certification audits.

A  clean.

B  accurate.

C  complete.

D  authorized.

A  two letters or one letter and one number.

B  two digits.

C  two letters.

D  two letters or two numbers.

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

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

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

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

A  Health Coding for Procedures and Claim Sets.

B  Healthcare Common Procedure Coding System.

C  Healthcare Coding for Procedures and Claims Systems.

D  Healthcare Current Procedures Coding System.

A  Anesthesia

B  Evaluation and Management

C  Radiology

D  Surgery

A  increased reimbursement.

B  denials of claims.

C  reduced reimbursement.

D  claim-processing delays.

A  evaluation and management.

B  osteopathic manipulation.

C  arthroscopy.

D  abdominal distention.

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  bill the patient.

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

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

D  write off the entire amount.

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  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  charges on the original claim were not detailed.

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

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  modifier.

C  written explanation.

D  Category III CPT code.

A  Evaluation and Management .

B  Anesthesia.

C  Medicine.

D  Surgery.

A  increased use of nonstandard CPT codes.

B  increased use of temporary codes for emerging technology.

C  use of local 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  Neoplasm Table.

D  Tabular List of Diseases and Injuries.

A  co-existing condition codes.

B  inpatient codes.

C  complication codes.

D  outpatient codes.

A  review costs and evaluate facilities.

B  conduct studies of disease trends.

C  forecast healthcare needs.

D  All of these.

A  reading and understanding the physician’s documentation.

B  registering the patient.

C  filling out a claim form.

D  calling the insurance carrier.