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  federal programs.

B  self-funded plans.

C  private insurance carriers.

D  state workers’ compensation funds.

A  Federal Employees’ Compensation Act.

B  Energy Employees Occupational Illness Compensation Program Act.

C  Longshore and Harbor Workers’ Compensation Act.

D  District of Columbia Workers’ Compensation 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 Standards for Health Administration.

B  Optional Standards for Health Act.

C  Occupational Safety and Health Administration.

D  Optional Safety and Health Act.

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

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

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

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

A  None of these.

B  the patient only.

C  the insurance carrier 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  request assistance from the state insurance commissioner.

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  posting charges and diagnoses.

B  entering patient information data into the computer.

C  obtaining correct and complete patient information.

D  verifying patient insurance benefits.

A  Department of Defense (DoD).

B  Veterans Administration (VA) Health Administration Center.

C  Veterans Administration (VA) hospital network.

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  $7,500 per beneficiary.

B  $7,500 per family.

C  $1,000 per family.

D  $1,000 per beneficiary.

A  September 30.

B  January 31.

C  December 31.

D  June 30.

A  TRICARE Prime.

B  TRICARE for Life

C  CHAMPVA.

D  TRICARE Standard.

A  service was not medically necessary.

B  necessary preauthorization was not obtained.

C  claim was not filed in a timely manner.

D  patient signed an advance beneficiary notice (ABN).

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  preventive services.

B  emergency services.

C  well-child checkups.

D  prenatal care.

A  a coinsurance amount applies.

B  Medicare begins paying for services.

C  Medicaid begins paying for services.

D  a deductible is paid.

A  each state government.

B  contracted insurance carriers.

C  the federal government.

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

A  outpatient hospital services.

B  clinical laboratory services.

C  routine foot care.

D  ambulance transportation.

A  unlimited days if medically necessary.

B  30 days.

C  90 days.

D  60 days.

A  hospice care.

B  home healthcare.

C  telemedicine.

D  inpatient hospital care.

A  Centers for Medicare and Medicaid Services (CMS).

B  Internal Revenue Service (IRS).

C  Social Security Administration (SSA).

D  Department of Health and Human Services (DHHS).

A  end-stage renal disease.

B  age 65 or older.

C  low income.

D  disabled.

A  black

B  blue

C  red

D  purple

A  treatment difficulty.

B  discharge status.

C  severity of illness.

D  resource intensity.

A  fee for service.

B  capitation.

C  prospective payment system.

D  per diem.

A  per diem.

B  capitation.

C  prospective payment system.

D  fee for service.

A  diagnosis.

B  surgery.

C  discharge

D  admission.

A  UB-04 claim form

B  Verification of benefits form

C  CMS-1500 claim form

D  Superbill

A  at every visit.

B  every 3 years.

C  every 2 years.

D  once per year.

A  Patient information form

B  Assignment of benefits form

C  Release of information form

D  Explanation of benefits form

A  All of these.

B  employment information.

C  demographic information.

D  insurance information.

A  payments from patients.

B  private donations.

C  bank loans.

D  payments from insurance companies.

A  evaluation and management (E/M).

B  surgery.

C  radiology.

D  medicine.

A  downcoding.

B  bundling.

C  unbundling.

D  upcoding.

A  All of these.

B  determine the accuracy of the physician’s documentation.

C  ensure compliance with HIPAA regulations.

D  assess the completeness of the medical record.

A  It ensures compliance.

B  It increases the risk of errors.

C  It delays insurance payment.

D  It decreases the workload of the medical office specialist.

A  internal audits.

B  external audits.

C  accreditation audits.

D  certification audits.

A  clean.

B  complete.

C  accurate.

D  authorized.

A  two letters or two numbers.

B  two letters or one letter and one number.

C  two letters.

D  two digits.

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

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

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

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

A  Healthcare Coding for Procedures and Claims Systems.

B  Healthcare Current Procedures Coding System.

C  Health Coding for Procedures and Claim Sets.

D  Healthcare Common Procedure Coding System.

A  Anesthesia

B  Radiology

C  Evaluation and Management

D  Surgery

A  reduced reimbursement.

B  denials of claims.

C  claim-processing delays.

D  increased reimbursement.

A  arthroscopy.

B  abdominal distention.

C  evaluation and management.

D  osteopathic manipulation.

A  look under a related procedure for more information.

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

C  assign the code.

D  refer to the patient chart for more information.

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

B  write off the entire amount.

C  bill the patient.

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

A  negotiate with the patient for partial payment.

B  file an appeal with the insurance carrier.

C  write off the entire amount.

D  bill the patient.

A  charges on the original claim were not detailed.

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

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

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

A  fraudulent practice.

B  recommended practice.

C  requirement.

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

A  written explanation.

B  modifier.

C  Category III CPT code.

D  Category II CPT code.

A  Evaluation and Management .

B  Medicine.

C  Surgery.

D  Anesthesia.

A  increased use of nonstandard CPT codes.

B  elimination of local, temporary codes.

C  use of local codes.

D  increased use of temporary codes for emerging technology.

A  5 digits.

B  6 digits.

C  3 digits.

D  4 digits.

A  External Causes Index.

B  Tabular List of Diseases and Injuries.

C  Neoplasm Table.

D  Table of Drugs and Chemicals.

A  complication codes.

B  inpatient codes.

C  outpatient codes.

D  co-existing condition codes.

A  conduct studies of disease trends.

B  forecast healthcare needs.

C  review costs and evaluate facilities.

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.