Final Exam

A  worker is also receiving Social Security disability benefits.

B  worker signed an acknowledgement of workplace hazards.

C  worker failed to follow safety procedures.

A  federal programs.

B  self-funded plans.

C  private insurance carriers.

D  state workers’ compensation funds.

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  Federal Employees’ Compensation Act.

B  Energy Employees Occupational Illness Compensation Program Act.

C  District of Columbia Workers’ Compensation Act.

D  Occupational Safety and Health for Private Employers Act.

A  Occupational Safety and Health Administration.

B  Occupational Standards for Health Administration.

C  Optional Safety and Health Act.

D  Optional Standards for Health Act.

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

B  $160 from the insurance carrier and $40 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 only.

B  the patient only.

C  the insurance carrier and the patient.

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 Centers for Medicare and Medicaid Services (CMS).

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

A  medically feasible.

B  medically reasonable.

C  medically appropriate.

D  medically necessary.

A  posting charges and diagnoses.

B  obtaining correct and complete patient information.

C  verifying patient insurance benefits.

D  entering patient information data into the computer.

A  Centers for Medicare and Medicaid Services (CMS).

B  Veterans Administration (VA) Health Administration Center.

C  Department of Defense (DoD).

D  Veterans Administration (VA) hospital network.

A  primary care manager.

B  physician case manager.

C  preventive care manager.

D  physician consulting manager.

A  $1,000 per beneficiary.

B  $7,500 per family.

C  $7,500 per beneficiary.

D  $1,000 per family.

A  September 30.

B  December 31.

C  June 30.

D  January 31.

A  CHAMPVA.

B  TRICARE Standard.

C  TRICARE for Life

D  TRICARE Prime.

A  claim was not filed in a timely manner.

B  necessary preauthorization was not obtained.

C  service was not medically necessary.

D  patient signed an advance beneficiary notice (ABN).

A  transportation services.

B  physical therapy 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  Medicare begins paying for services.

B  a coinsurance amount applies.

C  Medicaid begins paying for services.

D  a deductible is paid.

A  the federal government.

B  contracted insurance carriers.

C  each state government.

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

A  routine foot care.

B  outpatient hospital services.

C  ambulance transportation.

D  clinical laboratory services.

A  60 days.

B  30 days.

C  90 days.

D  unlimited days if medically necessary.

A  home healthcare.

B  inpatient hospital care.

C  telemedicine.

D  hospice care.

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  age 65 or older.

B  low income.

C  disabled.

D  end-stage renal disease.

A  black

B  blue

C  purple

D  red

A  resource intensity.

B  treatment difficulty.

C  severity of illness.

D  discharge status.

A  per diem.

B  fee for service.

C  prospective payment system.

D  capitation.

A  fee for service.

B  capitation.

C  per diem.

D  prospective payment system.

A  discharge

B  diagnosis.

C  surgery.

D  admission.

A  CMS-1500 claim form

B  Verification of benefits form

C  UB-04 claim form

D  Superbill

A  once per year.

B  every 3 years.

C  every 2 years.

D  at every visit.

A  Explanation of benefits form

B  Assignment of benefits form

C  Patient information form

D  Release of information form

A  All of these.

B  insurance information.

C  demographic information.

D  employment information.

A  payments from insurance companies.

B  private donations.

C  payments from patients.

D  bank loans.

A  medicine.

B  radiology.

C  evaluation and management (E/M).

D  surgery.

A  bundling.

B  downcoding.

C  upcoding.

D  unbundling.

A  assess the completeness of the medical record.

B  determine the accuracy of the physician’s documentation.

C  All of these.

D  ensure compliance with HIPAA regulations.

A  It delays insurance payment.

B  It increases the risk of errors.

C  It ensures compliance.

D  It decreases the workload of the medical office specialist.

A  internal audits.

B  accreditation audits.

C  certification audits.

D  external audits.

A  complete.

B  clean.

C  accurate.

D  authorized.

A  two digits.

B  two letters.

C  two letters or two numbers.

D  two letters or one letter and one number.

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

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

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

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

A  Healthcare Common Procedure Coding System.

B  Healthcare Coding for Procedures and Claims Systems.

C  Health Coding for Procedures and Claim Sets.

D  Healthcare Current Procedures Coding System.

A  Evaluation and Management

B  Surgery

C  Radiology

D  Anesthesia

A  increased reimbursement.

B  claim-processing delays.

C  reduced reimbursement.

D  denials of claims.

A  evaluation and management.

B  osteopathic manipulation.

C  arthroscopy.

D  abdominal distention.

A  look under a related procedure for more information.

B  refer to the patient chart for more information.

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

D  assign the code.

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

B  write off the entire amount.

C  bill the patient.

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

A  write off the entire amount.

B  file an appeal with the insurance carrier.

C  negotiate with the patient for partial payment.

D  bill the patient.

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  fraudulent practice.

C  requirement.

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

A  written explanation.

B  Category II CPT code.

C  Category III CPT code.

D  modifier.

A  Evaluation and Management .

B  Surgery.

C  Medicine.

D  Anesthesia.

A  elimination of local, temporary codes.

B  increased use of nonstandard CPT codes.

C  increased use of temporary codes for emerging technology.

D  use of local codes.

A  3 digits.

B  5 digits.

C  6 digits.

D  4 digits.

A  External Causes Index.

B  Tabular List of Diseases and Injuries.

C  Table of Drugs and Chemicals.

D  Neoplasm Table.

A  outpatient codes.

B  complication 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  registering the patient.

B  filling out a claim form.

C  calling the insurance carrier.

D  reading and understanding the physician’s documentation.