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  state workers’ compensation funds.

B  private insurance carriers.

C  federal programs.

D  self-funded plans.

A  District of Columbia Workers’ Compensation Act.

B  Longshore and Harbor Workers’ Compensation Act.

C  Energy Employees Occupational Illness Compensation Program Act.

D  Federal Employees’ Compensation Act.

A  Occupational Safety and Health for Private Employers Act.

B  Energy Employees Occupational Illness Compensation Program Act.

C  Federal Employees’ Compensation Act.

D  District of Columbia Workers’ Compensation Act.

A  Optional Standards for Health Act.

B  Occupational Safety and Health Administration.

C  Occupational Standards for Health Administration.

D  Optional Safety and Health Act.

A  $150 from the insurance carrier and $50 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  $160 from the insurance carrier and $40 from the patient.

A  None of these.

B  the insurance carrier only.

C  the patient only.

D  the insurance carrier and the patient.

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

B  bill the patient for the remaining balance.

C  request assistance from the state insurance commissioner.

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

A  medically feasible.

B  medically necessary.

C  medically reasonable.

D  medically appropriate.

A  entering patient information data into the computer.

B  obtaining correct and complete patient information.

C  posting charges and diagnoses.

D  verifying patient insurance benefits.

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  $1,000 per family.

C  $7,500 per beneficiary.

D  $7,500 per family.

A  December 31.

B  September 30.

C  January 31.

D  June 30.

A  TRICARE Standard.

B  TRICARE for Life

C  TRICARE Prime.

D  CHAMPVA.

A  patient signed an advance beneficiary notice (ABN).

B  claim was not filed in a timely manner.

C  service was not medically necessary.

D  necessary preauthorization was not obtained.

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

B  physical therapy services.

C  transportation services.

D  prescribed drugs.

A  emergency services.

B  prenatal care.

C  preventive services.

D  well-child checkups.

A  a coinsurance amount applies.

B  Medicare begins paying for services.

C  Medicaid begins paying for services.

D  a deductible is paid.

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

B  contracted insurance carriers.

C  the federal government.

D  each state government.

A  ambulance transportation.

B  clinical laboratory services.

C  outpatient hospital services.

D  routine foot care.

A  30 days.

B  60 days.

C  90 days.

D  unlimited days if medically necessary.

A  inpatient hospital care.

B  home healthcare.

C  telemedicine.

D  hospice care.

A  Internal Revenue Service (IRS).

B  Centers for Medicare and Medicaid Services (CMS).

C  Department of Health and Human Services (DHHS).

D  Social Security Administration (SSA).

A  end-stage renal disease.

B  low income.

C  age 65 or older.

D  disabled.

A  purple

B  black

C  blue

D  red

A  resource intensity.

B  discharge status.

C  severity of illness.

D  treatment difficulty.

A  per diem.

B  fee for service.

C  capitation.

D  prospective payment system.

A  per diem.

B  capitation.

C  prospective payment system.

D  fee for service.

A  diagnosis.

B  admission.

C  surgery.

D  discharge

A  UB-04 claim form

B  Superbill

C  CMS-1500 claim form

D  Verification of benefits form

A  once per year.

B  every 3 years.

C  at every visit.

D  every 2 years.

A  Patient information form

B  Release of information form

C  Assignment of benefits form

D  Explanation of benefits form

A  insurance information.

B  All of these.

C  employment information.

D  demographic information.

A  payments from insurance companies.

B  payments from patients.

C  bank loans.

D  private donations.

A  evaluation and management (E/M).

B  radiology.

C  surgery.

D  medicine.

A  downcoding.

B  upcoding.

C  bundling.

D  unbundling.

A  ensure compliance with HIPAA regulations.

B  determine the accuracy of the physician’s documentation.

C  assess the completeness of the medical record.

D  All of these.

A  It decreases the workload of the medical office specialist.

B  It delays insurance payment.

C  It increases the risk of errors.

D  It ensures compliance.

A  certification audits.

B  external audits.

C  accreditation audits.

D  internal audits.

A  authorized.

B  accurate.

C  complete.

D  clean.

A  two letters or one letter and one number.

B  two letters or two numbers.

C  two letters.

D  two digits.

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

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  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 Current Procedures Coding System.

D  Healthcare Coding for Procedures and Claims Systems.

A  Evaluation and Management

B  Anesthesia

C  Radiology

D  Surgery

A  increased reimbursement.

B  reduced reimbursement.

C  claim-processing delays.

D  denials of claims.

A  evaluation and management.

B  osteopathic manipulation.

C  abdominal distention.

D  arthroscopy.

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  write off the entire amount.

B  bill the patient.

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

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

C  charges on the original claim were not detailed.

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

A  requirement.

B  fraudulent practice.

C  recommended practice.

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

A  written explanation.

B  Category III CPT code.

C  modifier.

D  Category II CPT code.

A  Anesthesia.

B  Evaluation and Management .

C  Medicine.

D  Surgery.

A  increased use of temporary codes for emerging technology.

B  use of local codes.

C  elimination of local, temporary codes.

D  increased use of nonstandard CPT codes.

A  3 digits.

B  5 digits.

C  6 digits.

D  4 digits.

A  Table of Drugs and Chemicals.

B  Neoplasm Table.

C  External Causes Index.

D  Tabular List of Diseases and Injuries.

A  co-existing condition codes.

B  outpatient codes.

C  complication codes.

D  inpatient codes.

A  conduct studies of disease trends.

B  review costs and evaluate facilities.

C  All of these.

D  forecast healthcare needs.

A  filling out a claim form.

B  registering the patient.

C  calling the insurance carrier.

D  reading and understanding the physician’s documentation.