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  self-funded plans.

C  private insurance carriers.

D  federal programs.

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  Federal Employees’ Compensation Act.

B  Energy Employees Occupational Illness Compensation Program Act.

C  Occupational Safety and Health for Private Employers Act.

D  District of Columbia Workers’ Compensation Act.

A  Occupational Standards for Health Administration.

B  Occupational Safety and Health Administration.

C  Optional Safety and Health Act.

D  Optional Standards for Health Act.

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

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

B  the patient only.

C  the insurance carrier only.

D  None of these.

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

B  request assistance from the state insurance commissioner.

C  bill the patient for the remaining balance.

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

A  medically feasible.

B  medically reasonable.

C  medically necessary.

D  medically appropriate.

A  entering patient information data into the computer.

B  verifying patient insurance benefits.

C  obtaining correct and complete patient information.

D  posting charges and diagnoses.

A  Veterans Administration (VA) hospital network.

B  Department of Defense (DoD).

C  Veterans Administration (VA) Health Administration Center.

D  Centers for Medicare and Medicaid Services (CMS).

A  physician consulting manager.

B  physician case manager.

C  primary care manager.

D  preventive care manager.

A  $7,500 per family.

B  $1,000 per family.

C  $7,500 per beneficiary.

D  $1,000 per beneficiary.

A  June 30.

B  September 30.

C  January 31.

D  December 31.

A  CHAMPVA.

B  TRICARE for Life

C  TRICARE Standard.

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

B  physical therapy services.

C  prescribed drugs.

D  transportation services.

A  emergency services.

B  prenatal care.

C  well-child checkups.

D  preventive services.

A  a deductible is paid.

B  Medicare begins paying for services.

C  a coinsurance amount applies.

D  Medicaid begins paying for services.

A  each state government.

B  the federal government.

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

D  contracted insurance carriers.

A  outpatient hospital services.

B  clinical laboratory services.

C  ambulance transportation.

D  routine foot care.

A  30 days.

B  60 days.

C  unlimited days if medically necessary.

D  90 days.

A  inpatient hospital care.

B  home healthcare.

C  telemedicine.

D  hospice care.

A  Department of Health and Human Services (DHHS).

B  Centers for Medicare and Medicaid Services (CMS).

C  Social Security Administration (SSA).

D  Internal Revenue Service (IRS).

A  low income.

B  end-stage renal disease.

C  disabled.

D  age 65 or older.

A  red

B  blue

C  black

D  purple

A  severity of illness.

B  discharge status.

C  resource intensity.

D  treatment difficulty.

A  capitation.

B  per diem.

C  prospective payment system.

D  fee for service.

A  capitation.

B  prospective payment system.

C  fee for service.

D  per diem.

A  admission.

B  discharge

C  diagnosis.

D  surgery.

A  Superbill

B  UB-04 claim form

C  CMS-1500 claim form

D  Verification of benefits form

A  at every visit.

B  once per year.

C  every 2 years.

D  every 3 years.

A  Patient information form

B  Assignment of benefits form

C  Release of information form

D  Explanation of benefits form

A  employment information.

B  All of these.

C  insurance information.

D  demographic information.

A  private donations.

B  bank loans.

C  payments from patients.

D  payments from insurance companies.

A  evaluation and management (E/M).

B  surgery.

C  radiology.

D  medicine.

A  unbundling.

B  downcoding.

C  bundling.

D  upcoding.

A  ensure compliance with HIPAA regulations.

B  assess the completeness of the medical record.

C  All of these.

D  determine the accuracy of the physician’s documentation.

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  certification audits.

B  accreditation audits.

C  internal audits.

D  external audits.

A  complete.

B  accurate.

C  authorized.

D  clean.

A  two letters.

B  two letters or one letter and one number.

C  two letters or two numbers.

D  two digits.

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  Healthcare Coding for Procedures and Claims Systems.

B  Health Coding for Procedures and Claim Sets.

C  Healthcare Current Procedures Coding System.

D  Healthcare Common Procedure Coding System.

A  Evaluation and Management

B  Surgery

C  Radiology

D  Anesthesia

A  reduced reimbursement.

B  denials of claims.

C  increased reimbursement.

D  claim-processing delays.

A  abdominal distention.

B  arthroscopy.

C  evaluation and management.

D  osteopathic manipulation.

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

B  refer to the patient chart for more information.

C  look under a related procedure for more information.

D  assign the code.

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

B  bill the patient.

C  write off the entire amount.

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  bill the patient.

D  negotiate with the patient for partial payment.

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

B  fraudulent practice.

C  recommended practice.

D  requirement.

A  modifier.

B  Category III CPT code.

C  written explanation.

D  Category II CPT code.

A  Surgery.

B  Evaluation and Management .

C  Anesthesia.

D  Medicine.

A  increased use of nonstandard CPT codes.

B  elimination of local, temporary codes.

C  increased use of temporary codes for emerging technology.

D  use of local codes.

A  6 digits.

B  3 digits.

C  4 digits.

D  5 digits.

A  Neoplasm Table.

B  External Causes Index.

C  Tabular List of Diseases and Injuries.

D  Table of Drugs and Chemicals.

A  outpatient codes.

B  complication codes.

C  inpatient 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  filling out a claim form.

B  reading and understanding the physician’s documentation.

C  calling the insurance carrier.

D  registering the patient.