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  self-funded plans.

B  federal programs.

C  state workers’ compensation funds.

D  private insurance carriers.

A  Federal Employees’ Compensation Act.

B  Energy Employees Occupational Illness Compensation Program Act.

C  District of Columbia Workers’ Compensation Act.

D  Longshore and Harbor Workers’ Compensation Act.

A  Federal Employees’ Compensation Act.

B  District of Columbia Workers’ Compensation Act.

C  Occupational Safety and Health for Private Employers Act.

D  Energy Employees Occupational Illness Compensation Program Act.

A  Optional Standards for Health Act.

B  Optional Safety and Health Act.

C  Occupational Standards for Health Administration.

D  Occupational Safety and Health Administration.

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

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

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

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

A  the insurance carrier only.

B  the patient only.

C  None of these.

D  the insurance carrier and the patient.

A  bill the patient for the remaining balance.

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

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 appropriate.

C  medically reasonable.

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  Department of Defense (DoD).

B  Centers for Medicare and Medicaid Services (CMS).

C  Veterans Administration (VA) hospital network.

D  Veterans Administration (VA) Health Administration Center.

A  physician consulting manager.

B  primary care manager.

C  physician case manager.

D  preventive care manager.

A  $1,000 per family.

B  $7,500 per family.

C  $1,000 per beneficiary.

D  $7,500 per beneficiary.

A  December 31.

B  September 30.

C  June 30.

D  January 31.

A  TRICARE Standard.

B  TRICARE Prime.

C  CHAMPVA.

D  TRICARE for Life

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  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  well-child checkups.

B  emergency services.

C  prenatal care.

D  preventive services.

A  Medicare begins paying for services.

B  a deductible is paid.

C  a coinsurance amount applies.

D  Medicaid begins paying for services.

A  each state government.

B  contracted insurance carriers.

C  the federal government.

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

A  clinical laboratory services.

B  ambulance transportation.

C  routine foot care.

D  outpatient hospital services.

A  unlimited days if medically necessary.

B  30 days.

C  60 days.

D  90 days.

A  home healthcare.

B  hospice care.

C  telemedicine.

D  inpatient hospital care.

A  Social Security Administration (SSA).

B  Centers for Medicare and Medicaid Services (CMS).

C  Department of Health and Human Services (DHHS).

D  Internal Revenue Service (IRS).

A  disabled.

B  low income.

C  age 65 or older.

D  end-stage renal disease.

A  blue

B  red

C  purple

D  black

A  severity of illness.

B  treatment difficulty.

C  discharge status.

D  resource intensity.

A  prospective payment system.

B  capitation.

C  fee for service.

D  per diem.

A  fee for service.

B  prospective payment system.

C  capitation.

D  per diem.

A  surgery.

B  discharge

C  admission.

D  diagnosis.

A  UB-04 claim form

B  CMS-1500 claim form

C  Superbill

D  Verification of benefits form

A  every 2 years.

B  every 3 years.

C  once per year.

D  at every visit.

A  Explanation of benefits form

B  Release of information form

C  Patient information form

D  Assignment of benefits form

A  employment information.

B  All of these.

C  demographic information.

D  insurance information.

A  private donations.

B  payments from patients.

C  bank loans.

D  payments from insurance companies.

A  radiology.

B  medicine.

C  evaluation and management (E/M).

D  surgery.

A  downcoding.

B  bundling.

C  upcoding.

D  unbundling.

A  All of these.

B  determine the accuracy of the physician’s documentation.

C  assess the completeness of the medical record.

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  certification audits.

C  accreditation audits.

D  external audits.

A  clean.

B  complete.

C  accurate.

D  authorized.

A  two letters.

B  two digits.

C  two letters or two numbers.

D  two letters or one letter and one number.

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

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

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

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

A  Healthcare Common Procedure Coding System.

B  Healthcare Coding for Procedures and Claims Systems.

C  Healthcare Current Procedures Coding System.

D  Health Coding for Procedures and Claim Sets.

A  Anesthesia

B  Surgery

C  Evaluation and Management

D  Radiology

A  reduced reimbursement.

B  increased reimbursement.

C  denials of claims.

D  claim-processing delays.

A  arthroscopy.

B  evaluation and management.

C  osteopathic manipulation.

D  abdominal distention.

A  assign the code.

B  look under a related procedure for more information.

C  refer to the patient chart for more information.

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

A  bill the patient.

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

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

D  write off the entire amount.

A  negotiate with the patient for partial payment.

B  file an appeal with the insurance carrier.

C  bill the patient.

D  write off the entire amount.

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

B  charges on the original claim were not detailed.

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

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  requirement.

D  recommended practice.

A  written explanation.

B  Category III CPT code.

C  modifier.

D  Category II CPT code.

A  Evaluation and Management .

B  Surgery.

C  Medicine.

D  Anesthesia.

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  4 digits.

B  3 digits.

C  5 digits.

D  6 digits.

A  External Causes Index.

B  Table of Drugs and Chemicals.

C  Neoplasm Table.

D  Tabular List of Diseases and Injuries.

A  complication codes.

B  co-existing condition codes.

C  inpatient codes.

D  outpatient codes.

A  forecast healthcare needs.

B  review costs and evaluate facilities.

C  conduct studies of disease trends.

D  All of these.

A  reading and understanding the physician’s documentation.

B  calling the insurance carrier.

C  filling out a claim form.

D  registering the patient.