Final Exam

A  worker failed to follow safety procedures.

B  worker is also receiving Social Security disability benefits.

C  worker signed an acknowledgement of workplace hazards.

A  self-funded plans.

B  private insurance carriers.

C  state workers’ compensation funds.

D  federal programs.

A  Energy Employees Occupational Illness Compensation Program Act.

B  Longshore and Harbor Workers’ Compensation Act.

C  Federal Employees’ Compensation Act.

D  District of Columbia Workers’ Compensation Act.

A  Occupational Safety and Health for Private Employers Act.

B  District of Columbia Workers’ Compensation Act.

C  Energy Employees Occupational Illness Compensation Program Act.

D  Federal Employees’ Compensation Act.

A  Optional Standards for Health Act.

B  Occupational Standards for Health Administration.

C  Occupational Safety and Health Administration.

D  Optional Safety and Health Act.

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

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

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

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

A  None of these.

B  the patient only.

C  the insurance carrier only.

D  the insurance carrier and the patient.

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

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

C  request assistance from the state insurance commissioner.

D  bill the patient for the remaining balance.

A  medically necessary.

B  medically appropriate.

C  medically reasonable.

D  medically feasible.

A  verifying patient insurance benefits.

B  posting charges and diagnoses.

C  obtaining correct and complete patient information.

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 case manager.

B  primary care manager.

C  preventive care manager.

D  physician consulting manager.

A  $1,000 per beneficiary.

B  $7,500 per family.

C  $1,000 per family.

D  $7,500 per beneficiary.

A  September 30.

B  December 31.

C  January 31.

D  June 30.

A  CHAMPVA.

B  TRICARE Standard.

C  TRICARE for Life

D  TRICARE Prime.

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  prescribed drugs.

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

C  transportation services.

D  physical therapy services.

A  prenatal care.

B  emergency services.

C  well-child checkups.

D  preventive services.

A  Medicare begins paying for services.

B  Medicaid begins paying for services.

C  a deductible is paid.

D  a coinsurance amount applies.

A  each state government.

B  contracted insurance carriers.

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

D  the federal government.

A  routine foot care.

B  clinical laboratory services.

C  ambulance transportation.

D  outpatient hospital services.

A  unlimited days if medically necessary.

B  60 days.

C  90 days.

D  30 days.

A  inpatient hospital care.

B  telemedicine.

C  hospice care.

D  home healthcare.

A  Centers for Medicare and Medicaid Services (CMS).

B  Social Security Administration (SSA).

C  Internal Revenue Service (IRS).

D  Department of Health and Human Services (DHHS).

A  disabled.

B  low income.

C  age 65 or older.

D  end-stage renal disease.

A  blue

B  red

C  purple

D  black

A  discharge status.

B  resource intensity.

C  treatment difficulty.

D  severity of illness.

A  per diem.

B  fee for service.

C  capitation.

D  prospective payment system.

A  capitation.

B  fee for service.

C  prospective payment system.

D  per diem.

A  discharge

B  surgery.

C  diagnosis.

D  admission.

A  UB-04 claim form

B  Verification of benefits form

C  CMS-1500 claim form

D  Superbill

A  every 2 years.

B  at every visit.

C  every 3 years.

D  once per year.

A  Explanation of benefits form

B  Release of information form

C  Patient information form

D  Assignment of benefits form

A  insurance information.

B  All of these.

C  demographic information.

D  employment information.

A  bank loans.

B  private donations.

C  payments from insurance companies.

D  payments from patients.

A  radiology.

B  medicine.

C  surgery.

D  evaluation and management (E/M).

A  upcoding.

B  unbundling.

C  bundling.

D  downcoding.

A  determine the accuracy of the physician’s documentation.

B  ensure compliance with HIPAA regulations.

C  All of these.

D  assess the completeness of the medical record.

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  external audits.

B  accreditation audits.

C  certification audits.

D  internal audits.

A  clean.

B  accurate.

C  authorized.

D  complete.

A  two digits.

B  two letters or two numbers.

C  two letters or one letter and one number.

D  two letters.

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

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

A  Health Coding for Procedures and Claim Sets.

B  Healthcare Coding for Procedures and Claims Systems.

C  Healthcare Common Procedure Coding System.

D  Healthcare Current Procedures Coding System.

A  Evaluation and Management

B  Surgery

C  Radiology

D  Anesthesia

A  denials of claims.

B  claim-processing delays.

C  reduced reimbursement.

D  increased reimbursement.

A  arthroscopy.

B  osteopathic manipulation.

C  evaluation and management.

D  abdominal distention.

A  refer to the patient chart for more information.

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

C  assign the code.

D  look under a related procedure for more information.

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  bill the patient.

C  negotiate with the patient for partial payment.

D  file an appeal with the insurance carrier.

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

B  charges on the original claim were not detailed.

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

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

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

B  recommended practice.

C  fraudulent practice.

D  requirement.

A  modifier.

B  written explanation.

C  Category II CPT code.

D  Category III CPT code.

A  Anesthesia.

B  Surgery.

C  Evaluation and Management .

D  Medicine.

A  increased use of temporary codes for emerging technology.

B  increased use of nonstandard CPT codes.

C  use of local codes.

D  elimination of local, temporary codes.

A  3 digits.

B  4 digits.

C  6 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  complication codes.

B  outpatient codes.

C  co-existing condition codes.

D  inpatient codes.

A  forecast healthcare needs.

B  review costs and evaluate facilities.

C  All of these.

D  conduct studies of disease trends.

A  reading and understanding the physician’s documentation.

B  calling the insurance carrier.

C  registering the patient.

D  filling out a claim form.