Final Exam

A  worker signed an acknowledgement of workplace hazards.

B  worker failed to follow safety procedures.

C  worker is also receiving Social Security disability benefits.

A  self-funded plans.

B  federal programs.

C  private insurance carriers.

D  state workers’ compensation funds.

A  Energy Employees Occupational Illness Compensation Program Act.

B  District of Columbia Workers’ Compensation Act.

C  Federal Employees’ Compensation Act.

D  Longshore and Harbor Workers’ 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 Standards for Health Administration.

C  Optional Safety and Health Act.

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 and the patient.

B  the patient only.

C  None of these.

D  the insurance carrier only.

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 necessary.

B  medically appropriate.

C  medically reasonable.

D  medically feasible.

A  posting charges and diagnoses.

B  entering patient information data into the computer.

C  verifying patient insurance benefits.

D  obtaining correct and complete patient information.

A  Centers for Medicare and Medicaid Services (CMS).

B  Veterans Administration (VA) hospital network.

C  Department of Defense (DoD).

D  Veterans Administration (VA) Health Administration Center.

A  preventive care manager.

B  physician consulting manager.

C  primary care manager.

D  physician case manager.

A  $7,500 per beneficiary.

B  $1,000 per family.

C  $7,500 per family.

D  $1,000 per beneficiary.

A  January 31.

B  September 30.

C  December 31.

D  June 30.

A  TRICARE for Life

B  TRICARE Standard.

C  CHAMPVA.

D  TRICARE Prime.

A  patient signed an advance beneficiary notice (ABN).

B  necessary preauthorization was not obtained.

C  service was not medically necessary.

D  claim was not filed in a timely manner.

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  emergency services.

B  prenatal care.

C  well-child checkups.

D  preventive services.

A  a coinsurance amount applies.

B  a deductible is paid.

C  Medicaid begins paying for services.

D  Medicare begins paying for services.

A  contracted insurance carriers.

B  each state government.

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

D  the federal government.

A  clinical laboratory services.

B  outpatient hospital services.

C  routine foot care.

D  ambulance transportation.

A  90 days.

B  60 days.

C  unlimited days if medically necessary.

D  30 days.

A  home healthcare.

B  inpatient hospital care.

C  telemedicine.

D  hospice care.

A  Internal Revenue Service (IRS).

B  Department of Health and Human Services (DHHS).

C  Centers for Medicare and Medicaid Services (CMS).

D  Social Security Administration (SSA).

A  disabled.

B  end-stage renal disease.

C  age 65 or older.

D  low income.

A  blue

B  red

C  purple

D  black

A  severity of illness.

B  treatment difficulty.

C  discharge status.

D  resource intensity.

A  capitation.

B  per diem.

C  prospective payment system.

D  fee for service.

A  fee for service.

B  prospective payment system.

C  capitation.

D  per diem.

A  diagnosis.

B  admission.

C  discharge

D  surgery.

A  CMS-1500 claim form

B  UB-04 claim form

C  Superbill

D  Verification of benefits form

A  once per year.

B  at every visit.

C  every 3 years.

D  every 2 years.

A  Patient information form

B  Release of information form

C  Assignment of benefits form

D  Explanation of benefits form

A  demographic information.

B  insurance information.

C  employment information.

D  All of these.

A  bank loans.

B  payments from insurance companies.

C  private donations.

D  payments from patients.

A  radiology.

B  surgery.

C  evaluation and management (E/M).

D  medicine.

A  upcoding.

B  bundling.

C  unbundling.

D  downcoding.

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 increases the risk of errors.

B  It decreases the workload of the medical office specialist.

C  It delays insurance payment.

D  It ensures compliance.

A  internal audits.

B  certification audits.

C  external audits.

D  accreditation audits.

A  clean.

B  accurate.

C  complete.

D  authorized.

A  two digits.

B  two letters or one letter and one number.

C  two letters.

D  two letters or two numbers.

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

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

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  Radiology

B  Surgery

C  Evaluation and Management

D  Anesthesia

A  reduced reimbursement.

B  claim-processing delays.

C  denials of claims.

D  increased reimbursement.

A  osteopathic manipulation.

B  abdominal distention.

C  arthroscopy.

D  evaluation and management.

A  look under a related procedure for more information.

B  assign the code.

C  refer to the patient chart for more information.

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

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

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

C  bill the patient.

D  write off the entire amount.

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  the medical office specialist made a mistake on the claim.

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  charges on the original claim were not detailed.

A  recommended practice.

B  requirement.

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

D  fraudulent practice.

A  Category III CPT code.

B  written explanation.

C  Category II CPT code.

D  modifier.

A  Anesthesia.

B  Surgery.

C  Medicine.

D  Evaluation and Management .

A  elimination of local, temporary codes.

B  increased use of temporary codes for emerging technology.

C  use of local codes.

D  increased use of nonstandard CPT codes.

A  4 digits.

B  6 digits.

C  5 digits.

D  3 digits.

A  Table of Drugs and Chemicals.

B  Tabular List of Diseases and Injuries.

C  Neoplasm Table.

D  External Causes Index.

A  outpatient codes.

B  complication codes.

C  co-existing condition codes.

D  inpatient codes.

A  review costs and evaluate facilities.

B  forecast healthcare needs.

C  All of these.

D  conduct studies of disease trends.

A  calling the insurance carrier.

B  registering the patient.

C  reading and understanding the physician’s documentation.

D  filling out a claim form.