Navigation » List of Schools » Glendale Community College » Medical Office Administration » MOA 183 – Intro to Health Insurance » Fall 2022 » Midterm Exam Chapter 2 to 9 & 16
Below are the questions for the exam with the choices of answers:
Question #1
A both noncovered emergency services and not related to diagnoses
B not related to diagnoses
C claim processing error
D noncovered emergency services
Question #2
A the physician must pay for the review.
B there is no charge for the review.
C the insurance carrier will pay for the review.
D the patient should be billed for the review.
Question #3
A All of these.
B an incorrect payment is received.
C reimbursement is received for an unknown patient.
D unclear denial of payment is received.
Question #4
A wait until the effective date of the coverage, then bill the insurance carrier.
B bill the patient.
C change the date of service and resubmit the claim.
D write off the entire amount.
Question #5
A reconsideration.
B appeal.
C review.
D audit.
Question #6
A All of these.
B amount and/or complexity of data to be reviewed.
C number of diagnoses or management options.
D risk of significant complications, morbidity, and/or mortality.
Question #7
A neurological system.
B respiratory system.
C musculoskeletal system.
D cardiovascular system.
Question #8
A once a year.
B twice a year.
C once a quarter.
D once a month.
Question #9
A whether procedures were coded correctly.
B All of these.
C if additional training is needed for office staff.
D the coder’s skill and knowledge.
Question #10
A date of service.
B patient insurance identification number.
C patient insurance eligibility.
D sign-in sheets and appointment scheduling practices.
Question #11
A base the decision on past practices.
B submit the claim, and request an explanation if denied.
C get the advice of an attorney.
D obtain an advisory opinion from the Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS).
Question #12
A downcoding.
B bundling.
C unbundling.
D upcoding.
Question #13
A accurate.
B authorized.
C clean.
D complete.
Question #14
A public insurers only.
B private insurers only.
C self-funded plans only.
D public and private insurers.
Question #15
A Level III HCPCS code book.
B This is not considered a HCPCS code.
C Level II HCPCS code book.
D Level I HCPCS code book.
Question #16
A private payer codes.
B temporary hospital outpatient.
C diagnostic radiology services.
D orthotic procedures.
Question #17
A False
B True
Question #18
A National Center for Competency Testing.
B American Academy of Professional Coders.
C American Health Information Management Association.
D National Healthcareer Association.
Question #19
A answering questions about privacy regulations.
B data entry of patient demographics.
C posting payments or making adjustments to patient accounts.
D explaining DNR orders to patients and their family members.
Question #20
A explaining HIPAA regulations.
B analyzing patient charge information.
C submitting insurance claims.
D contacting insurance carriers on incorrectly paid claims.
Question #21
A admitting clerk.
B insurance verification representative.
C privacy compliance officer.
D medical collector.
Question #22
A medical coder.
B payment poster.
C medical office assistant.
D medical collector.
Question #23
A solo practice.
B large-group practice.
C private practice.
D small-group practice.
Question #24
A provided only by in-network physicians.
B monitored to control costs.
C based on the patient’s ability to pay.
D at the discretion of the physician.
Question #25
A history of present illness.
B family history.
C past history.
D social history.
Question #26
A family history.
B social history.
C past history.
D history of present illness.
Question #27
A 3 years.
B 5 years.
C 1 year.
D 2 years.
Question #28
A consultations.
B hospital (inpatient) services.
C office and other outpatient services.
D emergency room services.
Question #29
A Category II CPT codes.
B Category I CPT codes.
C ICD-10-CM codes.
D Category III CPT codes.
Question #30
A 1992
B 1986
C 2006
D 1977
Question #31
A particularly severe flu epidemic has occurred.
B person may have been exposed to certain communicable diseases.
C patient has returned from a trip to a country with poor sanitation.
D patient or staff member has a prison record.
Question #32
A respond to requests for medical records and handle privacy-related complaints.
B represent the practice in any lawsuits that arise over privacy issues.
C respond to insurance carriers’ questions and handle patient billing complaints.
D file monthly reports with the office of the state insurance commissioner.
Question #33
A default code.
B specified code.
C combination code.
D primary code.
Question #34
A the cause or origin of the disease.
B treatments of the disease.
C another name for the disease.
D a better description of the disease.
Question #35
A External Causes Index.
B Tabular List of Diseases and Injuries.
C Alphabetic Index.
D Neoplasm Table.
Question #36
A inpatient procedure coding.
B proper diagnosis coding.
C proper mortality coding.
D outpatient procedure coding.
Question #37
A determine medical necessity for covered procedures and services.
B record a patient’s office visits or inpatient days.
C report patient demographic information.
D report specific procedures and services.
Question #38
A translation.
B coding.
C encryption.
D transcription.
Question #39
A Centers for Medicare and Medicaid Services (CMS).
B Office for Civil Rights (OCR).
C American Medical Association (AMA).
Question #40
A electronically transmitted data.
B protected health information.
C managed care plan information.
D secure medical data.
Question #41
A disciplinary actions.
B criminal activity.
C malpractice history.
D salary history.
Question #42
A expand office hours and/or staff to permit more patients to be seen each day.
B see as many patients each day as possible, even if this means less time with each patient.
C treat the patient as much as possible without a specialist referral unless absolutely necessary.
D make frequent referrals to contracted network specialists.
Question #43
A providers in the contracted network.
B benefits of participating in the managed care plan.
C deductible and coinsurance amounts that patients must pay.
D medical services covered under the managed care plan.
Question #44
A be familiar with managed care terms.
B know the Patient Bill of Rights.
C promote the provider network.
D explain the ACO to the patient.
Question #45
A when payment should be received from the MCO.
B the list of employers with MCO contracts.
C the time limit for submitting claims to the MCO.
D how much the physician will be paid for services.
Question #46
A individual practice association.
B group model.
C preferred provider model.
D open access model.
Question #47
A deliver MCO-required preventive care.
B minimize malpractice suits.
C enroll more members in the health plan.
D maintain their income.
Question #48
A internal medicine doctor.
B dermatologist.
C general practitioner.
D family practitioner.
Question #49
A diagnostic code.
B allowed amount.
C adjusted amount.
D billed amount.
Question #50
A prohibiting the use of out-of-network providers.
B provider networks and regular premium increases.
C provider networks and discounted fees for services.
D discounted fees for services and mandatory high deductibles across all health plans.