Midterm Exam Chapter 2 to 9 & 16

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

Need help with your exam preparation?

Existing Quiz Clients Login here

Below are the questions for the exam with the choices of answers:

Try The Exam

Question #1

Which of the following are reason codes that require a formal appeal?

A claim processing error

B noncovered emergency services

C both noncovered emergency services and not related to diagnoses

D not related to diagnoses

Question #2

If a physician requests a peer review that results in confirmation that services were NOT medically necessary:

A there is no charge for the review.

B the patient should be billed for the review.

C the insurance carrier will pay for the review.

D the physician must pay for the review.

Question #3

Reasons for follow-up include:

A unclear denial of payment is received.

B an incorrect payment is received.

C All of these.

D reimbursement is received for an unknown patient.

Question #4

If a claim is denied because services were provided before insurance coverage was in effect, the medical office specialist should:

A bill the patient.

B write off the entire amount.

C wait until the effective date of the coverage, then bill the insurance carrier.

D change the date of service and resubmit the claim.

Question #5

An examination and verification of claims and supporting documentation submitted by a physician is known as a(n):

A reconsideration.

B audit.

C review.

D appeal.

Question #6

If a physician who ordered a test personally reviews the results to supplement information from the physician who prepared the test report, the work would add to the level of the:

A amount and/or complexity of data to be reviewed.

B number of diagnoses or management options.

C All of these.

D risk of significant complications, morbidity, and/or mortality.

Question #7

If a physician documents that an exam included the measurement of a patient’s blood pressure, the system examined would be the:

A neurological system.

B respiratory system.

C musculoskeletal system.

D cardiovascular system.

Question #8

An independent audit should be performed a minimum of:

A once a year.

B once a quarter.

C once a month.

D twice a year.

Question #9

An internal audit would determine:

A All of these.

B if additional training is needed for office staff.

C the coder’s skill and knowledge.

D whether procedures were coded correctly.

Question #10

A postpayment audit would verify:

A patient insurance eligibility.

B sign-in sheets and appointment scheduling practices.

C patient insurance identification number.

D date of service.

Question #11

The best way to be sure that an intended action will NOT be subject to investigation as fraud is to:

A obtain an advisory opinion from the Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS).

B base the decision on past practices.

C submit the claim, and request an explanation if denied.

D get the advice of an attorney.

Question #12

Billing the parts of a bundled procedure as separate procedures is referred to as:

A bundling.

B unbundling.

C downcoding.

D upcoding.

Question #13

When each reported service is connected to a diagnosis that supports the procedure as medically necessary, the claim is referred to as:

A accurate.

B authorized.

C complete.

D clean.

Question #14

HCPCS Level II national codes are used in claims submitted to:

A private insurers only.

B public insurers only.

C self-funded plans only.

D public and private insurers.

Question #15

The code for durable medical equipment (DME) would be found in the:

A This is not considered a HCPCS code.

B Level II HCPCS code book.

C Level III HCPCS code book.

D Level I HCPCS code book.

Question #16

HCPCS Level II codes in the range C1300—C9899 would be used for:

A diagnostic radiology services.

B orthotic procedures.

C temporary hospital outpatient.

D private payer codes.

Question #17

A large-group practice will frequently contract out its billing and accounts receivable.

A True

B False

Question #18

The Certified Professional Coder (CPC) certification is awarded through the:

A American Academy of Professional Coders.

B National Center for Competency Testing.

C American Health Information Management Association.

D National Healthcareer Association.

Question #19

The duties and responsibilities of a privacy compliance officer may include all of the following EXCEPT:

A answering questions about privacy regulations.

B explaining DNR orders to patients and their family members.

C data entry of patient demographics.

D posting payments or making adjustments to patient accounts.

Question #20

The duties and responsibilities of a medical biller may include all of the following EXCEPT:

A analyzing patient charge information.

B explaining HIPAA regulations.

C submitting insurance claims.

D contacting insurance carriers on incorrectly paid claims.

Question #21

The healthcare professional who is responsible for answering questions and explaining topics such as HIPAA privacy regulations, living wills, and do-not-resuscitate orders (DNRs) to patients and their family members is the:

A medical collector.

B insurance verification representative.

C admitting clerk.

D privacy compliance officer.

Question #22

The healthcare professional who researches data in medical records in order to accurately document diagnoses and procedures and obtain maximum reimbursement for physicians is the:

A payment poster.

B medical office assistant.

C medical collector.

D medical coder.

Question #23

A practice with 10 or more physicians would generally be categorized as a:

A small-group practice.

B solo practice.

C private practice.

D large-group practice.

Question #24

Managed care is a system in which physicians contract to participate in a health insurance network and healthcare delivery is:

A based on the patient’s ability to pay.

B monitored to control costs.

C at the discretion of the physician.

D provided only by in-network physicians.

Question #25

Details about the health status or cause of death of parents, siblings, and children would be part of a:

A social history.

B past history.

C history of present illness.

D family history.

Question #26

Details about a patient’s current employment or school history would be part of a:

A history of present illness.

B social history.

C past history.

D family history.

Question #27

A new patient is considered one who has NOT received professional services from the physician or another physician of the same specialty in the same group within the past:

A 5 years.

B 2 years.

C 3 years.

D 1 year.

Question #28

The most-often reported evaluation and management (E/M) services are:

A emergency room services.

B hospital (inpatient) services.

C consultations.

D office and other outpatient services.

Question #29

The temporary codes used for emerging technology, services, or procedures are:

A Category I CPT codes.

B ICD-10-CM codes.

C Category II CPT codes.

D Category III CPT codes.

Question #30

In what year did CMS require state Medicaid agencies to use CPT codes for reporting outpatient hospital procedures as part of the Omnibus Budget Reconciliation Act?

A 2006

B 1977

C 1986

D 1992

Question #31

Providers are legally obligated to disclose protected health information (PHI) to public health authorities when a:

A patient has returned from a trip to a country with poor sanitation.

B person may have been exposed to certain communicable diseases.

C particularly severe flu epidemic has occurred.

D patient or staff member has a prison record.

Question #32

Each medical practice must appoint a person to serve as its Privacy Compliance Officer, who must be familiar with federal and state privacy regulations in order to:

A respond to requests for medical records and handle privacy-related complaints.

B respond to insurance carriers’ questions and handle patient billing complaints.

C represent the practice in any lawsuits that arise over privacy issues.

D file monthly reports with the office of the state insurance commissioner.

Question #33

The code next to the main term is called the:

A specified code.

B primary code.

C combination code.

D default code.

Question #34

Subterms in an ICD-10-CM entry may show:

A treatments of the disease.

B another name for the disease.

C the cause or origin of the disease.

D a better description of the disease.

Question #35

To locate the correct code for the first encounter, the medical specialist must first look for the term in the:

A Alphabetic Index.

B Neoplasm Table.

C Tabular List of Diseases and Injuries.

D External Causes Index.

Question #36

The ICD-10-PCS is used to report:

A outpatient procedure coding.

B proper diagnosis coding.

C proper mortality coding.

D inpatient procedure coding.

Question #37

ICD-10-CM codes submitted on insurance claim forms are used to:

A report specific procedures and services.

B determine medical necessity for covered procedures and services.

C report patient demographic information.

D record a patient’s office visits or inpatient days.

Question #38

The process of scrambling and encoding electronic data to prevent it from being read by unauthorized users is known as:

A coding.

B translation.

C transcription.

D encryption.

Question #39

A person who has a privacy complaint can file it with the:

A American Medical Association (AMA).

B Centers for Medicare and Medicaid Services (CMS).

C Office for Civil Rights (OCR).

Question #40

Under the HIPAA Privacy Rule, a patient’s medical record and payment history are considered:

A secure medical data.

B protected health information.

C managed care plan information.

D electronically transmitted data.

Question #41

The credentialing process of a managed care organization (MCO) will examine each physician’s background for evidence of all of the following EXCEPT:

A malpractice history.

B criminal activity.

C salary history.

D disciplinary actions.

Question #42

In plans that require the primary care physician (PCP) to play a gatekeeper role, the PCP is given incentives to:

A treat the patient as much as possible without a specialist referral unless absolutely necessary.

B make frequent referrals to contracted network specialists.

C see as many patients each day as possible, even if this means less time with each patient.

D expand office hours and/or staff to permit more patients to be seen each day.

Question #43

The schedule of benefits section of a managed care contract lists the:

A benefits of participating in the managed care plan.

B providers in the contracted network.

C deductible and coinsurance amounts that patients must pay.

D medical services covered under the managed care plan.

Question #44

A medical office specialist must do all the following EXCEPT:

A promote the provider network.

B be familiar with managed care terms.

C know the Patient Bill of Rights.

D explain the ACO to the patient.

Question #45

A managed care contract should clearly state all of the following EXCEPT:

A how much the physician will be paid for services.

B the time limit for submitting claims to the MCO.

C the list of employers with MCO contracts.

D when payment should be received from the MCO.

Question #46

All of the following are types of health maintenance organizations (HMOs) EXCEPT the:

A individual practice association.

B preferred provider model.

C open access model.

D group model.

Question #47

By accepting lower payments from MCOs, physicians are forced to see more patients each day in order to:

A minimize malpractice suits.

B maintain their income.

C enroll more members in the health plan.

D deliver MCO-required preventive care.

Question #48

In a managed care organization (MCO), a primary care physician (PCP) is any of the following EXCEPT:

A family practitioner.

B internal medicine doctor.

C dermatologist.

D general practitioner.

Question #49

To determine the amount due from a patient, it is necessary to know the:

A adjusted amount.

B diagnostic code.

C allowed amount.

D billed amount.

Question #50

Managed care systems ensure the delivery of high-quality care while managing costs through:

A provider networks and discounted fees for services.

B provider networks and regular premium increases.

C prohibiting the use of out-of-network providers.

D discounted fees for services and mandatory high deductibles across all health plans.

Try The Exam

Fresh Grad Lands Job as Real Estate Agent With Help from Professional Writers

Midterm Exam Chapter 2 to 9 & 16

Need help with your exam preparation?

Below are the questions for the exam with the choices of answers:

Christian S.

Tyra

Linda

Manush

We accept payment