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