Weekly Quiz 7 Chapter 9 & 16

A  embezzlement.

B  conversion.

C  fraud.

D  retention.

A  5 years.

B  180 days.

C  1 year.

D  3 years.

A  Department of Labor.

B  Department of Insurance.

C  carrier legal department.

D  carrier president.

A  120 days.

B  30 days.

C  60 days.

D  90 days.

A  review by a qualified independent contractor.

B  review by the state insurance commissioner.

C  review by an administrative law judge.

D  redetermination by the carrier.

A  review by the state insurance commissioner.

B  review by a qualified independent contractor.

C  redetermination by the carrier.

D  review by an administrative law judge.

A  redetermination by the carrier.

B  review by an administrative law judge.

C  review by a qualified independent contractor.

D  review by the state insurance commissioner.

A  30 days after denial.

B  180 days after denial.

C  60 days after denial.

D  90 days after denial.

A  Title XXI of the Social Security Act.

B  HIPAA.

C  ERISA.

D  FECA.

A  a billing error was made by the medical office assistant.

B  the patient had a routine service covered by the policy.

C  the claim was for services related to an accident.

D  the carrier requested information from the patient that was not received.

A  sending a form letter.

B  sending a copy of pertinent court decisions.

C  rebilling the claim.

D  telephone or fax.

A  a modifier was used to indicate multiple procedures that the carrier bundled.

B  the carrier requested information from the patient that was not received.

C  the patient had a routine service covered by the policy.

D  the claim was considered not medically necessary.

A  about the physician’s financial situation.

B  about payment from other carriers for the reported service.

C  from the patient medical record.

D  about why the patient cannot afford to pay more.

A  All of these.

B  an administrative manual.

C  phone calls to the carrier.

D  newsletters from the carrier.

A  part of the plan.

B  objective information.

C  subjective information.

D  part of the assessment.

A  assessment information.

B  the plan.

C  subjective information.

D  objective information.

A  the plan.

B  objective information.

C  assessment information.

D  subjective information.

A  patient should be contacted to confirm the service was rendered.

B  service was not performed and cannot be billed.

C  medical office specialist should be contacted to modify the record.

D  physician should verbally verify that the service was provided.

A  documentation.

B  claims processing.

C  medical transcription.

D  encounter form completion.

A  explain in simple language why the insurance carrier denied payment.

B  use respect and care when explaining policy benefits.

C  if the denial was due to a need for additional information, submit the additional documentation immediately and let the patient know it has been done.

D  ask the patient to call the insurance carrier to try to get them to reconsider.

A  appeal.

B  audit.

C  adjudication.

D  reconsideration.

A  routine examination of claims.

B  peer review.

C  appeal committee review.

D  utilization review.

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

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

C  write off the entire amount.

D  bill the patient.

A  file an appeal with the insurance carrier.

B  bill the patient.

C  negotiate with the patient for partial payment.

D  write off the entire amount.

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

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

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  bundling.

B  unbundling.

C  downcoding.

D  upcoding.

A  False

B  True

A  a new patient office visit.

B  critical care services.

C  an established patient office visit.

D  subsequent in-hospital care.

A  CPT Guidelines.

B  CPT Index.

C  CPT Appendix C.

D  CPT Appendix A.

A  the presenting problems.

B  the possible management options.

C  the diagnostic procedures.

D  All of these.

A  low.

B  high.

C  minimal.

D  moderate.

A  must be coded.

B  must be part of the HPI.

C  must be explicitly stated.

D  can be stated or implied.

A  detailed exam.

B  comprehensive exam.

C  problem-focused exam.

D  expanded problem-focused exam.

A  body organs.

B  organ systems.

C  body areas.

D  tissue systems.

A  general multisystem exam.

B  single organ system exam.

C  multibody-area exam.

D  general organ system exam.

A  family history.

B  past history.

C  HPI.

D  social history.

A  comprehensive.

B  pertinent.

C  complete.

D  detailed.

A  brief or extended.

B  brief or complicated.

C  brief or comprehensive.

D  brief or detailed.

A  four HPI elements.

B  one HPI element.

C  three HPI elements.

D  two HPI elements.

A  associated signs and symptoms.

B  severity.

C  context.

D  quality.

A  timing.

B  duration.

C  quality.

D  severity.

A  chief complaint (CC).

B  past, family, and social history (PFSH).

C  history of present illness (HPI).

D  review of systems (ROS).

A  detailed.

B  expanded problem focused.

C  comprehensive.

D  problem focused.

A  unbundle the service.

B  deny payment.

C  pay the service as billed.

D  upcode the service.

A  extent of the exam documented.

B  extent of the history documented.

C  complexity of the medical decision making.

D  complexity of the diagnosis.

A  the provider.

B  all office staff.

C  the office manager.

D  the provider and the office manager.

A  unbundling.

B  upcoding.

C  downcoding.

D  bundling.

A  government investigator.

B  All of these.

C  private payer.

D  practice employee.

A  retrospectively only.

B  either prospectively or retrospectively.

C  prospectively only.

D  neither prospectively or retrospectively.

A  appropriate documentation of the visit.

B  the date of service and the patient’s insurance identification number.

C  accurate coding and billing.

D  completeness of progress reports.