Weekly Quiz 7 Chapter 9 & 16

A  embezzlement.

B  conversion.

C  retention.

D  fraud.

A  180 days.

B  5 years.

C  3 years.

D  1 year.

A  carrier president.

B  Department of Labor.

C  carrier legal department.

D  Department of Insurance.

A  60 days.

B  90 days.

C  120 days.

D  30 days.

A  review by the state insurance commissioner.

B  review by an administrative law judge.

C  review by a qualified independent contractor.

D  redetermination by the carrier.

A  review by the state insurance commissioner.

B  review by an administrative law judge.

C  review by a qualified independent contractor.

D  redetermination by the carrier.

A  review by an administrative law judge.

B  redetermination by the carrier.

C  review by the state insurance commissioner.

D  review by a qualified independent contractor.

A  90 days after denial.

B  60 days after denial.

C  30 days after denial.

D  180 days after denial.

A  Title XXI of the Social Security Act.

B  HIPAA.

C  FECA.

D  ERISA.

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

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 for services related to an accident.

A  sending a copy of pertinent court decisions.

B  rebilling the claim.

C  sending a form letter.

D  telephone or fax.

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

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

C  the claim was considered not medically necessary.

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

A  about payment from other carriers for the reported service.

B  about why the patient cannot afford to pay more.

C  about the physician’s financial situation.

D  from the patient medical record.

A  All of these.

B  newsletters from the carrier.

C  an administrative manual.

D  phone calls to the carrier.

A  objective information.

B  part of the assessment.

C  subjective information.

D  part of the plan.

A  objective information.

B  the plan.

C  assessment information.

D  subjective information.

A  the plan.

B  subjective information.

C  assessment information.

D  objective 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  claims processing.

B  medical transcription.

C  encounter form completion.

D  documentation.

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

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

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  use respect and care when explaining policy benefits.

A  audit.

B  appeal.

C  reconsideration.

D  adjudication.

A  utilization review.

B  appeal committee review.

C  peer review.

D  routine examination of claims.

A  bill the patient.

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

C  write off the entire amount.

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

A  write off the entire amount.

B  negotiate with the patient for partial payment.

C  bill the patient.

D  file an appeal with the insurance carrier.

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

B  charges on the original claim were not detailed.

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

D  some of the services provided to a patient were not billed on prior claims.

A  downcoding.

B  bundling.

C  unbundling.

D  upcoding.

A  False

B  True

A  a new patient office visit.

B  an established patient office visit.

C  critical care services.

D  subsequent in-hospital care.

A  CPT Index.

B  CPT Appendix A.

C  CPT Appendix C.

D  CPT Guidelines.

A  the possible management options.

B  the presenting problems.

C  All of these.

D  the diagnostic procedures.

A  minimal.

B  moderate.

C  low.

D  high.

A  must be coded.

B  can be stated or implied.

C  must be explicitly stated.

D  must be part of the HPI.

A  expanded problem-focused exam.

B  comprehensive exam.

C  problem-focused exam.

D  detailed exam.

A  organ systems.

B  tissue systems.

C  body areas.

D  body organs.

A  general multisystem exam.

B  multibody-area exam.

C  single organ system exam.

D  general organ system exam.

A  past history.

B  social history.

C  HPI.

D  family history.

A  pertinent.

B  comprehensive.

C  detailed.

D  complete.

A  brief or extended.

B  brief or complicated.

C  brief or detailed.

D  brief or comprehensive.

A  four HPI elements.

B  two HPI elements.

C  one HPI element.

D  three HPI elements.

A  context.

B  associated signs and symptoms.

C  quality.

D  severity.

A  severity.

B  timing.

C  quality.

D  duration.

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

B  history of present illness (HPI).

C  chief complaint (CC).

D  review of systems (ROS).

A  problem focused.

B  expanded problem focused.

C  comprehensive.

D  detailed.

A  unbundle the service.

B  upcode the service.

C  pay the service as billed.

D  deny payment.

A  complexity of the diagnosis.

B  extent of the exam documented.

C  complexity of the medical decision making.

D  extent of the history documented.

A  the provider.

B  the provider and the office manager.

C  all office staff.

D  the office manager.

A  bundling.

B  downcoding.

C  unbundling.

D  upcoding.

A  practice employee.

B  government investigator.

C  private payer.

D  All of these.

A  prospectively only.

B  either prospectively or retrospectively.

C  neither prospectively or retrospectively.

D  retrospectively only.

A  accurate coding and billing.

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

C  completeness of progress reports.

D  appropriate documentation of the visit.