Weekly Quiz 7 Chapter 9 & 16

A  fraud.

B  embezzlement.

C  retention.

D  conversion.

A  180 days.

B  3 years.

C  5 years.

D  1 year.

A  carrier legal department.

B  Department of Labor.

C  Department of Insurance.

D  carrier president.

A  60 days.

B  120 days.

C  90 days.

D  30 days.

A  redetermination by the carrier.

B  review by the state insurance commissioner.

C  review by a qualified independent contractor.

D  review by an administrative law judge.

A  redetermination by the carrier.

B  review by a qualified independent contractor.

C  review by the state insurance commissioner.

D  review by an administrative law judge.

A  review by a qualified independent contractor.

B  redetermination by the carrier.

C  review by the state insurance commissioner.

D  review by an administrative law judge.

A  90 days after denial.

B  180 days after denial.

C  30 days after denial.

D  60 days after denial.

A  ERISA.

B  Title XXI of the Social Security Act.

C  HIPAA.

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  rebilling the claim.

B  telephone or fax.

C  sending a form letter.

D  sending a copy of pertinent court decisions.

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

B  the claim was considered not medically necessary.

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

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

A  about payment from other carriers for the reported service.

B  from the patient medical record.

C  about the physician’s financial situation.

D  about why the patient cannot afford to pay more.

A  phone calls to the carrier.

B  an administrative manual.

C  All of these.

D  newsletters from the carrier.

A  objective information.

B  subjective information.

C  part of the plan.

D  part of the assessment.

A  the plan.

B  objective information.

C  assessment information.

D  subjective information.

A  assessment information.

B  objective information.

C  the plan.

D  subjective information.

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

B  physician should verbally verify that the service was provided.

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

D  service was not performed and cannot be billed.

A  documentation.

B  medical transcription.

C  encounter form completion.

D  claims processing.

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

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

C  use respect and care when explaining policy benefits.

D  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.

A  appeal.

B  adjudication.

C  reconsideration.

D  audit.

A  peer review.

B  routine examination of claims.

C  appeal committee review.

D  utilization review.

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

B  write off the entire amount.

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

D  bill the patient.

A  write off the entire amount.

B  file an appeal with the insurance carrier.

C  bill the patient.

D  negotiate with the patient for partial payment.

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

B  charges on the original claim were not detailed.

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

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

A  unbundling.

B  bundling.

C  downcoding.

D  upcoding.

A  True

B  False

A  subsequent in-hospital care.

B  a new patient office visit.

C  an established patient office visit.

D  critical care services.

A  CPT Guidelines.

B  CPT Appendix C.

C  CPT Index.

D  CPT Appendix A.

A  the diagnostic procedures.

B  All of these.

C  the possible management options.

D  the presenting problems.

A  moderate.

B  low.

C  high.

D  minimal.

A  must be explicitly stated.

B  must be part of the HPI.

C  can be stated or implied.

D  must be coded.

A  comprehensive exam.

B  problem-focused exam.

C  expanded problem-focused exam.

D  detailed exam.

A  tissue systems.

B  body organs.

C  organ systems.

D  body areas.

A  general organ system exam.

B  single organ system exam.

C  multibody-area exam.

D  general multisystem exam.

A  family history.

B  HPI.

C  past history.

D  social history.

A  detailed.

B  comprehensive.

C  complete.

D  pertinent.

A  brief or extended.

B  brief or detailed.

C  brief or complicated.

D  brief or comprehensive.

A  three HPI elements.

B  four HPI elements.

C  one HPI element.

D  two HPI elements.

A  quality.

B  context.

C  severity.

D  associated signs and symptoms.

A  quality.

B  duration.

C  timing.

D  severity.

A  history of present illness (HPI).

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

C  chief complaint (CC).

D  review of systems (ROS).

A  problem focused.

B  detailed.

C  expanded problem focused.

D  comprehensive.

A  deny payment.

B  upcode the service.

C  pay the service as billed.

D  unbundle the service.

A  complexity of the diagnosis.

B  extent of the history documented.

C  complexity of the medical decision making.

D  extent of the exam documented.

A  the provider.

B  the provider and the office manager.

C  all office staff.

D  the office manager.

A  bundling.

B  downcoding.

C  upcoding.

D  unbundling.

A  private payer.

B  government investigator.

C  All of these.

D  practice employee.

A  retrospectively only.

B  neither prospectively or retrospectively.

C  either prospectively or retrospectively.

D  prospectively only.

A  appropriate documentation of the visit.

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

C  completeness of progress reports.

D  accurate coding and billing.