Weekly Quiz 7 Chapter 9 & 16

A  fraud.

B  embezzlement.

C  retention.

D  conversion.

A  3 years.

B  5 years.

C  180 days.

D  1 year.

A  Department of Labor.

B  carrier legal department.

C  carrier president.

D  Department of Insurance.

A  30 days.

B  120 days.

C  90 days.

D  60 days.

A  review by an administrative law judge.

B  redetermination by the carrier.

C  review by a qualified independent contractor.

D  review by the state insurance commissioner.

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  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  90 days after denial.

B  60 days after denial.

C  180 days after denial.

D  30 days after denial.

A  ERISA.

B  HIPAA.

C  Title XXI of the Social Security Act.

D  FECA.

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 claim was for services related to an accident.

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

A  rebilling the claim.

B  sending a copy of pertinent court decisions.

C  telephone or fax.

D  sending a form letter.

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

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

C  the claim was considered not medically necessary.

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

A  about why the patient cannot afford to pay more.

B  about payment from other carriers for the reported service.

C  from the patient medical record.

D  about the physician’s financial situation.

A  an administrative manual.

B  newsletters from the carrier.

C  All of these.

D  phone calls to the carrier.

A  part of the plan.

B  objective information.

C  part of the assessment.

D  subjective information.

A  the plan.

B  objective information.

C  assessment information.

D  subjective information.

A  assessment information.

B  the plan.

C  subjective information.

D  objective information.

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

B  physician should verbally verify that the service was provided.

C  service was not performed and cannot be billed.

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

A  documentation.

B  encounter form completion.

C  claims processing.

D  medical transcription.

A  use respect and care when explaining policy benefits.

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

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

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  adjudication.

B  reconsideration.

C  appeal.

D  audit.

A  peer review.

B  routine examination of claims.

C  utilization review.

D  appeal committee review.

A  bill the patient.

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

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

D  write off the entire amount.

A  bill the patient.

B  file an appeal with the insurance carrier.

C  write off the entire amount.

D  negotiate with the patient for partial payment.

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

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

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  upcoding.

B  downcoding.

C  unbundling.

D  bundling.

A  True

B  False

A  critical care services.

B  subsequent in-hospital care.

C  a new patient office visit.

D  an established patient office visit.

A  CPT Appendix A.

B  CPT Index.

C  CPT Appendix C.

D  CPT Guidelines.

A  the diagnostic procedures.

B  All of these.

C  the presenting problems.

D  the possible management options.

A  high.

B  minimal.

C  moderate.

D  low.

A  can be stated or implied.

B  must be explicitly stated.

C  must be coded.

D  must be part of the HPI.

A  detailed exam.

B  problem-focused exam.

C  comprehensive exam.

D  expanded problem-focused exam.

A  body organs.

B  tissue systems.

C  organ systems.

D  body areas.

A  single organ system exam.

B  general multisystem exam.

C  general organ system exam.

D  multibody-area exam.

A  family history.

B  social history.

C  HPI.

D  past history.

A  complete.

B  detailed.

C  comprehensive.

D  pertinent.

A  brief or complicated.

B  brief or comprehensive.

C  brief or detailed.

D  brief or extended.

A  four HPI elements.

B  one HPI element.

C  two HPI elements.

D  three HPI elements.

A  associated signs and symptoms.

B  context.

C  severity.

D  quality.

A  timing.

B  severity.

C  duration.

D  quality.

A  review of systems (ROS).

B  history of present illness (HPI).

C  chief complaint (CC).

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

A  problem focused.

B  comprehensive.

C  expanded problem focused.

D  detailed.

A  unbundle the service.

B  pay the service as billed.

C  deny payment.

D  upcode the service.

A  extent of the exam documented.

B  complexity of the diagnosis.

C  extent of the history documented.

D  complexity of the medical decision making.

A  the provider and the office manager.

B  all office staff.

C  the office manager.

D  the provider.

A  upcoding.

B  bundling.

C  downcoding.

D  unbundling.

A  practice employee.

B  private payer.

C  All of these.

D  government investigator.

A  retrospectively only.

B  either prospectively or retrospectively.

C  prospectively only.

D  neither prospectively or retrospectively.

A  appropriate documentation of the visit.

B  accurate coding and billing.

C  completeness of progress reports.

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