Weekly Quiz 7 Chapter 9 & 16

A  embezzlement.

B  retention.

C  fraud.

D  conversion.

A  180 days.

B  3 years.

C  1 year.

D  5 years.

A  Department of Labor.

B  carrier president.

C  Department of Insurance.

D  carrier legal department.

A  90 days.

B  120 days.

C  60 days.

D  30 days.

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  review by a qualified independent contractor.

B  review by an administrative law judge.

C  review by the state insurance commissioner.

D  redetermination by the carrier.

A  review by the state insurance commissioner.

B  redetermination by the carrier.

C  review by an administrative law judge.

D  review by a qualified independent contractor.

A  30 days after denial.

B  90 days after denial.

C  60 days after denial.

D  180 days after denial.

A  FECA.

B  HIPAA.

C  ERISA.

D  Title XXI of the Social Security Act.

A  the claim was for services related to an accident.

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

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

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

A  sending a copy of pertinent court decisions.

B  sending a form letter.

C  telephone or fax.

D  rebilling the claim.

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

B  the claim was considered not medically necessary.

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

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

A  about payment from other carriers for the reported service.

B  from the patient medical record.

C  about why the patient cannot afford to pay more.

D  about the physician’s financial situation.

A  phone calls to the carrier.

B  newsletters from the carrier.

C  an administrative manual.

D  All of these.

A  objective information.

B  part of the assessment.

C  part of the plan.

D  subjective information.

A  objective information.

B  the plan.

C  subjective information.

D  assessment information.

A  subjective information.

B  assessment information.

C  objective information.

D  the plan.

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

B  service was not performed and cannot be billed.

C  physician should verbally verify that the service was provided.

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

A  documentation.

B  medical transcription.

C  claims processing.

D  encounter form completion.

A  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.

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

C  use respect and care when explaining policy benefits.

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

A  audit.

B  reconsideration.

C  appeal.

D  adjudication.

A  utilization review.

B  appeal committee review.

C  peer review.

D  routine examination of claims.

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

B  bill the patient.

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

D  write off the entire amount.

A  write off the entire amount.

B  bill the patient.

C  file an appeal with the insurance carrier.

D  negotiate with the patient for partial payment.

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

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

C  charges on the original claim were not detailed.

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

A  upcoding.

B  bundling.

C  downcoding.

D  unbundling.

A  False

B  True

A  subsequent in-hospital care.

B  critical care services.

C  an established patient office visit.

D  a new patient office visit.

A  CPT Guidelines.

B  CPT Index.

C  CPT Appendix C.

D  CPT Appendix A.

A  All of these.

B  the diagnostic procedures.

C  the presenting problems.

D  the possible management options.

A  moderate.

B  minimal.

C  low.

D  high.

A  must be explicitly stated.

B  can be stated or implied.

C  must be part of the HPI.

D  must be coded.

A  detailed exam.

B  problem-focused exam.

C  expanded problem-focused exam.

D  comprehensive exam.

A  body organs.

B  body areas.

C  tissue systems.

D  organ systems.

A  general organ system exam.

B  single organ system exam.

C  multibody-area exam.

D  general multisystem exam.

A  past history.

B  social history.

C  family history.

D  HPI.

A  complete.

B  pertinent.

C  detailed.

D  comprehensive.

A  brief or comprehensive.

B  brief or extended.

C  brief or complicated.

D  brief or detailed.

A  three HPI elements.

B  two HPI elements.

C  four HPI elements.

D  one HPI element.

A  context.

B  associated signs and symptoms.

C  quality.

D  severity.

A  duration.

B  severity.

C  quality.

D  timing.

A  review of systems (ROS).

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

C  history of present illness (HPI).

D  chief complaint (CC).

A  expanded problem focused.

B  detailed.

C  comprehensive.

D  problem focused.

A  upcode the service.

B  pay the service as billed.

C  deny payment.

D  unbundle the service.

A  complexity of the medical decision making.

B  complexity of the diagnosis.

C  extent of the exam documented.

D  extent of the history documented.

A  the provider and the office manager.

B  the office manager.

C  the provider.

D  all office staff.

A  downcoding.

B  bundling.

C  upcoding.

D  unbundling.

A  practice employee.

B  government investigator.

C  private payer.

D  All of these.

A  neither prospectively or retrospectively.

B  either prospectively or retrospectively.

C  retrospectively only.

D  prospectively only.

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

B  completeness of progress reports.

C  appropriate documentation of the visit.

D  accurate coding and billing.