Weekly Quiz 7 Chapter 9 & 16

A  fraud.

B  retention.

C  embezzlement.

D  conversion.

A  1 year.

B  5 years.

C  180 days.

D  3 years.

A  Department of Labor.

B  carrier president.

C  carrier legal department.

D  Department of Insurance.

A  30 days.

B  90 days.

C  120 days.

D  60 days.

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  review by an administrative law judge.

B  review by a qualified independent contractor.

C  redetermination by the carrier.

D  review by the state insurance commissioner.

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  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  FECA.

C  HIPAA.

D  ERISA.

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  telephone or fax.

B  sending a copy of pertinent court decisions.

C  sending a form letter.

D  rebilling the claim.

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

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

C  the claim was considered not medically necessary.

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

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  newsletters from the carrier.

B  All of these.

C  an administrative manual.

D  phone calls to the carrier.

A  objective information.

B  part of the assessment.

C  part of the plan.

D  subjective information.

A  subjective information.

B  the plan.

C  assessment information.

D  objective information.

A  assessment information.

B  the plan.

C  subjective information.

D  objective information.

A  physician should verbally verify that the service was provided.

B  service was not performed and cannot be billed.

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

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

A  claims processing.

B  encounter form completion.

C  medical transcription.

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  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  reconsideration.

B  audit.

C  appeal.

D  adjudication.

A  utilization review.

B  routine examination of claims.

C  appeal committee review.

D  peer review.

A  write off the entire amount.

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

C  bill the patient.

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

A  write off the entire amount.

B  negotiate with the patient for partial payment.

C  file an appeal with the insurance carrier.

D  bill the patient.

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

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

C  charges on the original claim were not detailed.

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

A  unbundling.

B  bundling.

C  upcoding.

D  downcoding.

A  False

B  True

A  an established patient office visit.

B  subsequent in-hospital care.

C  a new patient office visit.

D  critical care services.

A  CPT Guidelines.

B  CPT Appendix C.

C  CPT Appendix A.

D  CPT Index.

A  the possible management options.

B  the presenting problems.

C  the diagnostic procedures.

D  All of these.

A  low.

B  high.

C  minimal.

D  moderate.

A  must be part of the HPI.

B  must be explicitly stated.

C  can be stated or implied.

D  must be coded.

A  problem-focused exam.

B  detailed exam.

C  expanded problem-focused exam.

D  comprehensive exam.

A  tissue systems.

B  organ systems.

C  body organs.

D  body areas.

A  multibody-area exam.

B  general organ system exam.

C  single organ system exam.

D  general multisystem exam.

A  HPI.

B  family history.

C  social history.

D  past history.

A  comprehensive.

B  complete.

C  detailed.

D  pertinent.

A  brief or complicated.

B  brief or detailed.

C  brief or comprehensive.

D  brief or extended.

A  three HPI elements.

B  one HPI element.

C  two HPI elements.

D  four HPI elements.

A  context.

B  associated signs and symptoms.

C  quality.

D  severity.

A  duration.

B  severity.

C  timing.

D  quality.

A  chief complaint (CC).

B  history of present illness (HPI).

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

D  review of systems (ROS).

A  problem focused.

B  comprehensive.

C  expanded problem focused.

D  detailed.

A  deny payment.

B  upcode the service.

C  unbundle the service.

D  pay the service as billed.

A  complexity of the diagnosis.

B  complexity of the medical decision making.

C  extent of the exam documented.

D  extent of the history documented.

A  the provider.

B  all office staff.

C  the office manager.

D  the provider and the office manager.

A  upcoding.

B  unbundling.

C  downcoding.

D  bundling.

A  All of these.

B  private payer.

C  practice employee.

D  government investigator.

A  prospectively only.

B  neither prospectively or retrospectively.

C  retrospectively only.

D  either prospectively or retrospectively.

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

B  appropriate documentation of the visit.

C  accurate coding and billing.

D  completeness of progress reports.