Final Exam

A  worker failed to follow safety procedures.

B  worker signed an acknowledgement of workplace hazards.

C  worker is also receiving Social Security disability benefits.

A  state workers’ compensation funds.

B  federal programs.

C  self-funded plans.

D  private insurance carriers.

A  District of Columbia Workers’ Compensation Act.

B  Longshore and Harbor Workers’ Compensation Act.

C  Energy Employees Occupational Illness Compensation Program Act.

D  Federal Employees’ Compensation Act.

A  Occupational Safety and Health for Private Employers Act.

B  Federal Employees’ Compensation Act.

C  Energy Employees Occupational Illness Compensation Program Act.

D  District of Columbia Workers’ Compensation Act.

A  Occupational Safety and Health Administration.

B  Optional Safety and Health Act.

C  Occupational Standards for Health Administration.

D  Optional Standards for Health Act.

A  $120 from the insurance carrier and $30 from the patient.

B  $160 from the insurance carrier and $40 from the patient.

C  $120 from the insurance carrier and $80 from the patient.

D  $150 from the insurance carrier and $50 from the patient.

A  the insurance carrier only.

B  the insurance carrier and the patient.

C  the patient only.

D  None of these.

A  file a complaint with the Centers for Medicare and Medicaid Services (CMS).

B  file a complaint with the Department of Health and Human Services (DHHS).

C  request assistance from the state insurance commissioner.

D  bill the patient for the remaining balance.

A  medically reasonable.

B  medically necessary.

C  medically feasible.

D  medically appropriate.

A  posting charges and diagnoses.

B  obtaining correct and complete patient information.

C  entering patient information data into the computer.

D  verifying patient insurance benefits.

A  Department of Defense (DoD).

B  Veterans Administration (VA) Health Administration Center.

C  Veterans Administration (VA) hospital network.

D  Centers for Medicare and Medicaid Services (CMS).

A  physician consulting manager.

B  primary care manager.

C  physician case manager.

D  preventive care manager.

A  $7,500 per beneficiary.

B  $1,000 per family.

C  $7,500 per family.

D  $1,000 per beneficiary.

A  January 31.

B  December 31.

C  September 30.

D  June 30.

A  TRICARE Standard.

B  CHAMPVA.

C  TRICARE Prime.

D  TRICARE for Life

A  claim was not filed in a timely manner.

B  service was not medically necessary.

C  necessary preauthorization was not obtained.

D  patient signed an advance beneficiary notice (ABN).

A  physical therapy services.

B  transportation services.

C  prescribed drugs.

D  early and periodic screening, diagnostic, and treatment services for children younger than age 21.

A  well-child checkups.

B  prenatal care.

C  preventive services.

D  emergency services.

A  a coinsurance amount applies.

B  Medicaid begins paying for services.

C  Medicare begins paying for services.

D  a deductible is paid.

A  the Centers for Medicare and Medicaid Services (CMS).

B  contracted insurance carriers.

C  the federal government.

D  each state government.

A  ambulance transportation.

B  routine foot care.

C  clinical laboratory services.

D  outpatient hospital services.

A  30 days.

B  60 days.

C  90 days.

D  unlimited days if medically necessary.

A  home healthcare.

B  telemedicine.

C  hospice care.

D  inpatient hospital care.

A  Department of Health and Human Services (DHHS).

B  Centers for Medicare and Medicaid Services (CMS).

C  Social Security Administration (SSA).

D  Internal Revenue Service (IRS).

A  disabled.

B  age 65 or older.

C  low income.

D  end-stage renal disease.

A  black

B  red

C  blue

D  purple

A  severity of illness.

B  resource intensity.

C  discharge status.

D  treatment difficulty.

A  prospective payment system.

B  per diem.

C  capitation.

D  fee for service.

A  capitation.

B  fee for service.

C  per diem.

D  prospective payment system.

A  surgery.

B  admission.

C  discharge

D  diagnosis.

A  UB-04 claim form

B  Superbill

C  CMS-1500 claim form

D  Verification of benefits form

A  at every visit.

B  every 3 years.

C  once per year.

D  every 2 years.

A  Patient information form

B  Release of information form

C  Assignment of benefits form

D  Explanation of benefits form

A  insurance information.

B  All of these.

C  employment information.

D  demographic information.

A  payments from patients.

B  private donations.

C  payments from insurance companies.

D  bank loans.

A  medicine.

B  radiology.

C  surgery.

D  evaluation and management (E/M).

A  unbundling.

B  bundling.

C  upcoding.

D  downcoding.

A  All of these.

B  ensure compliance with HIPAA regulations.

C  determine the accuracy of the physician’s documentation.

D  assess the completeness of the medical record.

A  It increases the risk of errors.

B  It decreases the workload of the medical office specialist.

C  It ensures compliance.

D  It delays insurance payment.

A  accreditation audits.

B  certification audits.

C  internal audits.

D  external audits.

A  complete.

B  accurate.

C  authorized.

D  clean.

A  two letters or one letter and one number.

B  two digits.

C  two letters or two numbers.

D  two letters.

A  coordinating government programs by uniform application of Centers for Medicare and Medicaid Services (CMS) policies.

B  ensuring the validity of profiles and fee schedules through standardized coding.

C  allowing providers and suppliers to communicate their services in a consistent manner.

D  implementing standard fee structures for all providers across all plans.

A  Health Coding for Procedures and Claim Sets.

B  Healthcare Common Procedure Coding System.

C  Healthcare Coding for Procedures and Claims Systems.

D  Healthcare Current Procedures Coding System.

A  Anesthesia

B  Evaluation and Management

C  Surgery

D  Radiology

A  claim-processing delays.

B  reduced reimbursement.

C  increased reimbursement.

D  denials of claims.

A  osteopathic manipulation.

B  evaluation and management.

C  abdominal distention.

D  arthroscopy.

A  verify the code in the main text of the CPT book.

B  look under a related procedure for more information.

C  refer to the patient chart for more information.

D  assign the code.

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

B  write off the entire amount.

C  bill the patient.

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

A  file an appeal with the insurance carrier.

B  bill the patient.

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  charges on the original claim were not detailed.

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

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

A  recommended practice.

B  requirement.

C  fraudulent practice.

D  sign of error on the part of the physician’s office.

A  written explanation.

B  Category II CPT code.

C  Category III CPT code.

D  modifier.

A  Medicine.

B  Anesthesia.

C  Evaluation and Management .

D  Surgery.

A  elimination of local, temporary codes.

B  use of local codes.

C  increased use of temporary codes for emerging technology.

D  increased use of nonstandard CPT codes.

A  3 digits.

B  4 digits.

C  5 digits.

D  6 digits.

A  Table of Drugs and Chemicals.

B  Neoplasm Table.

C  External Causes Index.

D  Tabular List of Diseases and Injuries.

A  complication codes.

B  inpatient codes.

C  outpatient codes.

D  co-existing condition codes.

A  forecast healthcare needs.

B  conduct studies of disease trends.

C  review costs and evaluate facilities.

D  All of these.

A  reading and understanding the physician’s documentation.

B  calling the insurance carrier.

C  filling out a claim form.

D  registering the patient.