Final Exam

A  worker failed to follow safety procedures.

B  worker is also receiving Social Security disability benefits.

C  worker signed an acknowledgement of workplace hazards.

A  self-funded plans.

B  state workers’ compensation funds.

C  private insurance carriers.

D  federal programs.

A  Longshore and Harbor Workers’ Compensation Act.

B  District of Columbia Workers’ Compensation Act.

C  Energy Employees Occupational Illness Compensation Program Act.

D  Federal Employees’ Compensation Act.

A  Energy Employees Occupational Illness Compensation Program Act.

B  Occupational Safety and Health for Private Employers Act.

C  District of Columbia Workers’ Compensation Act.

D  Federal Employees’ Compensation Act.

A  Occupational Standards for Health Administration.

B  Occupational Safety and Health Administration.

C  Optional Safety and Health Act.

D  Optional Standards for Health Act.

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

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

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

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

A  the insurance carrier and the patient.

B  the insurance carrier only.

C  the patient only.

D  None of these.

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

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

C  request assistance from the state insurance commissioner.

D  bill the patient for the remaining balance.

A  medically appropriate.

B  medically feasible.

C  medically reasonable.

D  medically necessary.

A  posting charges and diagnoses.

B  obtaining correct and complete patient information.

C  verifying patient insurance benefits.

D  entering patient information data into the computer.

A  Centers for Medicare and Medicaid Services (CMS).

B  Veterans Administration (VA) Health Administration Center.

C  Veterans Administration (VA) hospital network.

D  Department of Defense (DoD).

A  preventive care manager.

B  physician case manager.

C  physician consulting manager.

D  primary care manager.

A  $1,000 per beneficiary.

B  $7,500 per family.

C  $7,500 per beneficiary.

D  $1,000 per family.

A  December 31.

B  June 30.

C  September 30.

D  January 31.

A  CHAMPVA.

B  TRICARE for Life

C  TRICARE Standard.

D  TRICARE Prime.

A  claim was not filed in a timely manner.

B  patient signed an advance beneficiary notice (ABN).

C  service was not medically necessary.

D  necessary preauthorization was not obtained.

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

B  transportation services.

C  prescribed drugs.

D  physical therapy services.

A  emergency services.

B  well-child checkups.

C  preventive services.

D  prenatal care.

A  Medicaid begins paying for services.

B  Medicare begins paying for services.

C  a coinsurance amount applies.

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  clinical laboratory services.

C  outpatient hospital services.

D  routine foot care.

A  60 days.

B  unlimited days if medically necessary.

C  90 days.

D  30 days.

A  inpatient hospital care.

B  hospice care.

C  home healthcare.

D  telemedicine.

A  Internal Revenue Service (IRS).

B  Department of Health and Human Services (DHHS).

C  Social Security Administration (SSA).

D  Centers for Medicare and Medicaid Services (CMS).

A  end-stage renal disease.

B  disabled.

C  low income.

D  age 65 or older.

A  blue

B  purple

C  black

D  red

A  resource intensity.

B  discharge status.

C  severity of illness.

D  treatment difficulty.

A  fee for service.

B  prospective payment system.

C  per diem.

D  capitation.

A  per diem.

B  capitation.

C  prospective payment system.

D  fee for service.

A  surgery.

B  discharge

C  diagnosis.

D  admission.

A  Superbill

B  UB-04 claim form

C  Verification of benefits form

D  CMS-1500 claim form

A  once per year.

B  at every visit.

C  every 3 years.

D  every 2 years.

A  Assignment of benefits form

B  Release of information form

C  Patient information form

D  Explanation of benefits form

A  employment information.

B  insurance information.

C  All of these.

D  demographic information.

A  payments from patients.

B  bank loans.

C  payments from insurance companies.

D  private donations.

A  medicine.

B  surgery.

C  evaluation and management (E/M).

D  radiology.

A  upcoding.

B  unbundling.

C  downcoding.

D  bundling.

A  determine the accuracy of the physician’s documentation.

B  ensure compliance with HIPAA regulations.

C  All of these.

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  internal audits.

C  external audits.

D  certification audits.

A  complete.

B  clean.

C  accurate.

D  authorized.

A  two digits.

B  two letters or one letter and one number.

C  two letters or two numbers.

D  two letters.

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

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

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

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

A  Healthcare Common Procedure Coding System.

B  Health Coding for Procedures and Claim Sets.

C  Healthcare Coding for Procedures and Claims Systems.

D  Healthcare Current Procedures Coding System.

A  Surgery

B  Anesthesia

C  Evaluation and Management

D  Radiology

A  reduced reimbursement.

B  claim-processing delays.

C  increased reimbursement.

D  denials of claims.

A  abdominal distention.

B  osteopathic manipulation.

C  evaluation and management.

D  arthroscopy.

A  look under a related procedure for more information.

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

C  refer to the patient chart for more information.

D  assign the code.

A  write off the entire amount.

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

C  bill the patient.

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

A  file an appeal with the insurance carrier.

B  write off the entire amount.

C  negotiate with the patient for partial payment.

D  bill the patient.

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

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 medical office specialist made a mistake on the claim.

A  requirement.

B  fraudulent practice.

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

D  recommended practice.

A  written explanation.

B  modifier.

C  Category III CPT code.

D  Category II CPT code.

A  Medicine.

B  Surgery.

C  Anesthesia.

D  Evaluation and Management .

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  4 digits.

B  3 digits.

C  6 digits.

D  5 digits.

A  Tabular List of Diseases and Injuries.

B  Neoplasm Table.

C  External Causes Index.

D  Table of Drugs and Chemicals.

A  inpatient codes.

B  co-existing condition codes.

C  complication codes.

D  outpatient codes.

A  conduct studies of disease trends.

B  All of these.

C  review costs and evaluate facilities.

D  forecast healthcare needs.

A  registering the patient.

B  filling out a claim form.

C  calling the insurance carrier.

D  reading and understanding the physician’s documentation.