Glendale Community College » Medical Office Administration » MOA 183 - Medical Billing and Coding » Fall 2020

MOA 183 - Medical Billing and Coding » Fall 2020 » Final Exam

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Question #1

A coder's first step in the reimbursement process is:

A. registering the patient.

B. calling the insurance carrier.

C. filling out a claim form.

D. reading and understanding the physician's documentation.

Question #2

In addition to the reimbursement process, ICD-10-CM codes are used by outside agencies to:

A. conduct studies of disease trends.

B. All of these.

C. review costs and evaluate facilities.

D. forecast healthcare needs.

Question #3

ICD-10-CM offers an expanded selection of:

A. co-existing condition codes.

B. complication codes.

C. outpatient codes.

D. inpatient codes.

Question #4

Once the correct code is located in the Alphabetic Index it must then be verified in the:

A. Neoplasm Table.

B. External Causes Index.

C. Tabular List of Diseases and Injuries.

D. Table of Drugs and Chemicals.

Question #5

The current CPT system uses codes with:

A. 5 digits.

B. 4 digits.

C. 3 digits.

D. 6 digits.

Question #6

The Health Insurance Portability and Accountability Act (HIPAA) supports the:

A. increased use of temporary codes for emerging technology.

B. increased use of nonstandard CPT codes.

C. elimination of local, temporary codes.

D. use of local codes.

Question #7

The first section of the CPT code book is:

A. Anesthesia.

B. Evaluation and Management .

C. Surgery.

D. Medicine.

Question #8

To report that the description of a service or procedure has been altered in some way, the coder should use a:

A. Category II CPT code.

B. Category III CPT code.

C. modifier.

D. written explanation.

Question #9

Some insurance carriers perceive automatic rebilling after 30 days to be aggressive and a:

A. requirement.

B. sign of error on the part of the physician's office.

C. recommended practice.

D. fraudulent practice.

Question #10

Reasons to rebill an insurance claim include all of the following EXCEPT:

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

B. charges on the original claim were not detailed.

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

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

Question #11

If a claim is denied as a noncovered service, the medical office specialist should:

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.

Question #12

If a claim is denied because additional information is needed to prove medical necessity, the medical office specialist should:

A. write off the entire amount.

B. bill the patient.

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

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

Question #13

If only one code for a procedure or service occurs in the index, the user should:

A. assign the code.

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

C. refer to the patient chart for more information.

D. look under a related procedure for more information.

Question #14

Examples of procedures or services include all of the following EXCEPT:

A. osteopathic manipulation.

B. evaluation and management.

C. arthroscopy.

D. abdominal distention.

Question #15

The proper use of CPT modifiers can result in:

A. increased reimbursement.

B. denials of claims.

C. claim-processing delays.

D. reduced reimbursement.

Question #16

A physical status modifier is used with which of the following CPT codes?

A. Radiology

B. Anesthesia

C. Evaluation and Management

D. Surgery

Question #17

HCPCS is the acronym for the:

A. Healthcare Common Procedure Coding System.

B. Healthcare Coding for Procedures and Claims Systems.

C. Health Coding for Procedures and Claim Sets.

D. Healthcare Current Procedures Coding System.

Question #18

HCPCS was developed to achieve all of the following goals EXCEPT:

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

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

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

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

Question #19

HCPCS modifiers consist of:

A. two letters.

B. two letters or two numbers.

C. two digits.

D. two letters or one letter and one number.

Question #20

When each reported service is connected to a diagnosis that supports the procedure as medically necessary, the claim is referred to as:

A. authorized.

B. complete.

C. clean.

D. accurate.

Question #21

Types of audits for medical records include all of the following EXCEPT:

A. certification audits.

B. internal audits.

C. external audits.

D. accreditation audits.

Question #22

Which of the following is a disadvantage of a prospective internal audit?

A. It increases the risk of errors.

B. It decreases the workload of the medical office specialist.

C. It delays insurance payment.

D. It ensures compliance.

Question #23

Physician offices should audit their medical records to:

A. assess the completeness of the medical record.

B. determine the accuracy of the physician's documentation.

C. All of these.

D. ensure compliance with HIPAA regulations.

Question #24

If documentation in the patient chart supports a lower level of service than that coded, the error would be called:

A. upcoding.

B. downcoding.

C. unbundling.

D. bundling.

Question #25

The most widely used Current Procedural Terminology (CPT) codes are:

A. medicine.

B. radiology.

C. evaluation and management (E/M).

D. surgery.

Question #26

The majority of income in a physician's office comes from:

A. private donations.

B. payments from patients.

C. payments from insurance companies.

D. bank loans.

Question #27

A patient information form typically includes:

A. insurance information.

B. All of these.

C. demographic information.

D. employment information.

Question #28

If a patient wishes insurance payments to be made directly to the provider, the patient must sign which type of form?

A. Assignment of benefits form

B. Explanation of benefits form

C. Release of information form

D. Patient information form

Question #29

The policy in most medical offices is to request that the patient sign and update a release of information form:

A. every 3 years.

B. once per year.

C. every 2 years.

D. at every visit.

Question #30

Most physicians bill insurance carriers by completing paper or electronic versions of which form?

A. UB-04 claim form

B. CMS-1500 claim form

C. Verification of benefits form

D. Superbill

Question #31

A patient control number (PCN) is a unique identifier assigned to each hospital patient at the time of:

A. admission.

B. surgery.

C. diagnosis.

D. discharge

Question #32

Reimbursement methods for inpatient and outpatient hospital services include all of the following EXCEPT:

A. capitation.

B. per diem.

C. prospective payment system.

D. fee for service.

Question #33

The method of reimbursement that pays hospitals a fixed rate per day for all services provided is:

A. per diem.

B. prospective payment system.

C. fee for service.

D. capitation.

Question #34

A facility's case mix is based on all of the following EXCEPT:

A. severity of illness.

B. resource intensity.

C. discharge status.

D. treatment difficulty.

Question #35

What color of ink is the UB-04 form printed in to allow for processing with optical scanning equipment?

A. red

B. black

C. purple

D. blue

Question #36

Individuals eligible for Medicare may be classified into one or more of the following categories EXCEPT:

A. low income.

B. age 65 or older.

C. disabled.

D. end-stage renal disease.

Question #37

The organization that enrolls new Medicare beneficiaries into the program is the:

A. Social Security Administration (SSA).

B. Centers for Medicare and Medicaid Services (CMS).

C. Internal Revenue Service (IRS).

D. Department of Health and Human Services (DHHS).

Question #38

Medicare Part A provides coverage for all of the following services EXCEPT:

A. inpatient hospital care.

B. telemedicine.

C. hospice care.

D. home healthcare.

Question #39

When receiving inpatient hospital care, a Medicare Part A beneficiary has a lifetime reserve of:

A. 90 days.

B. 60 days.

C. unlimited days if medically necessary.

D. 30 days.

Question #40

Medicare Part B insurance helps pay for all of the following services EXCEPT:

A. routine foot care.

B. ambulance transportation.

C. outpatient hospital services.

D. clinical laboratory services.

Question #41

The organization responsible for determining the type, amount, and scope of services covered by Medicaid is:

A. each state government.

B. contracted insurance carriers.

C. the federal government.

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

Question #42

In some states, a spend-down program requires that individuals must spend a portion of their income or resources each month on medical expenses before:

A. Medicaid begins paying for services.

B. a deductible is paid.

C. a coinsurance amount applies.

D. Medicare begins paying for services.

Question #43

Under the Welfare Reform Bill, mandatory covered services for immigrants include:

A. preventive services.

B. well-child checkups.

C. emergency services.

D. prenatal care.

Question #44

Mandatory Medicaid services include coverage for:

A. physical therapy services.

B. prescribed drugs.

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

D. transportation services.

Question #45

A physician may bill a Medicaid patient for services if the:

A. necessary preauthorization was not obtained.

B. patient signed an advance beneficiary notice (ABN).

C. claim was not filed in a timely manner.

D. service was not medically necessary.

Question #46

The TRICARE plan option that provides benefits using a fee-for-service, cost-sharing structure is:

A. TRICARE Prime.

B. TRICARE Standard.

C. TRICARE for Life

D. CHAMPVA.

Question #47

The TRICARE fiscal year ends on:

A. June 30.

B. January 31.

C. December 31.

D. September 30.

Question #48

The TRICARE Standard annual catastrophic cap (maximum amount beneficiaries are required to pay within 1 year) for retired members' families is:

A. $1,000 per beneficiary.

B. $1,000 per family.

C. $7,500 per family.

D. $7,500 per beneficiary.

Question #49

Under TRICARE Prime, a PCM is a:

A. preventive care manager.

B. physician consulting manager.

C. physician case manager.

D. primary care manager.

Question #50

The CHAMPVA program is administered by the:

A. Department of Defense (DoD).

B. Veterans Administration (VA) Health Administration Center.

C. Centers for Medicare and Medicaid Services (CMS).

D. Veterans Administration (VA) hospital network.

Question #51

The first step that the medical office specialist is responsible for before submitting a medical claim is:

A. obtaining correct and complete patient information.

B. verifying patient insurance benefits.

C. entering patient information data into the computer.

D. posting charges and diagnoses.

Question #52

When treatment is determined to be appropriate for the diagnosis, the care is considered:

A. medically feasible.

B. medically necessary.

C. medically appropriate.

D. medically reasonable.

Question #53

If an insurance carrier does NOT reconsider a downcoded claim that has been appealed, the medical office specialist can:

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

B. request assistance from the state insurance commissioner.

C. bill the patient for the remaining balance.

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

Question #54

The allowed charge includes the amount that will be paid by:

A. the patient only.

B. None of these.

C. the insurance carrier and the patient.

D. the insurance carrier only.

Question #55

Under an 80/20 plan, if a participating provider's usual charge is $200 for a procedure and the allowed amount is $150, the provider can collect:

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

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

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

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

Question #56

OSHA stands for the:

A. Occupational Standards for Health Administration.

B. Optional Standards for Health Act.

C. Optional Safety and Health Act.

D. Occupational Safety and Health Administration.

Question #57

The programs administered by the Office of Workers' Compensation Programs include all of the following EXCEPT the:

A. Energy Employees Occupational Illness Compensation Program Act.

B. Occupational Safety and Health for Private Employers Act.

C. Federal Employees' Compensation Act.

D. District of Columbia Workers' Compensation Act.

Question #58

The act that covers maritime workers injured or killed on or adjacent to navigable waters of the United States is known as the:

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.

Question #59

injury occurred while the worker was intoxicated.

A. self-funded plans.

B. federal programs.

C. private insurance carriers.

D. state workers' compensation funds.

Question #60

A worker may NOT receive benefits for a generally covered injury if any of the following are true EXCEPT the: