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. calling the insurance carrier.

B. reading and understanding the physician's documentation.

C. registering the patient.

D. filling out a claim form.

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. review costs and evaluate facilities.

C. All of these.

D. forecast healthcare needs.

Question #3

ICD-10-CM offers an expanded selection of:

A. co-existing condition codes.

B. inpatient codes.

C. outpatient codes.

D. complication codes.

Question #4

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

A. Tabular List of Diseases and Injuries.

B. Table of Drugs and Chemicals.

C. External Causes Index.

D. Neoplasm Table.

Question #5

The current CPT system uses codes with:

A. 4 digits.

B. 3 digits.

C. 6 digits.

D. 5 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. use of local codes.

D. elimination of local, temporary codes.

Question #7

The first section of the CPT code book is:

A. Surgery.

B. Medicine.

C. Anesthesia.

D. Evaluation and Management .

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 III CPT code.

B. written explanation.

C. Category II CPT code.

D. modifier.

Question #9

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

A. recommended practice.

B. requirement.

C. fraudulent practice.

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

Question #10

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

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.

Question #11

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

A. negotiate with the patient for partial payment.

B. write off the entire amount.

C. file an appeal with the insurance carrier.

D. bill the patient.

Question #12

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

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

B. write off the entire amount.

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

D. bill the patient.

Question #13

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

A. look under a related procedure for more information.

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

C. assign the code.

D. refer to the patient chart for more information.

Question #14

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

A. osteopathic manipulation.

B. abdominal distention.

C. evaluation and management.

D. arthroscopy.

Question #15

The proper use of CPT modifiers can result in:

A. denials of claims.

B. increased reimbursement.

C. reduced reimbursement.

D. claim-processing delays.

Question #16

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

A. Anesthesia

B. Radiology

C. Evaluation and Management

D. Surgery

Question #17

HCPCS is the acronym for the:

A. Healthcare Current Procedures Coding System.

B. Health Coding for Procedures and Claim Sets.

C. Healthcare Coding for Procedures and Claims Systems.

D. Healthcare Common Procedure 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. implementing standard fee structures for all providers across all plans.

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

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

Question #19

HCPCS modifiers consist of:

A. two digits.

B. two letters or two numbers.

C. two letters or one letter and one number.

D. two letters.

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. complete.

B. accurate.

C. authorized.

D. clean.

Question #21

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

A. certification audits.

B. internal audits.

C. accreditation audits.

D. external audits.

Question #22

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

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

B. It increases the risk of errors.

C. It ensures compliance.

D. It delays insurance payment.

Question #23

Physician offices should audit their medical records to:

A. ensure compliance with HIPAA regulations.

B. All of these.

C. assess the completeness of the medical record.

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

Question #24

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

A. unbundling.

B. upcoding.

C. bundling.

D. downcoding.

Question #25

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

A. radiology.

B. evaluation and management (E/M).

C. medicine.

D. surgery.

Question #26

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

A. payments from insurance companies.

B. bank loans.

C. private donations.

D. payments from patients.

Question #27

A patient information form typically includes:

A. All of these.

B. insurance information.

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. Explanation of benefits form

B. Assignment 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 2 years.

B. once per year.

C. every 3 years.

D. at every visit.

Question #30

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

A. Verification of benefits form

B. Superbill

C. UB-04 claim form

D. CMS-1500 claim form

Question #31

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

A. discharge

B. surgery.

C. diagnosis.

D. admission.

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. prospective payment system.

B. fee for service.

C. per diem.

D. capitation.

Question #34

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

A. resource intensity.

B. discharge status.

C. severity of illness.

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. black

B. red

C. purple

D. blue

Question #36

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

A. disabled.

B. end-stage renal disease.

C. age 65 or older.

D. low income.

Question #37

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

A. Social Security Administration (SSA).

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

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

D. Internal Revenue Service (IRS).

Question #38

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

A. hospice care.

B. telemedicine.

C. home healthcare.

D. inpatient hospital care.

Question #39

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

A. unlimited days if medically necessary.

B. 30 days.

C. 90 days.

D. 60 days.

Question #40

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

A. routine foot care.

B. outpatient hospital services.

C. ambulance transportation.

D. clinical laboratory services.

Question #41

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

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

B. each state government.

C. contracted insurance carriers.

D. the federal government.

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. Medicare begins paying for services.

B. a coinsurance amount applies.

C. a deductible is paid.

D. Medicaid begins paying for services.

Question #43

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

A. emergency services.

B. well-child checkups.

C. prenatal care.

D. preventive services.

Question #44

Mandatory Medicaid services include coverage for:

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

B. prescribed drugs.

C. transportation services.

D. physical therapy services.

Question #45

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

A. necessary preauthorization was not obtained.

B. service was not medically necessary.

C. claim was not filed in a timely manner.

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

Question #46

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

A. CHAMPVA.

B. TRICARE Standard.

C. TRICARE Prime.

D. TRICARE for Life

Question #47

The TRICARE fiscal year ends on:

A. September 30.

B. December 31.

C. June 30.

D. January 31.

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 beneficiary.

D. $7,500 per family.

Question #49

Under TRICARE Prime, a PCM is a:

A. preventive care manager.

B. physician case manager.

C. physician consulting 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. Veterans Administration (VA) hospital network.

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

Question #51

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

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.

Question #52

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

A. medically feasible.

B. medically necessary.

C. medically reasonable.

D. medically appropriate.

Question #53

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

A. bill the patient for the remaining balance.

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

C. request assistance from the state insurance commissioner.

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

Question #54

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

A. the insurance carrier and the patient.

B. the insurance carrier only.

C. None of these.

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

D. $150 from the insurance carrier and $50 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. District of Columbia Workers' Compensation Act.

C. Occupational Safety and Health for Private Employers Act.

D. Federal Employees' 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. Federal Employees' Compensation Act.

B. Energy Employees Occupational Illness Compensation Program Act.

C. District of Columbia Workers' Compensation Act.

D. Longshore and Harbor Workers' Compensation Act.

Question #59

injury occurred while the worker was intoxicated.

A. federal programs.

B. private insurance carriers.

C. self-funded plans.

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: