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. filling out a claim form.

C. registering the patient.

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. review costs and evaluate facilities.

B. conduct studies of disease trends.

C. forecast healthcare needs.

D. All of these.

Question #3

ICD-10-CM offers an expanded selection of:

A. complication codes.

B. inpatient codes.

C. outpatient codes.

D. co-existing condition codes.

Question #4

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

A. Table of Drugs and Chemicals.

B. Neoplasm Table.

C. External Causes Index.

D. Tabular List of Diseases and Injuries.

Question #5

The current CPT system uses codes with:

A. 6 digits.

B. 4 digits.

C. 5 digits.

D. 3 digits.

Question #6

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

A. use of local codes.

B. elimination of local, temporary codes.

C. increased use of nonstandard CPT codes.

D. increased use of temporary codes for emerging technology.

Question #7

The first section of the CPT code book is:

A. Medicine.

B. Surgery.

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. modifier.

B. Category II CPT code.

C. Category III CPT code.

D. written explanation.

Question #9

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

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

B. requirement.

C. fraudulent practice.

D. recommended practice.

Question #10

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

A. charges on the original claim were not detailed.

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

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

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. bill the patient.

B. file an appeal with the insurance carrier.

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. bill the patient.

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

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

D. write off the entire amount.

Question #13

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

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

B. assign the code.

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. arthroscopy.

C. evaluation and management.

D. abdominal distention.

Question #15

The proper use of CPT modifiers can result in:

A. claim-processing delays.

B. increased reimbursement.

C. reduced reimbursement.

D. denials of claims.

Question #16

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

A. Surgery

B. Evaluation and Management

C. Anesthesia

D. Radiology

Question #17

HCPCS is the acronym for the:

A. Health Coding for Procedures and Claim Sets.

B. Healthcare Current Procedures Coding System.

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

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

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 digits.

B. two letters or two numbers.

C. two letters.

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. clean.

B. authorized.

C. accurate.

D. complete.

Question #21

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

A. accreditation audits.

B. certification audits.

C. internal 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 delays insurance payment.

C. It increases the risk of errors.

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. ensure compliance with HIPAA regulations.

D. All of these.

Question #24

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

A. downcoding.

B. unbundling.

C. upcoding.

D. bundling.

Question #25

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

A. surgery.

B. evaluation and management (E/M).

C. medicine.

D. radiology.

Question #26

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

A. bank loans.

B. private donations.

C. payments from insurance companies.

D. payments from patients.

Question #27

A patient information form typically includes:

A. employment information.

B. demographic information.

C. All of these.

D. insurance 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. Patient information form

B. Assignment of benefits form

C. Release of information form

D. Explanation of benefits form

Question #29

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

A. at every visit.

B. every 2 years.

C. once per year.

D. every 3 years.

Question #30

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

A. Superbill

B. CMS-1500 claim form

C. UB-04 claim form

D. Verification of benefits form

Question #31

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

A. diagnosis.

B. admission.

C. surgery.

D. discharge

Question #32

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

A. prospective payment system.

B. capitation.

C. fee for service.

D. per diem.

Question #33

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

A. fee for service.

B. per diem.

C. prospective payment system.

D. capitation.

Question #34

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

A. severity of illness.

B. treatment difficulty.

C. resource intensity.

D. discharge status.

Question #35

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

A. purple

B. black

C. red

D. blue

Question #36

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

A. end-stage renal disease.

B. age 65 or older.

C. low income.

D. disabled.

Question #37

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

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

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

C. Internal Revenue Service (IRS).

D. Social Security Administration (SSA).

Question #38

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

A. hospice care.

B. inpatient hospital care.

C. home healthcare.

D. telemedicine.

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. 60 days.

D. 90 days.

Question #40

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

A. clinical laboratory services.

B. outpatient hospital services.

C. ambulance transportation.

D. routine foot care.

Question #41

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

A. the federal government.

B. contracted insurance carriers.

C. each state 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. 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. well-child checkups.

B. preventive services.

C. emergency services.

D. prenatal care.

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. physical therapy services.

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

D. claim was not filed in a timely manner.

Question #46

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

A. TRICARE Standard.

B. TRICARE for Life

C. TRICARE Prime.

D. CHAMPVA.

Question #47

The TRICARE fiscal year ends on:

A. June 30.

B. September 30.

C. January 31.

D. December 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. $7,500 per family.

B. $1,000 per family.

C. $7,500 per beneficiary.

D. $1,000 per beneficiary.

Question #49

Under TRICARE Prime, a PCM is a:

A. physician consulting manager.

B. primary care manager.

C. preventive care manager.

D. physician case manager.

Question #50

The CHAMPVA program is administered by the:

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

B. Department of Defense (DoD).

C. Veterans Administration (VA) hospital network.

D. Veterans Administration (VA) Health Administration Center.

Question #51

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

A. verifying patient insurance benefits.

B. posting charges and diagnoses.

C. entering patient information data into the computer.

D. obtaining correct and complete patient information.

Question #52

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

A. medically necessary.

B. medically feasible.

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 Department of Health and Human Services (DHHS).

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

D. request assistance from the state insurance commissioner.

Question #54

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

A. the insurance carrier only.

B. the insurance carrier and the patient.

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

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

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

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

Question #56

OSHA stands for the:

A. Optional Safety and Health Act.

B. Occupational Safety and Health Administration.

C. Occupational Standards for Health Administration.

D. Optional Standards for Health Act.

Question #57

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

A. District of Columbia Workers' Compensation Act.

B. Occupational Safety and Health for Private Employers Act.

C. Federal Employees' Compensation Act.

D. Energy Employees Occupational Illness Compensation Program 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. Energy Employees Occupational Illness Compensation Program Act.

C. District of Columbia Workers' Compensation Act.

D. Federal Employees' Compensation Act.

Question #59

injury occurred while the worker was intoxicated.

A. self-funded plans.

B. private insurance carriers.

C. state workers' compensation funds.

D. federal programs.

Question #60

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