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

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

Need help with your exam preparation?

Existing Quiz Clients Login here

Question #1

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

A. reading and understanding the physician's documentation.

B. filling out a claim form.

C. registering the patient.

D. calling the insurance carrier.

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. 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. Table of Drugs and Chemicals.

D. Tabular List of Diseases and Injuries.

Question #5

The current CPT system uses codes with:

A. 3 digits.

B. 6 digits.

C. 4 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. use of local codes.

C. increased use of nonstandard CPT codes.

D. elimination of local, temporary codes.

Question #7

The first section of the CPT code book is:

A. Anesthesia.

B. Surgery.

C. Evaluation and Management .

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. modifier.

B. Category II CPT code.

C. written explanation.

D. Category III CPT code.

Question #9

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

A. fraudulent practice.

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

C. recommended practice.

D. requirement.

Question #10

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

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

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

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

D. charges on the original claim were not detailed.

Question #11

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

A. write off the entire amount.

B. negotiate with the patient for partial payment.

C. bill the patient.

D. file an appeal with the insurance carrier.

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. bill the patient.

C. write off the entire amount.

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

B. refer to the patient chart for more information.

C. assign the code.

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. abdominal distention.

D. evaluation and management.

Question #15

The proper use of CPT modifiers can result in:

A. reduced reimbursement.

B. increased reimbursement.

C. claim-processing delays.

D. denials of claims.

Question #16

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

A. Evaluation and Management

B. Surgery

C. Radiology

D. Anesthesia

Question #17

HCPCS is the acronym for the:

A. Healthcare Common Procedure Coding System.

B. Healthcare Current Procedures Coding System.

C. Health Coding for Procedures and Claim Sets.

D. Healthcare Coding for Procedures and Claims Systems.

Question #18

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

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.

Question #19

HCPCS modifiers consist of:

A. two letters or one letter and one number.

B. two letters or two numbers.

C. two digits.

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. accurate.

B. complete.

C. clean.

D. authorized.

Question #21

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

A. external audits.

B. accreditation audits.

C. internal audits.

D. certification 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 ensures compliance.

D. It increases the risk of errors.

Question #23

Physician offices should audit their medical records to:

A. ensure compliance with HIPAA regulations.

B. assess the completeness of the medical record.

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

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. upcoding.

B. unbundling.

C. downcoding.

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. private donations.

B. payments from insurance companies.

C. bank loans.

D. payments from patients.

Question #27

A patient information form typically includes:

A. All of these.

B. demographic information.

C. insurance 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. Release of information form

C. Explanation of benefits 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. every 3 years.

C. at every visit.

D. once per year.

Question #30

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

A. Superbill

B. UB-04 claim form

C. CMS-1500 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. admission.

B. surgery.

C. diagnosis.

D. discharge

Question #32

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

A. per diem.

B. prospective payment system.

C. capitation.

D. fee for service.

Question #33

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

A. capitation.

B. prospective payment system.

C. per diem.

D. fee for service.

Question #34

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

A. discharge status.

B. resource intensity.

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. red

B. purple

C. black

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. Centers for Medicare and Medicaid Services (CMS).

B. Internal Revenue Service (IRS).

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

D. Social Security Administration (SSA).

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. 30 days.

B. unlimited days if medically necessary.

C. 90 days.

D. 60 days.

Question #40

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

A. outpatient hospital services.

B. routine foot care.

C. clinical laboratory services.

D. ambulance transportation.

Question #41

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

A. contracted insurance carriers.

B. each state government.

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

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. a coinsurance amount applies.

B. Medicaid begins paying for services.

C. Medicare begins paying for services.

D. a deductible is paid.

Question #43

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

A. emergency services.

B. prenatal care.

C. well-child checkups.

D. preventive services.

Question #44

Mandatory Medicaid services include coverage for:

A. physical therapy services.

B. prescribed drugs.

C. transportation services.

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

Question #45

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

A. claim was not filed in a timely manner.

B. service was not medically necessary.

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

D. necessary preauthorization was not obtained.

Question #46

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

A. TRICARE Standard.

B. CHAMPVA.

C. TRICARE Prime.

D. TRICARE for Life

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 beneficiary.

D. $7,500 per family.

Question #49

Under TRICARE Prime, a PCM is a:

A. primary care manager.

B. physician case manager.

C. preventive care manager.

D. physician consulting manager.

Question #50

The CHAMPVA program is administered by the:

A. Veterans Administration (VA) Health Administration Center.

B. Veterans Administration (VA) hospital network.

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

D. Department of Defense (DoD).

Question #51

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

A. entering patient information data into the computer.

B. posting charges and diagnoses.

C. obtaining correct and complete patient information.

D. verifying patient insurance benefits.

Question #52

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

A. medically necessary.

B. medically appropriate.

C. medically reasonable.

D. medically feasible.

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 Centers for Medicare and Medicaid Services (CMS).

B. bill the patient for the remaining balance.

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

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

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

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

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

Question #56

OSHA stands for the:

A. Optional Standards for Health Act.

B. Occupational Standards for Health Administration.

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. District of Columbia Workers' Compensation Act.

B. Longshore and Harbor Workers' Compensation Act.

C. Federal Employees' Compensation Act.

D. Energy Employees Occupational Illness Compensation Program Act.

Question #59

injury occurred while the worker was intoxicated.

A. private insurance carriers.

B. self-funded plans.

C. federal programs.

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: