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. calling the insurance carrier.

D. registering the patient.

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. outpatient codes.

B. complication codes.

C. inpatient 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. 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. 3 digits.

B. 4 digits.

C. 6 digits.

D. 5 digits.

Question #6

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

A. increased use of nonstandard CPT codes.

B. elimination of local, temporary codes.

C. increased use of temporary codes for emerging technology.

D. use of local codes.

Question #7

The first section of the CPT code book is:

A. Anesthesia.

B. Medicine.

C. Evaluation and Management .

D. Surgery.

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

C. fraudulent practice.

D. requirement.

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. 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. bill the patient.

B. negotiate with the patient for partial payment.

C. write off the entire amount.

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. bill the patient.

B. write off the entire amount.

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. look under a related procedure for more information.

C. refer to the patient chart for more information.

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

Question #14

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

A. evaluation and management.

B. abdominal distention.

C. arthroscopy.

D. osteopathic manipulation.

Question #15

The proper use of CPT modifiers can result in:

A. increased reimbursement.

B. reduced reimbursement.

C. denials of claims.

D. claim-processing delays.

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 Common Procedure Coding System.

D. Healthcare Coding for Procedures and Claims Systems.

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 letters or two numbers.

B. two letters or one letter and one number.

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. complete.

B. accurate.

C. authorized.

D. clean.

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 ensures compliance.

B. It increases the risk of errors.

C. It delays insurance payment.

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

Question #23

Physician offices should audit their medical records to:

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

B. assess the completeness of the medical record.

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. unbundling.

B. upcoding.

C. downcoding.

D. bundling.

Question #25

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

A. evaluation and management (E/M).

B. medicine.

C. radiology.

D. surgery.

Question #26

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

A. payments from insurance companies.

B. private donations.

C. bank loans.

D. payments from patients.

Question #27

A patient information form typically includes:

A. All of these.

B. employment information.

C. insurance information.

D. demographic 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. Patient information form

C. Release of information form

D. Assignment 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. once per year.

C. every 2 years.

D. every 3 years.

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. Superbill

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. surgery.

C. discharge

D. admission.

Question #32

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

A. per diem.

B. capitation.

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. capitation.

C. per diem.

D. fee for service.

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. disabled.

C. low income.

D. age 65 or older.

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. Department of Health and Human Services (DHHS).

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. inpatient hospital 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. 90 days.

C. 60 days.

D. unlimited days if medically necessary.

Question #40

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

A. clinical laboratory services.

B. ambulance transportation.

C. outpatient hospital services.

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

C. contracted insurance carriers.

D. each state 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 deductible is paid.

C. a coinsurance amount applies.

D. Medicaid begins paying for services.

Question #43

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

A. preventive services.

B. prenatal care.

C. emergency services.

D. well-child checkups.

Question #44

Mandatory Medicaid services include coverage for:

A. physical therapy services.

B. transportation services.

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

D. prescribed drugs.

Question #45

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

A. service was not medically necessary.

B. claim was not filed in a timely manner.

C. necessary preauthorization was not obtained.

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 Prime.

C. TRICARE for Life

D. TRICARE Standard.

Question #47

A. January 31.

B. December 31.

C. June 30.

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. $7,500 per beneficiary.

C. $7,500 per family.

D. $1,000 per family.

Question #49

Under TRICARE Prime, a PCM is a:

A. preventive care manager.

B. primary care manager.

C. physician case manager.

D. physician consulting manager.

Question #50

The CHAMPVA program is administered by the:

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).

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 appropriate.

B. medically necessary.

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 Department of Health and Human Services (DHHS).

B. request assistance from the state insurance commissioner.

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

D. bill the patient for the remaining balance.

Question #54

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

A. None of these.

B. the insurance carrier and the patient.

C. the patient only.

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. $150 from the insurance carrier and $50 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.

Question #56

OSHA stands for the:

A. Occupational Safety and Health Administration.

B. Optional Standards for Health Act.

C. Occupational Standards for Health Administration.

D. Optional Safety and Health Act.

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. Federal Employees' Compensation Act.

C. District of Columbia Workers' Compensation Act.

D. Occupational Safety and Health for Private Employers 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. federal programs.

B. private insurance carriers.

C. state workers' compensation funds.

D. self-funded plans.

Question #60

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