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. reading and understanding the physician's documentation.

B. calling the insurance carrier.

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. forecast healthcare needs.

C. All of these.

D. review costs and evaluate facilities.

Question #3

ICD-10-CM offers an expanded selection of:

A. complication codes.

B. co-existing condition 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. Tabular List of Diseases and Injuries.

C. External Causes Index.

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 temporary codes for emerging technology.

B. elimination of local, temporary codes.

C. use of local codes.

D. increased use of nonstandard CPT codes.

Question #7

The first section of the CPT code book is:

A. Medicine.

B. Evaluation and Management .

C. Surgery.

D. Anesthesia.

Question #8

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

A. written explanation.

B. Category III CPT code.

C. modifier.

D. Category II 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. requirement.

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

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

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

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. 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. refer to the patient chart for more information.

B. look under a related procedure for more information.

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

D. assign the code.

Question #14

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

A. evaluation and management.

B. arthroscopy.

C. osteopathic manipulation.

D. abdominal distention.

Question #15

The proper use of CPT modifiers can result in:

A. increased reimbursement.

B. denials of claims.

C. reduced reimbursement.

D. claim-processing delays.

Question #16

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

A. Evaluation and Management

B. Radiology

C. Anesthesia

D. Surgery

Question #17

HCPCS is the acronym for the:

A. Health Coding for Procedures and Claim Sets.

B. Healthcare Common Procedure Coding System.

C. Healthcare Current Procedures Coding System.

D. Healthcare Coding for Procedures and Claims Systems.

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

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

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

Question #19

HCPCS modifiers consist of:

A. two letters or two numbers.

B. two letters or one letter and one number.

C. two letters.

D. two digits.

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. accurate.

C. clean.

D. complete.

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 delays insurance payment.

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

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. All of these.

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

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. downcoding.

B. bundling.

C. upcoding.

D. unbundling.

Question #25

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

A. surgery.

B. radiology.

C. evaluation and management (E/M).

D. medicine.

Question #26

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

A. bank loans.

B. payments from insurance companies.

C. private donations.

D. payments from patients.

Question #27

A patient information form typically includes:

A. All of these.

B. employment information.

C. demographic information.

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. Assignment of benefits form

B. Patient information 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. CMS-1500 claim form

B. Verification of benefits form

C. UB-04 claim form

D. Superbill

Question #31

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

A. discharge

B. admission.

C. surgery.

D. diagnosis.

Question #32

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

A. prospective payment system.

B. per diem.

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. prospective payment system.

B. capitation.

C. fee for service.

D. per diem.

Question #34

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

A. treatment difficulty.

B. severity of illness.

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. blue

B. black

C. purple

D. red

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. disabled.

D. low income.

Question #37

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

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

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

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. home healthcare.

B. hospice care.

C. inpatient hospital care.

D. telemedicine.

Question #39

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

A. 30 days.

B. 60 days.

C. unlimited days if medically necessary.

D. 90 days.

Question #40

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

A. routine foot care.

B. ambulance transportation.

C. clinical laboratory services.

D. outpatient hospital 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. 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. well-child checkups.

B. emergency services.

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

B. necessary preauthorization was not obtained.

C. service was not medically necessary.

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 Prime.

B. TRICARE for Life

C. CHAMPVA.

D. TRICARE Standard.

Question #47

The TRICARE fiscal year ends on:

A. December 31.

B. January 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 family.

B. $1,000 per beneficiary.

C. $7,500 per beneficiary.

D. $7,500 per family.

Question #49

Under TRICARE Prime, a PCM is a:

A. physician case manager.

B. preventive care manager.

C. primary care manager.

D. physician consulting manager.

Question #50

The CHAMPVA program is administered by the:

A. Department of Defense (DoD).

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

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. entering patient information data into the computer.

B. obtaining correct and complete patient information.

C. posting charges and diagnoses.

D. verifying patient insurance benefits.

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

B. request assistance from the state insurance commissioner.

C. bill the patient for the remaining balance.

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. the patient only.

D. None of these.

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 $80 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. $160 from the insurance carrier and $40 from the patient.

Question #56

OSHA stands for the:

A. Occupational Standards for Health Administration.

B. Optional Safety and Health Act.

C. Occupational Safety and 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. Federal Employees' Compensation Act.

B. Occupational Safety and Health for Private Employers Act.

C. District of Columbia Workers' 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. District of Columbia 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. 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: