A.   provider networks and regular premium increases.

B.   discounted fees for services and mandatory high deductibles across all health plans.

C.   prohibiting the use of out-of-network providers.

D.   provider networks and discounted fees for services.

A.   allowed amount.

B.   adjusted amount.

C.   diagnostic code.

D.   billed amount.

A.   family practitioner.

B.   dermatologist.

C.   internal medicine doctor.

D.   general practitioner.

A.   enroll more members in the health plan.

B.   maintain their income.

C.   minimize malpractice suits.

D.   deliver MCO-required preventive care.

A.   individual practice association.

B.   group model.

C.   preferred provider model.

D.   open access model.

A.   the time limit for submitting claims to the MCO.

B.   the list of employers with MCO contracts.

C.   how much the physician will be paid for services.

D.   when payment should be received from the MCO.

A.   know the Patient Bill of Rights.

B.   be familiar with managed care terms.

C.   promote the provider network.

D.   explain the ACO to the patient.

A.   medical services covered under the managed care plan.

B.   deductible and coinsurance amounts that patients must pay.

C.   benefits of participating in the managed care plan.

D.   providers in the contracted network.

A.   treat the patient as much as possible without a specialist referral unless absolutely necessary.

B.   see as many patients each day as possible, even if this means less time with each patient.

C.   make frequent referrals to contracted network specialists.

D.   expand office hours and/or staff to permit more patients to be seen each day.

A.   salary history.

B.   malpractice history.

C.   disciplinary actions.

D.   criminal activity.

A.   secure medical data.

B.   electronically transmitted data.

C.   managed care plan information.

D.   protected health information.

A.   American Medical Association (AMA).

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

C.   Office for Civil Rights (OCR).

A.   translation.

B.   encryption.

C.   transcription.

D.   coding.

A.   report specific procedures and services.

B.   determine medical necessity for covered procedures and services.

C.   record a patient's office visits or inpatient days.

D.   report patient demographic information.

A.   inpatient procedure coding.

B.   outpatient procedure coding.

C.   proper mortality coding.

D.   proper diagnosis coding.

A.   Neoplasm Table.

B.   Tabular List of Diseases and Injuries.

C.   Alphabetic Index.

D.   External Causes Index.

A.   another name for the disease.

B.   the cause or origin of the disease.

C.   a better description of the disease.

D.   treatments of the disease.

A.   default code.

B.   combination code.

C.   specified code.

D.   primary code.

A.   file monthly reports with the office of the state insurance commissioner.

B.   represent the practice in any lawsuits that arise over privacy issues.

C.   respond to insurance carriers' questions and handle patient billing complaints.

D.   respond to requests for medical records and handle privacy-related complaints.

A.   particularly severe flu epidemic has occurred.

B.   person may have been exposed to certain communicable diseases.

C.   patient has returned from a trip to a country with poor sanitation.

D.   patient or staff member has a prison record.

A.   1986

B.   2006

C.   1992

D.   1977

A.   Category II CPT codes.

B.   Category I CPT codes.

C.   ICD-10-CM codes.

D.   Category III CPT codes.

A.   emergency room services.

B.   office and other outpatient services.

C.   consultations.

D.   hospital (inpatient) services.

A.   5 years.

B.   2 years.

C.   1 year.

D.   3 years.

A.   social history.

B.   history of present illness.

C.   past history.

D.   family history.

A.   social history.

B.   past history.

C.   family history.

D.   history of present illness.

A.   based on the patient's ability to pay.

B.   at the discretion of the physician.

C.   provided only by in-network physicians.

D.   monitored to control costs.

A.   large-group practice.

B.   small-group practice.

C.   solo practice.

D.   private practice.

A.   medical office assistant.

B.   medical coder.

C.   medical collector.

D.   payment poster.

A.   insurance verification representative.

B.   admitting clerk.

C.   medical collector.

D.   privacy compliance officer.

A.   explaining HIPAA regulations.

B.   submitting insurance claims.

C.   contacting insurance carriers on incorrectly paid claims.

D.   analyzing patient charge information.

A.   data entry of patient demographics.

B.   explaining DNR orders to patients and their family members.

C.   answering questions about privacy regulations.

D.   posting payments or making adjustments to patient accounts.

A.   American Health Information Management Association.

B.   National Healthcareer Association.

C.   National Center for Competency Testing.

D.   American Academy of Professional Coders.

A.   False

B.   True

A.   private payer codes.

B.   diagnostic radiology services.

C.   temporary hospital outpatient.

D.   orthotic procedures.

A.   Level II HCPCS code book.

B.   This is not considered a HCPCS code.

C.   Level I HCPCS code book.

D.   Level III HCPCS code book.

A.   private insurers only.

B.   self-funded plans only.

C.   public insurers only.

D.   public and private insurers.

A.   clean.

B.   complete.

C.   authorized.

D.   accurate.

A.   bundling.

B.   downcoding.

C.   upcoding.

D.   unbundling.

A.   get the advice of an attorney.

B.   obtain an advisory opinion from the Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS).

C.   base the decision on past practices.

D.   submit the claim, and request an explanation if denied.

A.   sign-in sheets and appointment scheduling practices.

B.   date of service.

C.   patient insurance identification number.

D.   patient insurance eligibility.

A.   if additional training is needed for office staff.

B.   whether procedures were coded correctly.

C.   the coder's skill and knowledge.

D.   All of these.

A.   twice a year.

B.   once a quarter.

C.   once a year.

D.   once a month.

A.   musculoskeletal system.

B.   cardiovascular system.

C.   respiratory system.

D.   neurological system.

A.   amount and/or complexity of data to be reviewed.

B.   All of these.

C.   number of diagnoses or management options.

D.   risk of significant complications, morbidity, and/or mortality.

A.   reconsideration.

B.   audit.

C.   review.

D.   appeal.

A.   write off the entire amount.

B.   change the date of service and resubmit the claim.

C.   bill the patient.

D.   wait until the effective date of the coverage, then bill the insurance carrier.

A.   reimbursement is received for an unknown patient.

B.   an incorrect payment is received.

C.   unclear denial of payment is received.

D.   All of these.

A.   the insurance carrier will pay for the review.

B.   the physician must pay for the review.

C.   the patient should be billed for the review.

D.   there is no charge for the review.

A.   not related to diagnoses

B.   noncovered emergency services

C.   claim processing error

D.   both noncovered emergency services and not related to diagnoses