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.   billed amount.

B.   allowed amount.

C.   diagnostic code.

D.   adjusted amount.

A.   family practitioner.

B.   internal medicine doctor.

C.   dermatologist.

D.   general practitioner.

A.   enroll more members in the health plan.

B.   deliver MCO-required preventive care.

C.   minimize malpractice suits.

D.   maintain their income.

A.   open access model.

B.   preferred provider model.

C.   group model.

D.   individual practice association.

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

B.   the list of employers with MCO contracts.

C.   when payment should be received from the MCO.

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

A.   explain the ACO to the patient.

B.   be familiar with managed care terms.

C.   know the Patient Bill of Rights.

D.   promote the provider network.

A.   deductible and coinsurance amounts that patients must pay.

B.   medical services covered under the managed care plan.

C.   providers in the contracted network.

D.   benefits of participating in the managed care plan.

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

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

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

D.   make frequent referrals to contracted network specialists.

A.   criminal activity.

B.   malpractice history.

C.   salary history.

D.   disciplinary actions.

A.   electronically transmitted data.

B.   managed care plan information.

C.   protected health information.

D.   secure medical data.

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

B.   American Medical Association (AMA).

C.   Office for Civil Rights (OCR).

A.   transcription.

B.   encryption.

C.   coding.

D.   translation.

A.   report patient demographic information.

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

C.   report specific procedures and services.

D.   determine medical necessity for covered procedures and services.

A.   outpatient procedure coding.

B.   proper diagnosis coding.

C.   proper mortality coding.

D.   inpatient procedure coding.

A.   Alphabetic Index.

B.   External Causes Index.

C.   Neoplasm Table.

D.   Tabular List of Diseases and Injuries.

A.   a better description of the disease.

B.   another name for the disease.

C.   treatments of the disease.

D.   the cause or origin of the disease.

A.   default code.

B.   primary code.

C.   combination code.

D.   specified code.

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

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

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

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

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

B.   particularly severe flu epidemic has occurred.

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

D.   patient or staff member has a prison record.

A.   2006

B.   1986

C.   1977

D.   1992

A.   Category I CPT codes.

B.   Category II CPT codes.

C.   Category III CPT codes.

D.   ICD-10-CM codes.

A.   emergency room services.

B.   hospital (inpatient) services.

C.   consultations.

D.   office and other outpatient services.

A.   5 years.

B.   2 years.

C.   3 years.

D.   1 year.

A.   family history.

B.   past history.

C.   social history.

D.   history of present illness.

A.   social history.

B.   history of present illness.

C.   family history.

D.   past history.

A.   at the discretion of the physician.

B.   provided only by in-network physicians.

C.   monitored to control costs.

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

A.   small-group practice.

B.   solo practice.

C.   large-group practice.

D.   private practice.

A.   payment poster.

B.   medical office assistant.

C.   medical collector.

D.   medical coder.

A.   insurance verification representative.

B.   privacy compliance officer.

C.   admitting clerk.

D.   medical collector.

A.   submitting insurance claims.

B.   contacting insurance carriers on incorrectly paid claims.

C.   analyzing patient charge information.

D.   explaining HIPAA regulations.

A.   posting payments or making adjustments to patient accounts.

B.   data entry of patient demographics.

C.   answering questions about privacy regulations.

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

A.   American Academy of Professional Coders.

B.   National Healthcareer Association.

C.   National Center for Competency Testing.

D.   American Health Information Management Association.

A.   True

B.   False

A.   temporary hospital outpatient.

B.   diagnostic radiology services.

C.   private payer codes.

D.   orthotic procedures.

A.   Level II HCPCS code book.

B.   Level I HCPCS code book.

C.   Level III HCPCS code book.

D.   This is not considered a HCPCS code.

A.   public insurers only.

B.   self-funded plans only.

C.   private insurers only.

D.   public and private insurers.

A.   accurate.

B.   clean.

C.   complete.

D.   authorized.

A.   bundling.

B.   upcoding.

C.   downcoding.

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.   patient insurance identification number.

C.   date of service.

D.   patient insurance eligibility.

A.   the coder's skill and knowledge.

B.   whether procedures were coded correctly.

C.   All of these.

D.   if additional training is needed for office staff.

A.   once a month.

B.   twice a year.

C.   once a year.

D.   once a quarter.

A.   cardiovascular system.

B.   musculoskeletal system.

C.   neurological system.

D.   respiratory system.

A.   All of these.

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

C.   number of diagnoses or management options.

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

A.   audit.

B.   review.

C.   reconsideration.

D.   appeal.

A.   bill the patient.

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

C.   write off the entire amount.

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

A.   an incorrect payment is received.

B.   All of these.

C.   unclear denial of payment is received.

D.   reimbursement is received for an unknown patient.

A.   the physician must pay for the review.

B.   the insurance carrier will 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.   claim processing error

C.   noncovered emergency services

D.   both noncovered emergency services and not related to diagnoses