MOA 183 - Intro to Health Insurance » Fall 2022 » Weekly Quiz 7 Chapter 9 & 16
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Question #1
A prepayment audit would verify:
A.
the date of service and the patient's insurance identification number.
B.
accurate coding and billing.
C.
appropriate documentation of the visit.
D.
completeness of progress reports.
Question #2
An internal audit can be conducted:
A.
neither prospectively or retrospectively.
B.
either prospectively or retrospectively.
C.
prospectively only.
D.
retrospectively only.
Question #3
An internal audit may be performed by a:
A.
All of these.
B.
private payer.
C.
practice employee.
D.
government investigator.
Question #4
If documentation in the patient chart supports a higher level of service than that coded, the error would be called:
A.
bundling.
B.
downcoding.
C.
upcoding.
D.
unbundling.
Question #5
When auditing a medical chart, the auditor should verify that all documentation is initialed or signed by:
A.
the office manager.
B.
all office staff.
C.
the provider.
D.
the provider and the office manager.
Question #6
Key components for selecting evaluation and management (E/M) codes include all of the following EXCEPT:
A.
extent of the history documented.
B.
extent of the exam documented.
C.
complexity of the medical decision making.
D.
complexity of the diagnosis.
Question #7
If Medicare determines that an E/M service exceeds the patient's documented need, Medicare could:
A.
unbundle the service.
B.
deny payment.
C.
upcode the service.
D.
pay the service as billed.
Question #8
The most extensive type of history is:
A.
comprehensive.
B.
expanded problem focused.
C.
problem focused.
D.
detailed.
Question #9
An expanded problem-focused history requires all of the following elements EXCEPT:
A.
history of present illness (HPI).
B.
chief complaint (CC).
C.
review of systems (ROS).
D.
past, family, and social history (PFSH).
Question #10
If a patient states that the present illness started 3 days ago, the element he or she would be describing is the:
A.
severity.
B.
quality.
C.
duration.
D.
timing.
Question #11
If a patient states that the pain he or she is experiencing is burning, the element he or she would be describing is the:
A.
associated signs and symptoms.
B.
quality.
C.
context.
D.
severity.
Question #12
Documentation of an extended HPI includes at least:
A.
one HPI element.
B.
three HPI elements.
C.
four HPI elements.
D.
two HPI elements.
Question #13
HPI types include:
A.
brief or complicated.
B.
brief or extended.
C.
brief or comprehensive.
D.
brief or detailed.
Question #14
If a PFSH includes a review of the patient's past, family, and social history, it would be considered:
A.
complete.
B.
detailed.
C.
comprehensive.
D.
pertinent.
Question #15
If a medical record note documents that the patient has smoked two packs of cigarettes every day for the past 10 years, it would be an example of the patient's:
A.
family history.
B.
HPI.
C.
social history.
D.
past history.
Question #16
An examination that involves one or more organ systems or body areas is called a:
A.
multibody-area exam.
B.
single organ system exam.
C.
general multisystem exam.
D.
general organ system exam.
Question #17
In documentation of a medical exam, the terms musculoskeletal, respiratory, and gastrointestinal would refer to:
A.
organ systems.
B.
body organs.
C.
body areas.
D.
tissue systems.
Question #18
A medical chart that reports an exam involving at least nine organ systems or body areas would be documentation of a(n):
A.
detailed exam.
B.
problem-focused exam.
C.
comprehensive exam.
D.
expanded problem-focused exam.
Question #19
In a patient's chart, a diagnosis:
A.
must be part of the HPI.
B.
must be coded.
C.
can be stated or implied.
D.
must be explicitly stated.
Question #20
If the level of risk of mortality is very high, the medical decision making would be considered:
A.
high.
B.
low.
C.
moderate.
D.
minimal.
Question #21
The risk of significant complication, morbidity, and/or mortality is based on the risks of:
A.
All of these.
B.
the presenting problems.
C.
the possible management options.
D.
the diagnostic procedures.
Question #22
A medical office specialist can find clinical examples for documenting medical necessity in the:
A.
CPT Guidelines.
B.
CPT Index.
C.
CPT Appendix A.
D.
CPT Appendix C.
Question #23
An example of an E/M code that requires three key components documented and a comprehensive history and comprehensive exam is:
A.
subsequent in-hospital care.
B.
a new patient office visit.
C.
critical care services.
D.
an established patient office visit.
Question #24
An extended HPI will include one to three documented HPI elements.
A.
False
B.
True
Question #25
If documentation in the patient chart supports a lower level of service than that coded, the error would be called:
A.
downcoding.
B.
unbundling.
C.
upcoding.
D.
bundling.
Question #26
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.
charges on the original claim were not detailed.
D.
the patient was not eligible when the initial claim was filed.
Question #27
If a claim is denied as a noncovered service, the medical office specialist should:
A.
file an appeal with the insurance carrier.
B.
write off the entire amount.
C.
negotiate with the patient for partial payment.
D.
bill the patient.
Question #28
If a claim is denied because additional information is needed to prove medical necessity, the medical office specialist should:
A.
submit the required information and follow up with the carrier.
B.
bill the patient.
C.
ask the patient to write a letter explaining the situation.
D.
write off the entire amount.
Question #29
An objective, unbiased group of physicians that determines what payment is adequate for services provided is a(n):
A.
appeal committee review.
B.
peer review.
C.
utilization review.
D.
routine examination of claims.
Question #30
Providing additional clinical information to an insurance company as part of an attempt to overturn a claim denial is known as submitting a(n):
A.
adjudication.
B.
reconsideration.
C.
appeal.
D.
audit.
Question #31
If a patient is upset about a claim denial, the medical office specialist should do all of the following EXCEPT:
A.
use respect and care when explaining policy benefits.
B.
if the denial was due to a need for additional information, submit the additional documentation immediately and let the patient know it has been done.
C.
explain in simple language why the insurance carrier denied payment.
D.
ask the patient to call the insurance carrier to try to get them to reconsider.
Question #32
The chronological recording of pertinent facts and observations regarding a patient's health status is known as:
A.
claims processing.
B.
encounter form completion.
C.
documentation.
D.
medical transcription.
Question #33
From the insurance carrier's perspective, if a service is NOT documented in the medical record, the:
A.
patient should be contacted to confirm the service was rendered.
B.
service was not performed and cannot be billed.
C.
physician should verbally verify that the service was provided.
D.
medical office specialist should be contacted to modify the record.
Question #34
Using the SOAP format, the patient's chief complaint and reason for the encounter as the patient told it to the doctor are:
A.
subjective information.
B.
the plan.
C.
objective information.
D.
assessment information.
Question #35
Using the SOAP format, the evaluation and management (E/M) history that the physician takes is:
A.
assessment information.
B.
subjective information.
C.
objective information.
D.
the plan.
Question #36
Using the SOAP format, the diagnosis made by the doctor is:
A.
part of the plan.
B.
objective information.
C.
part of the assessment.
D.
subjective information.
Question #37
The medical office specialist can learn about an insurance carrier's appeals process through:
A.
an administrative manual.
B.
All of these.
C.
phone calls to the carrier.
D.
newsletters from the carrier.
Question #38
When appealing disallowances resulting from low maximum allowable fees, the medical office assistant should include information:
A.
from the patient medical record.
B.
about the physician's financial situation.
C.
about why the patient cannot afford to pay more.
D.
about payment from other carriers for the reported service.
Question #39
All of the following claims can be appealed by telephone EXCEPT those in which:
A.
the claim was considered not medically necessary.
B.
a modifier was used to indicate multiple procedures that the carrier bundled.
C.
the patient had a routine service covered by the policy.
D.
the carrier requested information from the patient that was not received.
Question #40
Simple appeals may be accepted by:
A.
rebilling the claim.
B.
sending a form letter.
C.
telephone or fax.
D.
sending a copy of pertinent court decisions.
Question #41
An appeal must be made in writing if:
A.
a billing error was made by the medical office assistant.
B.
the claim was for services related to an accident.
C.
the carrier requested information from the patient that was not received.
D.
the patient had a routine service covered by the policy.
Question #42
The law that protects the interests of beneficiaries enrolled in private employee benefit plans is known as:
A.
ERISA.
B.
Title XXI of the Social Security Act.
C.
HIPAA.
D.
FECA.
Question #43
According to ERISA, a provider must file an appeal within:
A.
90 days after denial.
B.
180 days after denial.
C.
30 days after denial.
D.
60 days after denial.
Question #44
The first level of Medicare appeals is a request for:
A.
review by the state insurance commissioner.
B.
redetermination by the carrier.
C.
review by a qualified independent contractor.
D.
review by an administrative law judge.
Question #45
The second level of Medicare appeals is a request for:
A.
review by a qualified independent contractor.
B.
review by an administrative law judge.
C.
redetermination by the carrier.
D.
review by the state insurance commissioner.
Question #46
The third level of a Medicare appeal is a request for:
A.
review by an administrative law judge.
B.
redetermination by the carrier.
C.
review by a qualified independent contractor.
D.
review by the state insurance commissioner.
Question #47
Physicians must file a Medicare appeal with an administrative law judge within:
A.
120 days.
B.
90 days.
C.
30 days.
D.
60 days.
Question #48
If a denial is upheld when regulatory information was included in the original appeal, the medical office assistant should appeal to the:
A.
Department of Insurance.
B.
carrier president.
C.
carrier legal department.
D.
Department of Labor.
Question #49
In general, Medicaid can request refunds for overpayments to providers for up to:
A.
3 years.
B.
1 year.
C.
180 days.
D.
5 years.
Question #50
Wrongfully keeping an overpayment is illegal and is called:
A.
retention.
B.
embezzlement.
C.
conversion.
D.
fraud.
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