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.
appropriate documentation of the visit.
C.
completeness of progress reports.
D.
accurate coding and billing.
Question #2
An internal audit can be conducted:
A.
either prospectively or retrospectively.
B.
neither prospectively or retrospectively.
C.
prospectively only.
D.
retrospectively only.
Question #3
An internal audit may be performed by a:
A.
practice employee.
B.
All of these.
C.
government investigator.
D.
private payer.
Question #4
If documentation in the patient chart supports a higher level of service than that coded, the error would be called:
A.
upcoding.
B.
bundling.
C.
downcoding.
D.
unbundling.
Question #5
When auditing a medical chart, the auditor should verify that all documentation is initialed or signed by:
A.
the provider.
B.
all office staff.
C.
the provider and the office manager.
D.
the office manager.
Question #6
Key components for selecting evaluation and management (E/M) codes include all of the following EXCEPT:
A.
complexity of the medical decision making.
B.
complexity of the diagnosis.
C.
extent of the history documented.
D.
extent of the exam documented.
Question #7
If Medicare determines that an E/M service exceeds the patient's documented need, Medicare could:
A.
unbundle the service.
B.
upcode the service.
C.
pay the service as billed.
D.
deny payment.
Question #8
The most extensive type of history is:
A.
comprehensive.
B.
problem focused.
C.
expanded 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.
quality.
B.
timing.
C.
severity.
D.
duration.
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.
quality.
B.
associated signs and symptoms.
C.
severity.
D.
context.
Question #12
Documentation of an extended HPI includes at least:
A.
one HPI element.
B.
two HPI elements.
C.
four HPI elements.
D.
three HPI elements.
Question #13
HPI types include:
A.
brief or comprehensive.
B.
brief or complicated.
C.
brief or detailed.
D.
brief or extended.
Question #14
If a PFSH includes a review of the patient's past, family, and social history, it would be considered:
A.
detailed.
B.
complete.
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.
social history.
B.
past history.
C.
HPI.
D.
family 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 organ system exam.
D.
general multisystem exam.
Question #17
In documentation of a medical exam, the terms musculoskeletal, respiratory, and gastrointestinal would refer to:
A.
body organs.
B.
tissue systems.
C.
organ systems.
D.
body areas.
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.
problem-focused exam.
B.
comprehensive exam.
C.
expanded problem-focused exam.
D.
detailed exam.
Question #19
In a patient's chart, a diagnosis:
A.
must be explicitly stated.
B.
can be stated or implied.
C.
must be part of the HPI.
D.
must be coded.
Question #20
If the level of risk of mortality is very high, the medical decision making would be considered:
A.
low.
B.
minimal.
C.
moderate.
D.
high.
Question #21
The risk of significant complication, morbidity, and/or mortality is based on the risks of:
A.
the diagnostic procedures.
B.
the possible management options.
C.
All of these.
D.
the presenting problems.
Question #22
A medical office specialist can find clinical examples for documenting medical necessity in the:
A.
CPT Guidelines.
B.
CPT Appendix C.
C.
CPT Index.
D.
CPT Appendix A.
Question #23
An example of an E/M code that requires three key components documented and a comprehensive history and comprehensive exam is:
A.
a new patient office visit.
B.
subsequent in-hospital care.
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.
unbundling.
B.
upcoding.
C.
downcoding.
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.
charges on the original claim were not detailed.
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 #27
If a claim is denied as a noncovered service, the medical office specialist should:
A.
bill the patient.
B.
write off the entire amount.
C.
negotiate with the patient for partial payment.
D.
file an appeal with the insurance carrier.
Question #28
If a claim is denied because additional information is needed to prove medical necessity, the medical office specialist should:
A.
ask the patient to write a letter explaining the situation.
B.
bill the patient.
C.
write off the entire amount.
D.
submit the required information and follow up with the carrier.
Question #29
An objective, unbiased group of physicians that determines what payment is adequate for services provided is a(n):
A.
peer review.
B.
routine examination of claims.
C.
utilization review.
D.
appeal committee review.
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.
appeal.
B.
adjudication.
C.
audit.
D.
reconsideration.
Question #31
If a patient is upset about a claim denial, the medical office specialist should do all of the following EXCEPT:
A.
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.
B.
ask the patient to call the insurance carrier to try to get them to reconsider.
C.
use respect and care when explaining policy benefits.
D.
explain in simple language why the insurance carrier denied payment.
Question #32
The chronological recording of pertinent facts and observations regarding a patient's health status is known as:
A.
medical transcription.
B.
claims processing.
C.
documentation.
D.
encounter form completion.
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.
physician should verbally verify that the service was provided.
C.
medical office specialist should be contacted to modify the record.
D.
service was not performed and cannot be billed.
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.
assessment information.
B.
objective information.
C.
the plan.
D.
subjective information.
Question #35
Using the SOAP format, the evaluation and management (E/M) history that the physician takes is:
A.
objective information.
B.
subjective information.
C.
assessment 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.
subjective information.
D.
part of the assessment.
Question #37
A.
All of these.
B.
an administrative manual.
C.
newsletters from the carrier.
D.
phone calls to the carrier.
Question #38
When appealing disallowances resulting from low maximum allowable fees, the medical office assistant should include information:
A.
about payment from other carriers for the reported service.
B.
about the physician's financial situation.
C.
about why the patient cannot afford to pay more.
D.
from the patient medical record.
Question #39
All of the following claims can be appealed by telephone EXCEPT those in which:
A.
the carrier requested information from the patient that was not received.
B.
the claim was considered not medically necessary.
C.
a modifier was used to indicate multiple procedures that the carrier bundled.
D.
the patient had a routine service covered by the policy.
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.
the patient had a routine service covered by the policy.
B.
a billing error was made by the medical office assistant.
C.
the carrier requested information from the patient that was not received.
D.
the claim was for services related to an accident.
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.
FECA.
D.
HIPAA.
Question #43
According to ERISA, a provider must file an appeal within:
A.
180 days after denial.
B.
90 days after denial.
C.
60 days after denial.
D.
30 days after denial.
Question #44
The first level of Medicare appeals is a request for:
A.
review by a qualified independent contractor.
B.
redetermination by the carrier.
C.
review by the state insurance commissioner.
D.
review by an administrative law judge.
Question #45
The second level of Medicare appeals is a request for:
A.
redetermination by the carrier.
B.
review by an administrative law judge.
C.
review by the state insurance commissioner.
D.
review by a qualified independent contractor.
Question #46
The third level of a Medicare appeal is a request for:
A.
redetermination by the carrier.
B.
review by a qualified independent contractor.
C.
review by an administrative law judge.
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.
60 days.
D.
30 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 legal department.
C.
carrier president.
D.
Department of Labor.
Question #49
In general, Medicaid can request refunds for overpayments to providers for up to:
A.
3 years.
B.
180 days.
C.
1 year.
D.
5 years.
Question #50
Wrongfully keeping an overpayment is illegal and is called:
A.
retention.
B.
conversion.
C.
embezzlement.
D.
fraud.
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