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.
accurate coding and billing.
B.
appropriate documentation of the visit.
C.
the date of service and the patient's insurance identification number.
D.
completeness of progress reports.
Question #2
An internal audit can be conducted:
A.
prospectively only.
B.
retrospectively only.
C.
neither prospectively or retrospectively.
D.
either prospectively or retrospectively.
Question #3
An internal audit may be performed by a:
A.
All of these.
B.
practice employee.
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.
unbundling.
B.
bundling.
C.
upcoding.
D.
downcoding.
Question #5
When auditing a medical chart, the auditor should verify that all documentation is initialed or signed by:
A.
all office staff.
B.
the office manager.
C.
the provider and the office manager.
D.
the provider.
Question #6
Key components for selecting evaluation and management (E/M) codes include all of the following EXCEPT:
A.
complexity of the diagnosis.
B.
extent of the history documented.
C.
complexity of the medical decision making.
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.
deny payment.
B.
unbundle the service.
C.
pay the service as billed.
D.
upcode the service.
Question #8
The most extensive type of history is:
A.
detailed.
B.
expanded problem focused.
C.
problem focused.
D.
comprehensive.
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.
timing.
C.
duration.
D.
quality.
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.
context.
C.
quality.
D.
severity.
Question #12
Documentation of an extended HPI includes at least:
A.
three HPI elements.
B.
four HPI elements.
C.
one HPI element.
D.
two HPI elements.
Question #13
HPI types include:
A.
brief or comprehensive.
B.
brief or detailed.
C.
brief or complicated.
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.
comprehensive.
C.
complete.
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.
general organ system exam.
B.
general multisystem exam.
C.
single organ system exam.
D.
multibody-area exam.
Question #17
In documentation of a medical exam, the terms musculoskeletal, respiratory, and gastrointestinal would refer to:
A.
tissue systems.
B.
body organs.
C.
body areas.
D.
organ 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.
expanded problem-focused exam.
B.
problem-focused exam.
C.
comprehensive exam.
D.
detailed exam.
Question #19
In a patient's chart, a diagnosis:
A.
must be part of the HPI.
B.
must be explicitly stated.
C.
can be stated or implied.
D.
must be coded.
Question #20
If the level of risk of mortality is very high, the medical decision making would be considered:
A.
high.
B.
minimal.
C.
moderate.
D.
low.
Question #21
The risk of significant complication, morbidity, and/or mortality is based on the risks of:
A.
All of these.
B.
the diagnostic procedures.
C.
the possible management options.
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 Index.
C.
CPT Appendix C.
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.
downcoding.
C.
upcoding.
D.
bundling.
Question #26
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.
some of the services provided to a patient were not billed on prior claims.
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.
bill the patient.
B.
file an appeal with the insurance carrier.
C.
write off the entire amount.
D.
negotiate with the patient for partial payment.
Question #28
If a claim is denied because additional information is needed to prove medical necessity, the medical office specialist should:
A.
write off the entire amount.
B.
submit the required information and follow up with the carrier.
C.
bill the patient.
D.
ask the patient to write a letter explaining the situation.
Question #29
An objective, unbiased group of physicians that determines what payment is adequate for services provided is a(n):
A.
routine examination of claims.
B.
appeal committee review.
C.
peer review.
D.
utilization 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.
audit.
B.
adjudication.
C.
reconsideration.
D.
appeal.
Question #31
If a patient is upset about a claim denial, the medical office specialist should do all of the following EXCEPT:
A.
explain in simple language why the insurance carrier denied payment.
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.
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.
Question #32
The chronological recording of pertinent facts and observations regarding a patient's health status is known as:
A.
medical transcription.
B.
encounter form completion.
C.
claims processing.
D.
documentation.
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.
medical office specialist should be contacted to modify the record.
C.
physician should verbally verify that the service was provided.
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.
subjective information.
C.
the plan.
D.
objective information.
Question #35
Using the SOAP format, the evaluation and management (E/M) history that the physician takes is:
A.
objective information.
B.
assessment information.
C.
the plan.
D.
subjective information.
Question #36
Using the SOAP format, the diagnosis made by the doctor is:
A.
part of the assessment.
B.
objective information.
C.
subjective information.
D.
part of the plan.
Question #37
A.
newsletters from the carrier.
B.
an administrative manual.
C.
phone calls to the carrier.
D.
All of these.
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 patient had a routine service covered by the policy.
B.
a modifier was used to indicate multiple procedures that the carrier bundled.
C.
the claim was considered not medically necessary.
D.
the carrier requested information from the patient that was not received.
Question #40
Simple appeals may be accepted by:
A.
telephone or fax.
B.
sending a copy of pertinent court decisions.
C.
rebilling the claim.
D.
sending a form letter.
Question #41
An appeal must be made in writing if:
A.
the claim was for services related to an accident.
B.
the carrier requested information from the patient that was not received.
C.
the patient had a routine service covered by the policy.
D.
a billing error was made by the medical office assistant.
Question #42
The law that protects the interests of beneficiaries enrolled in private employee benefit plans is known as:
A.
HIPAA.
B.
FECA.
C.
ERISA.
D.
Title XXI of the Social Security Act.
Question #43
According to ERISA, a provider must file an appeal within:
A.
30 days after denial.
B.
90 days after denial.
C.
180 days after denial.
D.
60 days after denial.
Question #44
The first level of Medicare appeals is a request for:
A.
review by a qualified independent contractor.
B.
review by an administrative law judge.
C.
review by the state insurance commissioner.
D.
redetermination by the carrier.
Question #45
The second 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 #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.
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.
carrier president.
B.
carrier legal department.
C.
Department of Labor.
D.
Department of Insurance.
Question #49
In general, Medicaid can request refunds for overpayments to providers for up to:
A.
5 years.
B.
1 year.
C.
180 days.
D.
3 years.
Question #50
Wrongfully keeping an overpayment is illegal and is called:
A.
conversion.
B.
fraud.
C.
embezzlement.
D.
retention.
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