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.
completeness of progress reports.
C.
appropriate documentation of the visit.
D.
the date of service and the patient's insurance identification number.
Question #2
An internal audit can be conducted:
A.
prospectively only.
B.
retrospectively only.
C.
either prospectively or retrospectively.
D.
neither prospectively or retrospectively.
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.
downcoding.
B.
upcoding.
C.
bundling.
D.
unbundling.
Question #5
When auditing a medical chart, the auditor should verify that all documentation is initialed or signed by:
A.
the provider and the office manager.
B.
the office manager.
C.
all office staff.
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 medical decision making.
B.
extent of the exam documented.
C.
complexity of the diagnosis.
D.
extent of the history documented.
Question #7
If Medicare determines that an E/M service exceeds the patient's documented need, Medicare could:
A.
pay the service as billed.
B.
unbundle the service.
C.
deny payment.
D.
upcode the service.
Question #8
The most extensive type of history is:
A.
expanded problem focused.
B.
detailed.
C.
comprehensive.
D.
problem focused.
Question #9
An expanded problem-focused history requires all of the following elements EXCEPT:
A.
past, family, and social history (PFSH).
B.
history of present illness (HPI).
C.
review of systems (ROS).
D.
chief complaint (CC).
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.
duration.
B.
quality.
C.
severity.
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.
severity.
B.
associated signs and symptoms.
C.
context.
D.
quality.
Question #12
Documentation of an extended HPI includes at least:
A.
two HPI elements.
B.
one HPI element.
C.
three HPI elements.
D.
four HPI elements.
Question #13
HPI types include:
A.
brief or detailed.
B.
brief or complicated.
C.
brief or extended.
D.
brief or comprehensive.
Question #14
If a PFSH includes a review of the patient's past, family, and social history, it would be considered:
A.
comprehensive.
B.
complete.
C.
pertinent.
D.
detailed.
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.
past history.
B.
social history.
C.
family history.
D.
HPI.
Question #16
An examination that involves one or more organ systems or body areas is called a:
A.
single organ system exam.
B.
general multisystem exam.
C.
general 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.
organ systems.
B.
tissue systems.
C.
body areas.
D.
body organs.
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 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.
minimal.
B.
low.
C.
high.
D.
moderate.
Question #21
The risk of significant complication, morbidity, and/or mortality is based on the risks of:
A.
the diagnostic procedures.
B.
the presenting problems.
C.
All of these.
D.
the possible management options.
Question #22
A medical office specialist can find clinical examples for documenting medical necessity in the:
A.
CPT Appendix A.
B.
CPT Guidelines.
C.
CPT Index.
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.
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.
bundling.
B.
downcoding.
C.
unbundling.
D.
upcoding.
Question #26
Reasons to rebill an insurance claim include all of the following EXCEPT:
A.
some of the services provided to a patient were not billed on prior claims.
B.
the medical office specialist made a mistake on the claim.
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.
write off the entire amount.
B.
negotiate with the patient for partial payment.
C.
bill the patient.
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.
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.
appeal committee review.
B.
routine examination of claims.
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.
reconsideration.
B.
audit.
C.
appeal.
D.
adjudication.
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.
explain in simple language why the insurance carrier denied payment.
C.
ask the patient to call the insurance carrier to try to get them to reconsider.
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.
claims processing.
B.
encounter form completion.
C.
medical transcription.
D.
documentation.
Question #33
From the insurance carrier's perspective, if a service is NOT documented in the medical record, the:
A.
medical office specialist should be contacted to modify the record.
B.
physician should verbally verify that the service was provided.
C.
service was not performed and cannot be billed.
D.
patient should be contacted to confirm the service was rendered.
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.
the plan.
C.
objective information.
D.
subjective information.
Question #35
Using the SOAP format, the evaluation and management (E/M) history that the physician takes is:
A.
the plan.
B.
assessment information.
C.
subjective information.
D.
objective 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
The medical office specialist can learn about an insurance carrier's appeals process through:
A.
an administrative manual.
B.
All of these.
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 the physician's financial situation.
B.
about payment from other carriers for the reported service.
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.
the claim was considered not medically necessary.
C.
the carrier requested information from the patient that was not received.
D.
a modifier was used to indicate multiple procedures that the carrier bundled.
Question #40
Simple appeals may be accepted by:
A.
sending a form letter.
B.
telephone or fax.
C.
sending a copy of pertinent court decisions.
D.
rebilling the claim.
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.
Title XXI of the Social Security Act.
B.
HIPAA.
C.
FECA.
D.
ERISA.
Question #43
According to ERISA, a provider must file an appeal within:
A.
180 days after denial.
B.
60 days after denial.
C.
30 days after denial.
D.
90 days after denial.
Question #44
The first level of Medicare appeals is a request for:
A.
redetermination by the carrier.
B.
review by the state insurance commissioner.
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 the state insurance commissioner.
B.
review by a qualified independent contractor.
C.
redetermination by the carrier.
D.
review by an administrative law judge.
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 the state insurance commissioner.
D.
review by an administrative law judge.
Question #47
Physicians must file a Medicare appeal with an administrative law judge within:
A.
90 days.
B.
120 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 legal department.
B.
Department of Labor.
C.
carrier president.
D.
Department of Insurance.
Question #49
In general, Medicaid can request refunds for overpayments to providers for up to:
A.
1 year.
B.
3 years.
C.
180 days.
D.
5 years.
Question #50
Wrongfully keeping an overpayment is illegal and is called:
A.
retention.
B.
fraud.
C.
conversion.
D.
embezzlement.
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