1 3 ptsThe Fair Debt Collection Practices Act is enforcedbyGroup of answer choicesHIPAAStark LawFalse Claims ActThe Federal Trade Commission (FTC)

  

1 3 ptsThe Fair Debt Collection Practices Act is enforcedbyGroup of answer choicesHIPAAStark LawFalse Claims ActThe Federal Trade Commission (FTC) Flag : 2 2 3 ptsMDs are also known asGroup of answer choicesAllopathic doctorOsteopathic doctorPhysicians AssistantNurse Practitioner Flag : 3 3 3 ptsThe OIG recommends to avoid any civil liabilities penalties, it is recommended that healthcare entities routinely check the ______________ to ensure new hires and current employees are not on the excluded listGroup of answer choicesExclusions databasesMedicare databasesMedicaid databasesFTC databases Flag : 4 4 3 ptsMandatory exclusions occur when an individual or entity commits the following types of criminal offenses except forGroup of answer choicesPatient abuse or neglectDefaulting on a health education loan or scholarship obligationsFelony convictions for other healthcare-related fraud, theft, or other financial misconductFelony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances Flag : 5 5 3 ptsThe most common types of fraud and abuse include (select all that apply)Group of answer choicesDocumenting a service that was never rendered and billing for that serviceBilling for more expensive services or procedures that were provided or performed.Performing medically unnecessary services solely for generating insurance reimbursementFalsifying a patient’s diagnosis to justify tests or procedure to generate insurance reimbursement Flag : 6 6 3 ptsWhich law or act states “physicians are not allowed to refer patients to another health care entity with which the physician or an immediate family member has a financial relationship”Group of answer choicesHIPAAFair Debt Collections Practice ActFalse Claims ActStark law Flag : 7 7 3 ptsWhich “metal” category is also known as the Cadillac plan?Group of answer choicesBronzeSilverGoldPlatinum Flag : 8 8 3 ptsWhat is the Federal program that provides healthcare to individuals over age 65?Group of answer choicesMedicareMedicaidCOBRACHAMPVA Flag : 9 9 3 ptsThere are three parties’ in a contract with insurance. (Select all that apply)Group of answer choicesProviderState and Federal representativesInsurance company (also known as the third-party payer)Patient Flag : 10 10 3 ptsMedicaid provides a list of mandatory benefits that states are required to provide under federal law.Group of answer choicesTrueFalse Flag : 11 11 3 ptsThe difference between a participating provider and a non-participating provider is:View keyboard shortcuts12ptParagraphpView keyboard shortcutsAccessibility Checker0 words>Switch to the html editorFullscreen Flag : 12 12 3 ptsMedicare Part D is for prescription coverage?Group of answer choicesTrueFalse Flag : 13 13 3 ptsWhat does FMLA stand for?Group of answer choicesFirst Medical Leave ActFamily Medical Leave ActForever Medical Leave AbsenceFinally My Leave Act Flag : 14 14 3 ptsWhat is the acronym for Health Maintenance Organizations?Group of answer choicesPPOHMOPMOMCO Flag : 15 15 3 ptsIn order to reduce financial burden, an employee can utilize the balance of their sick leave and vacation days?Group of answer choicesTrueFalse Flag : 16 16 3 ptsFor Workers’ Compensation claims, the employer isGroup of answer choicesThe PatientNot responsible for the medical billsThe EmployeeThe Insured Flag : 17 17 3 ptsIn Wisconsin, when a company employ one or more full-time or part-time employees to whom you have paid combined gross wages of $500 or more in any calendar quarter for work done at one or more locations, the employer must have insurance by _____Group of answer choicesThe end of the yearBy the 10th day of the first calendar month of the next calendar quarterBy the 31st of the current monthNever Flag : 18 18 3 ptsAutomobile coverage is required by law but is mainly limited to bodily injury and property damage liability.Group of answer choicesTrueFalse Flag : 19 19 3 ptsIn ICD-10-CM, what letter is used as the 7th character for a Subsequent Encounter?Group of answer choicesASDB Flag : 20 20 3 ptsIn ICD-10-CM, the 7th character “A – initial encounter” is used for what type of encounter?Group of answer choicesActive treatmentAfter the active phase of treatmentComplication or condition that arises as a direct result of the original injuryIt is never used Flag : 21 21 3 ptsCPT is divided into how many categories?Group of answer choicesFourThreeTenNine Flag : 22 22 3 ptsHow many chapters are in ICD-10-CM?Group of answer choices211913100 Flag : 23 23 3 ptsWhat code set does CPT fall under?Group of answer choicesHCPCS Level IIICD-10-CMHCPCS Level IICD-9-CM Flag : 24 24 3 ptsModifier 25 may be necessary to indicate that on a day of a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided.Group of answer choicesTrueFalse Flag : 25 25 3 ptsA claim that has been found to be valid by the payer is a(n):Group of answer choicesAccepted claimRejected claimDenied claimAuthorized claim Flag : 26 26 3 ptsBefore Starting the collections process what important thing should the office do first?Group of answer choicesDeem the patient account delinquentDeem the patient account is under a payment planDeem the patient account is currentDo not review the account and send the patient to collections Flag : 27 27 3 ptsWhen preparing and transmitting a claim, once the biller verifies that all the proper information is present, the biller will transmit the claim to a clearinghouse, or directly to the insurance provider for processing.Group of answer choicesTrueFalse Flag : 28 28 3 ptsWhen a patient calls to set up an appointment with a healthcare provider, they:Group of answer choicesEffectively preregister for their doctor’s visit.Will need to provide all their information to the provider even if they have been there within the past 3 years.Do not need to provide personal and insurance information to the provider if they have never been there because the provider can find it elsewhere.None of these are correct. Flag : 29 29 3 ptsWhen a patient arrives for their appointment and is checking in, the front desk establishes whether the patient is a New Patient or an Established Patient. Select the statement below that is true?Group of answer choicesA new patient is an individual who has not received services at this facility within the previous 3 years.A new patient is an individual who has not received services within the previous 5 years.An established patient is an individual who has moved away and is receiving services from a new provider who has been given the patient’s entire medical record.An established patient is an individual who has established residency in the state where they live. Flag : 30 30 3 ptsA clearinghouse is a third-party that scrubs an insurance claim to ensure that all information is present before transmitting directly to the proper insurance provider. If there is any missing or invalid information, the clearinghouse will make the necessary changes and transmit it.Group of answer choicesTrueFalse Flag : 31 31 3 ptsA Referring Provider’s NPI number goes in what block on the CMS 1500 form.Group of answer choicesBlock 24JBlock 11Block 17bBlock 2 Flag : 32 32 3 ptsA provider can use either a six (6) digits or eight (8) digits in all birthdate fields?Group of answer choicesTrueFalse Flag : 33 33 3 ptsThe current version of the form is 02/12, OMB control number 0938-1197Group of answer choicesTrueFalse Flag : 34 34 3 ptsWhat is the maximum number of diagnosis codes that may be reported on the CMS 1500 form?Group of answer choices130125 Flag : 35 35 3 ptsBy signing Block 12 on the CMS-1500 claim form, a patient is doing which of the following?Group of answer choicesAuthorizing hospice careAuthorizing the release of funds to a providerAuthorizing the release of medical information needed to process a claim.Authorizing the provider to perform a procedure Flag : 36 36 3 ptsWhich of the following is NOT required information to be on a claim?Group of answer choicesDriver’s LicensePatient’s nameSubscriber number, group or plan numberProvider’s name Flag : 37 37 3 ptsAll the following are true in the appeals process EXCEPT:Group of answer choicesIf the appeal concerns urgent care, the payer must respond within 24 hours of receiving the request.If the appeal concerns urgent care, the payer must respond within 72 hours of receiving the request.If the appeal concern is non-urgent care not yet received the payer has 30 days to respond.If the appeal concern is for services already received the payer has 60 days to respond. Flag : 38 38 3 ptsDenials occur for various reasons except forGroup of answer choicesInvalid dates of servicePatient no longer covered under the policyMedical necessity has been metPre-existing condition not covered by the patient’s policy Flag : 39 39 3 ptsIf a patient has an employer-based plan and Medicaid, which is primary and secondary?Group of answer choicesPrimary = Employer-Based; Secondary = MedicaidPrimary = Medicaid; Secondary = Employer-Based Flag : 40 40 3 ptsA patient has Medicare and Medicaid, which plan is secondary?Group of answer choicesMedicareMedicaidThe patient is self-payNeither plan Flag : 41 41 3 ptsUsing the Birthday Rule, if Jane Doe is covered under both of her parent’s insurance (Dad – March 1; Mom – July 1), which plan would be primary?Group of answer choicesMomDadNeitherBoth are Primary Flag : 42 42 3 ptsA good medical biller must make sure that all claims are filed within a specified time frame. This time frame is referred to as:Group of answer choicesTimely FilingTimely BillingModule BillingSpecified Filing Flag : 43 43 3 ptsFirst Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid “Coinsurance 20% of Allowed Amount” Patient ResponsibilityJen Jones Aetna 99215-Evaluation & Management, established patient $ 175.00 $ 150.00 $ 55.00 $ – $ 76.00 $ ___?____Patient Responsibility is: $ Flag : 44 44 3 ptsFirst Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid “Coinsurance 20% of Allowed Amount” Patient ResponsibilityOwen Hermit Medicare 66984-Cartract Extraction, Surgical $ 1,250.00 $ 656.27 $ – $ – $ 525.02 $ 131.25 $ ____?_____Patient Responsibility is: $ Flag : 45 45 3 ptsFirst Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount Patient ResponsibilityJuan Ramos Medicaid 71010-Chest x-ray, 1 view $ 130.00 $ 100.00 $ – $ 25.00 $ ____?____ $ 40.00Coinsurance 20% of Allowed Amount is: $ Flag : 46 46 3 ptsFirst Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid “Coinsurance 20% of Allowed Amount” Patient ResponsibilityJames Weaver Cigna 99203-Evaluation & Management, new patient $ 205.00 $ 205.00 $ – $ 20.00 $ ___?____ $ – Insurance Paid: $ Flag : 47 47 3 ptsFirst Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount Patient ResponsibilityPedro Tanner BCBS 99291-Critical Care first 30 Minutes $ 375.00 $ 270.00 $ 100.00 $ – $ 136.00 $ ____?_____ $ 134.00Coinsurance 20% of Allowed Amount is: $ Flag : 48 48 3 ptsFirst Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid “Coinsurance 20% of Allowed Amount” Patient ResponsbilityJames Weaver Cigna 99203-Evaluation & Management, new patient $ 205.00 $ 205.00 $ – $ 20.00 [G] $ – $ ____?____ Flag : 49 49 3 ptsFirst Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount is: $ Patient ResponsibilityJuan Ramos Medicaid 71010-Chest x-ray, 1 view $ 130.00 $ 100.00 $ – $ 25.00 $ ___?____ $ 40.00Insurance Paid is: $ Flag : 50 50 3 ptsFirst Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount Patient ResponsibilityJen Jones Aetna 99215-Evaluation & Management, established patient $ 175.00 $ 150.00 $ 55.00 $ – $ 76.00 $ ____?_____ Coinsurance 20% of Allowed Amount: $ Multiple Choice, True/False, and 8 Explanation of Benefits Scenarios, covering Units 1-7. 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