Question 1

An objective, unbiased group of physicians that determines what payment is adequate for services provided is a(n):

Accepted Answer

A)  appeal committee review. 
B)  routine examination of claims. 
C)  peer review. 
D)  utilization review. 
A)  appeal committee review. 
B)  routine examination of claims. 
C)  peer review. 
D)  utilization review.

Question 2

For the 2017 calendar year, to take a Medicare appeal to the level of a decision by an administrative law judge, the claim must be for a minimum of:

Accepted Answer

A)  $130.00. 
B)  $160.00. 
C)  $360.00. 
D)  $500.00. 
A)  $130.00. 
B)  $160.00. 
C)  $360.00. 
D)  $500.00.

Question 3

What are the three levels of Medicare appeals?

Accepted Answer

The three levels are redetermi

Question 4

Which of the following are reason codes that require a formal appeal?

Accepted Answer

A)  claim processing error 
B)  noncovered emergency services 
C)  not related to diagnoses 
D)  both B and C 
A)  claim processing error 
B)  noncovered emergency services 
C)  not related to diagnoses 
D)  both B and C

Question 5

Simple appeals may be accepted by:

Accepted Answer

A)  telephone or fax. 
B)  sending a form letter. 
C)  rebilling the claim. 
D)  sending a copy of pertinent court decisions. 
A)  telephone or fax. 
B)  sending a form letter. 
C)  rebilling the claim. 
D)  sending a copy of pertinent court decisions.

Question 6

When payment is denied, the insurance carrier only notifies the patient.

Accepted Answer

A) True 
 B)False

Question 7

What is a claim appeal?

Accepted Answer

A claim appeal is a formal way of asking

Question 8

What information should be included in an appeal letter?

Accepted Answer

An appeal letter should include a specif

Question 9

The procedure for rebilling paper claims is to reprint the claim from the computer and write "________" in black letters at the top.

Accepted Answer

The answer of The procedure for rebilling paper claims is...

Question 10

Explain what the medical specialists should do if the insurance carrier paid twice for the same date of service and is requesting a refund.

Accepted Answer

The specialist should check the first EO

Question 11

If a claim is denied because additional information is needed to prove medical necessity, the medical office specialist should:

Accepted Answer

A)  bill the patient. 
B)  write off the entire amount. 
C)  ask the patient to write a letter explaining the situation. 
D)  submit the required information and follow up with the carrier. 
A)  bill the patient. 
B)  write off the entire amount. 
C)  ask the patient to write a letter explaining the situation. 
D)  submit the required information and follow up with the carrier.

Question 12

List at least three reasons for contacting an insurance carrier to follow up on a claim.

Accepted Answer

Reasons for contacting an insurance carr

Question 13

From the insurance carrier's perspective, if a service is NOT documented in the medical record, the:

Accepted Answer

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. 
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 14

What is peer review?

Accepted Answer

A physician may want an object

Question 15

Using the SOAP format, documentation of the physician's medical decision making is:

Accepted Answer

A)  subjective information. 
B)  objective information. 
C)  part of the assessment. 
D)  part of the plan. 
A)  subjective information. 
B)  objective information. 
C)  part of the assessment. 
D)  part of the plan.

Question 16

An examination and verification of claims and supporting documentation submitted by a physician is known as a(n):

Accepted Answer

A)  appeal. 
B)  audit. 
C)  reconsideration. 
D)  review. 
A)  appeal. 
B)  audit. 
C)  reconsideration. 
D)  review.

Question 17

Match the following
-The submission of additional clinical and other pertinent information to an insurance carrier to overturn a denied or downcoded claim

Accepted Answer

A)  qualified independent contractors (QICs) 
B)  documentation 
C)  subjective, objective, assessment, plan (SOAP) 
D)  administrative law judge (ALJ) 
E)  ERISA
F) audit
G) peer review
H) Civil Practice and Remedies Code
I) appeal
J) redetermination 
A)  qualified independent contractors (QICs) 
B)  documentation 
C)  subjective, objective, assessment, plan (SOAP) 
D)  administrative law judge (ALJ) 
E)  ERISA
F) audit
G) peer review
H) Civil Practice and Remedies Code
I) appeal
J) redetermination

Question 18

The first level of Medicare appeals is a request for:

Accepted Answer

A)  review by a qualified independent contractor. 
B)  redetermination by the carrier. 
C)  review by an administrative law judge. 
D)  review by the state insurance commissioner. 
A)  review by a qualified independent contractor. 
B)  redetermination by the carrier. 
C)  review by an administrative law judge. 
D)  review by the state insurance commissioner.

Question 19

A medical office specialist can appeal a claim in writing or over the telephone.

Accepted Answer

A) True 
 B)False

Question 20

To ensure timely payment, claim status must be ________ and follow-up done with the insurance carrier.

Accepted Answer

The answer of To ensure timely payment, claim status must...

An objective, unbiased group of physicians that determines what payment is adequate for services provided is a(n):

For the 2017 calendar year, to take a Medicare appeal to the level of a decision by an administrative law judge, the claim must be for a minimum of:

What are the three levels of Medicare appeals?

Which of the following are reason codes that require a formal appeal?

Simple appeals may be accepted by:

When payment is denied, the insurance carrier only notifies the patient.

What is a claim appeal?

What information should be included in an appeal letter?

The procedure for rebilling paper claims is to reprint the claim from the computer and write "________" in black letters at the top.

Explain what the medical specialists should do if the insurance carrier paid twice for the same date of service and is requesting a refund.

If a claim is denied because additional information is needed to prove medical necessity, the medical office specialist should:

List at least three reasons for contacting an insurance carrier to follow up on a claim.

From the insurance carrier's perspective, if a service is NOT documented in the medical record, the:

What is peer review?

Using the SOAP format, documentation of the physician's medical decision making is:

An examination and verification of claims and supporting documentation submitted by a physician is known as a(n):

Match the following -The submission of additional clinical and other pertinent information to an insurance carrier to overturn a denied or downcoded claim

The first level of Medicare appeals is a request for:

A medical office specialist can appeal a claim in writing or over the telephone.

To ensure timely payment, claim status must be ________ and follow-up done with the insurance carrier.

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Understanding Managed Care: Medical Contracts and Ethics

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Auditing

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Explanation of Benefits and Payment Adjudication

Workers Compensation

Filters

Exam 16: Refunds and Appeals

An objective, unbiased group of physicians that determines what payment is adequate for services provided is a(n):

For the 2017 calendar year, to take a Medicare appeal to the level of a decision by an administrative law judge, the claim must be for a minimum of:

What are the three levels of Medicare appeals?

Which of the following are reason codes that require a formal appeal?

Simple appeals may be accepted by:

When payment is denied, the insurance carrier only notifies the patient.

What is a claim appeal?

What information should be included in an appeal letter?

The procedure for rebilling paper claims is to reprint the claim from the computer and write "________" in black letters at the top.

Explain what the medical specialists should do if the insurance carrier paid twice for the same date of service and is requesting a refund.

If a claim is denied because additional information is needed to prove medical necessity, the medical office specialist should:

List at least three reasons for contacting an insurance carrier to follow up on a claim.

From the insurance carrier's perspective, if a service is NOT documented in the medical record, the:

What is peer review?

Using the SOAP format, documentation of the physician's medical decision making is:

An examination and verification of claims and supporting documentation submitted by a physician is known as a(n):

Match the following -The submission of additional clinical and other pertinent information to an insurance carrier to overturn a denied or downcoded claim

The first level of Medicare appeals is a request for:

A medical office specialist can appeal a claim in writing or over the telephone.

To ensure timely payment, claim status must be ________ and follow-up done with the insurance carrier.

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Understanding Managed Care: Medical Contracts and Ethics

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Auditing

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Explanation of Benefits and Payment Adjudication

Workers Compensation

Filters