Question 1

Match the following
-The first level of a Medicare appeal in which the carrier is asked to review its initial decision

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 2

In medical record documentation, a commonly used format is SOAP, which stands for:

Accepted Answer

A)  subjective, objective, audit, process. 
B)  subjective, objective, action, plan. 
C)  subjective, objective, assessment, plan. 
D)  subjective, objective, assessment, payment. 
A)  subjective, objective, audit, process. 
B)  subjective, objective, action, plan. 
C)  subjective, objective, assessment, plan. 
D)  subjective, objective, assessment, payment.

Question 3

If a procedure is NOT documented in the medical record, it cannot be reported or billed.

Accepted Answer

A) True 
 B)False

Question 4

The statute of limitations for refunds in cases in which no contract language covers refunds is:

Accepted Answer

A)  2 years. 
B)  4 years. 
C)  5 years. 
D)  7 years. 
A)  2 years. 
B)  4 years. 
C)  5 years. 
D)  7 years.

Question 5

According to ERISA, a provider must file an appeal within:

Accepted Answer

A)  30 days after denial. 
B)  60 days after denial. 
C)  90 days after denial. 
D)  180 days after denial. 
A)  30 days after denial. 
B)  60 days after denial. 
C)  90 days after denial. 
D)  180 days after denial.

Question 6

Reasons for follow-up include:

Accepted Answer

A)  an incorrect payment is received. 
B)  reimbursement is received for an unknown patient. 
C)  unclear denial of payment is received. 
D)  all of the above. 
A)  an incorrect payment is received. 
B)  reimbursement is received for an unknown patient. 
C)  unclear denial of payment is received. 
D)  all of the above.

Question 7

Match the following
-The second level of appeal for Medicare claims, during which these entities process reconsiderations of a carrier's redetermination

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 8

Using the SOAP format, the documentation of vital signs, height, weight, and blood pressure 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 9

Using the SOAP format, the physician's recommended treatment, testing, or therapy is:

Accepted Answer

A)  a subjective finding. 
B)  an objective finding. 
C)  part of the assessment. 
D)  part of the plan. 
A)  a subjective finding. 
B)  an objective finding. 
C)  part of the assessment. 
D)  part of the plan.

Question 10

The threshold amount for a third-level appeal with a ALJ is recalculated each ________ and is subject to change.

Accepted Answer

The answer of The threshold amount for a third-level appeal...

Question 11

The chronological recording of pertinent facts and observations regarding a patient's health status is known as:

Accepted Answer

A)  medical transcription. 
B)  documentation. 
C)  claims processing. 
D)  encounter form completion. 
A)  medical transcription. 
B)  documentation. 
C)  claims processing. 
D)  encounter form completion.

Question 12

The number one reason that appeals of Medicare Part B claims are returned is for not:

Accepted Answer

A)  filing within the specified time limit. 
B)  including a valid signature. 
C)  including necessary documentation. 
D)  having patient consent. 
A)  filing within the specified time limit. 
B)  including a valid signature. 
C)  including necessary documentation. 
D)  having patient consent.

Question 13

Match the following
-The method of documentation most widely used by physicians for record keeping

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 14

Match the following
-Decision maker at the third level of a Medicare appeal, which includes a hearing

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 15

The third level of a Medicare appeal 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 16

Subjective information in the medical record includes the history of the present illness (HPI).

Accepted Answer

A) True 
 B)False

Question 17

If a claim is denied due to services NOT being covered under the insurance policy, the patient cannot be billed for the services.

Accepted Answer

A) True 
 B)False

Question 18

Medicare carriers must process a redetermination within:

Accepted Answer

A)  30 days. 
B)  60 days. 
C)  90 days. 
D)  180 days. 
A)  30 days. 
B)  60 days. 
C)  90 days. 
D)  180 days.

Question 19

Credit balances and refunds result from ________ by patients and third-party payers.

Accepted Answer

The answer of Credit balances and refunds result from ________...

Question 20

Match the following
-An objective, unbiased group of physicians that determines what payment is adequate for services provided

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

Match the following -The first level of a Medicare appeal in which the carrier is asked to review its initial decision

In medical record documentation, a commonly used format is SOAP, which stands for:

If a procedure is NOT documented in the medical record, it cannot be reported or billed.

The statute of limitations for refunds in cases in which no contract language covers refunds is:

According to ERISA, a provider must file an appeal within:

Reasons for follow-up include:

Match the following -The second level of appeal for Medicare claims, during which these entities process reconsiderations of a carrier's redetermination

Using the SOAP format, the documentation of vital signs, height, weight, and blood pressure is:

Using the SOAP format, the physician's recommended treatment, testing, or therapy is:

The threshold amount for a third-level appeal with a ALJ is recalculated each ________ and is subject to change.

The chronological recording of pertinent facts and observations regarding a patient's health status is known as:

The number one reason that appeals of Medicare Part B claims are returned is for not:

Match the following -The method of documentation most widely used by physicians for record keeping

Match the following -Decision maker at the third level of a Medicare appeal, which includes a hearing

The third level of a Medicare appeal is a request for:

Subjective information in the medical record includes the history of the present illness (HPI).

If a claim is denied due to services NOT being covered under the insurance policy, the patient cannot be billed for the services.

Medicare carriers must process a redetermination within:

Credit balances and refunds result from ________ by patients and third-party payers.

Match the following -An objective, unbiased group of physicians that determines what payment is adequate for services provided

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

Match the following -The first level of a Medicare appeal in which the carrier is asked to review its initial decision

In medical record documentation, a commonly used format is SOAP, which stands for:

If a procedure is NOT documented in the medical record, it cannot be reported or billed.

The statute of limitations for refunds in cases in which no contract language covers refunds is:

According to ERISA, a provider must file an appeal within:

Reasons for follow-up include:

Match the following -The second level of appeal for Medicare claims, during which these entities process reconsiderations of a carrier's redetermination

Using the SOAP format, the documentation of vital signs, height, weight, and blood pressure is:

Using the SOAP format, the physician's recommended treatment, testing, or therapy is:

The threshold amount for a third-level appeal with a ALJ is recalculated each ________ and is subject to change.

The chronological recording of pertinent facts and observations regarding a patient's health status is known as:

The number one reason that appeals of Medicare Part B claims are returned is for not:

Match the following -The method of documentation most widely used by physicians for record keeping

Match the following -Decision maker at the third level of a Medicare appeal, which includes a hearing

The third level of a Medicare appeal is a request for:

Subjective information in the medical record includes the history of the present illness (HPI).

If a claim is denied due to services NOT being covered under the insurance policy, the patient cannot be billed for the services.

Medicare carriers must process a redetermination within:

Credit balances and refunds result from ________ by patients and third-party payers.

Match the following -An objective, unbiased group of physicians that determines what payment is adequate for services provided

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