Question 1

ERISA stands for the:

Accepted Answer

A)  Employer Resources Income Security Act. 
B)  Employer Retirement Incentive Savings Act. 
C)  Employee Retirement Incentive Savings Act. 
D)  Employee Retirement Income Security Act. 
A)  Employer Resources Income Security Act. 
B)  Employer Retirement Incentive Savings Act. 
C)  Employee Retirement Incentive Savings Act. 
D)  Employee Retirement Income Security Act.

Question 2

All of the following claims can be appealed by telephone EXCEPT those in which:

Accepted Answer

A)  a modifier was used to indicate multiple procedures that the carrier bundled. 
B)  the claim was considered not medically necessary. 
C)  the carrier requested information from the patient that was not received. 
D)  the patient had a routine service covered by the policy. 
A)  a modifier was used to indicate multiple procedures that the carrier bundled. 
B)  the claim was considered not medically necessary. 
C)  the carrier requested information from the patient that was not received. 
D)  the patient had a routine service covered by the policy.

Question 3

A(n) ________ is an examination and verification of claims and supporting documentation submitted by a physician or medical facility to a carrier.

Accepted Answer

The answer of A(n) ________ is an examination and verification...

Question 4

Using the SOAP format, the patient's chief complaint and reason for the encounter as the patient told it to the doctor are:

Accepted Answer

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

Question 5

Match the following
-The law that protects the interests of beneficiaries enrolled in private employee benefit plans

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 6

When answering a patient's questions about claims, the medical office specialist should use technical terms in order to sound more professional and accurate.

Accepted Answer

A) True 
 B)False

Question 7

If a denial is upheld when regulatory information was included in the original appeal, the medical office assistant should appeal to the:

Accepted Answer

A)  carrier legal department. 
B)  carrier president. 
C)  Department of Labor. 
D)  Department of Insurance. 
A)  carrier legal department. 
B)  carrier president. 
C)  Department of Labor. 
D)  Department of Insurance.

Question 8

A patient's vital signs, height, and weight would be documented as subjective information in the medical record.

Accepted Answer

A) True 
 B)False

Question 9

Some insurance carriers perceive automatic rebilling after 30 days to be aggressive and a:

Accepted Answer

A)  requirement. 
B)  fraudulent practice. 
C)  sign of error on the part of the physician's office. 
D)  recommended practice. 
A)  requirement. 
B)  fraudulent practice. 
C)  sign of error on the part of the physician's office. 
D)  recommended practice.

Question 10

If a patient is upset about a claim denial, the medical office specialist should do all of the following EXCEPT:

Accepted Answer

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. 
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 11

An appeal letter is more effective when the medical office specialist includes information about the federal and state laws that affect the claim submission.

Accepted Answer

A) True 
 B)False

Question 12

A negative adjustment to a patient account will decrease the balance owed.

Accepted Answer

A) True 
 B)False

Question 13

If a physician requests a peer review that results in confirmation that services were NOT medically necessary:

Accepted Answer

A)  the patient should be billed for the review. 
B)  the insurance carrier will pay for the review. 
C)  there is no charge for the review. 
D)  the physician must pay for the review. 
A)  the patient should be billed for the review. 
B)  the insurance carrier will pay for the review. 
C)  there is no charge for the review. 
D)  the physician must pay for the review.

Question 14

The plan section of the medical record includes the diagnosis made at the time of the encounter or shortly thereafter.

Accepted Answer

A) True 
 B)False

Question 15

If a claim is denied because the carrier does NOT have details about an accident, the appeal can be handled through a telephone call.

Accepted Answer

A) True 
 B)False

Question 16

If the services provided are NOT appropriate in light of the diagnosis and the claim is denied, a telephone appeal can resolve the situation.

Accepted Answer

A) True 
 B)False

Question 17

When a provider receives a partial payment on a claim because the amount billed was in excess of the maximum allowed charge, this is a:

Accepted Answer

A)  denial. 
B)  downcode. 
C)  determination. 
D)  disallowance. 
A)  denial. 
B)  downcode. 
C)  determination. 
D)  disallowance.

Question 18

If a claim is denied because services were provided before insurance coverage was in effect, the medical office specialist should:

Accepted Answer

A)  bill the patient. 
B)  write off the entire amount. 
C)  wait until the effective date of the coverage, then bill the insurance carrier. 
D)  change the date of service and resubmit the claim. 
A)  bill the patient. 
B)  write off the entire amount. 
C)  wait until the effective date of the coverage, then bill the insurance carrier. 
D)  change the date of service and resubmit the claim.

Question 19

Benefit plans NOT covered by ERISA include:

Accepted Answer

A)  private employee benefit plans. 
B)  church plans. 
C)  self-funded plans. 
D)  insurance plans offered by employers. 
A)  private employee benefit plans. 
B)  church plans. 
C)  self-funded plans. 
D)  insurance plans offered by employers.

Question 20

Match the following
-The examination and verification of claims and supporting documents submitted by a physician

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

ERISA stands for the:

All of the following claims can be appealed by telephone EXCEPT those in which:

A(n) ________ is an examination and verification of claims and supporting documentation submitted by a physician or medical facility to a carrier.

Using the SOAP format, the patient's chief complaint and reason for the encounter as the patient told it to the doctor are:

Match the following -The law that protects the interests of beneficiaries enrolled in private employee benefit plans

When answering a patient's questions about claims, the medical office specialist should use technical terms in order to sound more professional and accurate.

If a denial is upheld when regulatory information was included in the original appeal, the medical office assistant should appeal to the:

A patient's vital signs, height, and weight would be documented as subjective information in the medical record.

Some insurance carriers perceive automatic rebilling after 30 days to be aggressive and a:

If a patient is upset about a claim denial, the medical office specialist should do all of the following EXCEPT:

An appeal letter is more effective when the medical office specialist includes information about the federal and state laws that affect the claim submission.

A negative adjustment to a patient account will decrease the balance owed.

If a physician requests a peer review that results in confirmation that services were NOT medically necessary:

The plan section of the medical record includes the diagnosis made at the time of the encounter or shortly thereafter.

If a claim is denied because the carrier does NOT have details about an accident, the appeal can be handled through a telephone call.

If the services provided are NOT appropriate in light of the diagnosis and the claim is denied, a telephone appeal can resolve the situation.

When a provider receives a partial payment on a claim because the amount billed was in excess of the maximum allowed charge, this is a:

If a claim is denied because services were provided before insurance coverage was in effect, the medical office specialist should:

Benefit plans NOT covered by ERISA include:

Match the following -The examination and verification of claims and supporting documents submitted by a physician

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

ERISA stands for the:

All of the following claims can be appealed by telephone EXCEPT those in which:

A(n) ________ is an examination and verification of claims and supporting documentation submitted by a physician or medical facility to a carrier.

Using the SOAP format, the patient's chief complaint and reason for the encounter as the patient told it to the doctor are:

Match the following -The law that protects the interests of beneficiaries enrolled in private employee benefit plans

When answering a patient's questions about claims, the medical office specialist should use technical terms in order to sound more professional and accurate.

If a denial is upheld when regulatory information was included in the original appeal, the medical office assistant should appeal to the:

A patient's vital signs, height, and weight would be documented as subjective information in the medical record.

Some insurance carriers perceive automatic rebilling after 30 days to be aggressive and a:

If a patient is upset about a claim denial, the medical office specialist should do all of the following EXCEPT:

An appeal letter is more effective when the medical office specialist includes information about the federal and state laws that affect the claim submission.

A negative adjustment to a patient account will decrease the balance owed.

If a physician requests a peer review that results in confirmation that services were NOT medically necessary:

The plan section of the medical record includes the diagnosis made at the time of the encounter or shortly thereafter.

If a claim is denied because the carrier does NOT have details about an accident, the appeal can be handled through a telephone call.

If the services provided are NOT appropriate in light of the diagnosis and the claim is denied, a telephone appeal can resolve the situation.

When a provider receives a partial payment on a claim because the amount billed was in excess of the maximum allowed charge, this is a:

If a claim is denied because services were provided before insurance coverage was in effect, the medical office specialist should:

Benefit plans NOT covered by ERISA include:

Match the following -The examination and verification of claims and supporting documents submitted by a physician

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