Question 1 3 pts The Fair Debt Collection Practices Act is enforced...

Question 1 3 pts The Fair Debt Collection Practices Act is enforced by Group of answer choices HIPAA Stark Law False Claims Act The Federal Trade Commission (FTC) Flag question: Question 2 Question 2 3 pts MDs are also known as Group of answer choices Allopathic doctor Osteopathic doctor Physicians Assistant Nurse Practitioner Flag question: Question 3 Question 3 3 pts The 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 list Group of answer choices Exclusions databases Medicare databases Medicaid databases FTC databases Flag question: Question 4 Question 4 3 pts Mandatory exclusions occur when an individual or entity commits the following types of criminal offenses except for Group of answer choices Patient abuse or neglect Defaulting on a health education loan or scholarship obligations Felony convictions for other healthcare-related fraud, theft, or other financial misconduct Felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances Flag question: Question 5 Question 5 3 pts The most common types of fraud and abuse include (select all that apply) Group of answer choices Documenting a service that was never rendered and billing for that service Billing for more expensive services or procedures that were provided or performed. Performing medically unnecessary services solely for generating insurance reimbursement Falsifying a patient's diagnosis to justify tests or procedure to generate insurance reimbursement Flag question: Question 6 Question 6 3 pts Which 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 choices HIPAA Fair Debt Collections Practice Act False Claims Act Stark law Flag question: Question 7 Question 7 3 pts Which "metal" category is also known as the Cadillac plan? Group of answer choices Bronze Silver Gold Platinum Flag question: Question 8 Question 8 3 pts What is the Federal program that provides healthcare to individuals over age 65? Group of answer choices Medicare Medicaid COBRA CHAMPVA Flag question: Question 9 Question 9 3 pts There are three parties' in a contract with insurance. (Select all that apply) Group of answer choices Provider State and Federal representatives Insurance company (also known as the third-party payer) Patient Flag question: Question 10 Question 10 3 pts Medicaid provides a list of mandatory benefits that states are required to provide under federal law. Group of answer choices True False Flag question: Question 11 Question 11 3 pts The difference between a participating provider and a non-participating provider is: View keyboard shortcuts 12pt Paragraph p View keyboard shortcuts Accessibility Checker 0 words > Switch to the html editor Fullscreen Flag question: Question 12 Question 12 3 pts Medicare Part D is for prescription coverage? Group of answer choices True False Flag question: Question 13 Question 13 3 pts What does FMLA stand for? Group of answer choices First Medical Leave Act Family Medical Leave Act Forever Medical Leave Absence Finally My Leave Act Flag question: Question 14 Question 14 3 pts What is the acronym for Health Maintenance Organizations? Group of answer choices PPO HMO PMO MCO Flag question: Question 15 Question 15 3 pts In order to reduce financial burden, an employee can utilize the balance of their sick leave and vacation days? Group of answer choices True False Flag question: Question 16 Question 16 3 pts For Workers' Compensation claims, the employer is Group of answer choices The Patient Not responsible for the medical bills The Employee The Insured Flag question: Question 17 Question 17 3 pts In 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 choices The end of the year By the 10th day of the first calendar month of the next calendar quarter By the 31st of the current month Never Flag question: Question 18 Question 18 3 pts Automobile coverage is required by law but is mainly limited to bodily injury and property damage liability. Group of answer choices True False Flag question: Question 19 Question 19 3 pts In ICD-10-CM, what letter is used as the 7th character for a Subsequent Encounter? Group of answer choices A S D B Flag question: Question 20 Question 20 3 pts In ICD-10-CM, the 7th character "A - initial encounter" is used for what type of encounter? Group of answer choices Active treatment After the active phase of treatment Complication or condition that arises as a direct result of the original injury It is never used Flag question: Question 21 Question 21 3 pts CPT is divided into how many categories? Group of answer choices Four Three Ten Nine Flag question: Question 22 Question 22 3 pts How many chapters are in ICD-10-CM? Group of answer choices 21 19 13 100 Flag question: Question 23 Question 23 3 pts What code set does CPT fall under? Group of answer choices HCPCS Level II ICD-10-CM HCPCS Level I ICD-9-CM Flag question: Question 24 Question 24 3 pts Modifier 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 choices True False Flag question: Question 25 Question 25 3 pts A claim that has been found to be valid by the payer is a(n): Group of answer choices Accepted claim Rejected claim Denied claim Authorized claim Flag question: Question 26 Question 26 3 pts Before Starting the collections process what important thing should the office do first? Group of answer choices Deem the patient account delinquent Deem the patient account is under a payment plan Deem the patient account is current Do not review the account and send the patient to collections Flag question: Question 27 Question 27 3 pts When 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 choices True False Flag question: Question 28 Question 28 3 pts When a patient calls to set up an appointment with a healthcare provider, they: Group of answer choices Effectively 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 question: Question 29 Question 29 3 pts When 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 choices A 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 question: Question 30 Question 30 3 pts A 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 choices True False Flag question: Question 31 Question 31 3 pts A Referring Provider's NPI number goes in what block on the CMS 1500 form. Group of answer choices Block 24J Block 11 Block 17b Block 2 Flag question: Question 32 Question 32 3 pts A provider can use either a six (6) digits or eight (8) digits in all birthdate fields? Group of answer choices True False Flag question: Question 33 Question 33 3 pts The current version of the form is 02/12, OMB control number 0938-1197 Group of answer choices True False Flag question: Question 34 Question 34 3 pts What is the maximum number of diagnosis codes that may be reported on the CMS 1500 form? Group of answer choices 1 30 12 5 Flag question: Question 35 Question 35 3 pts By signing Block 12 on the CMS-1500 claim form, a patient is doing which of the following? Group of answer choices Authorizing hospice care Authorizing the release of funds to a provider Authorizing the release of medical information needed to process a claim. Authorizing the provider to perform a procedure Flag question: Question 36 Question 36 3 pts Which of the following is NOT required information to be on a claim? Group of answer choices Driver's License Patient's name Subscriber number, group or plan number Provider's name Flag question: Question 37 Question 37 3 pts All the following are true in the appeals process EXCEPT: Group of answer choices If 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 question: Question 38 Question 38 3 pts Denials occur for various reasons except for Group of answer choices Invalid dates of service Patient no longer covered under the policy Medical necessity has been met Pre-existing condition not covered by the patient's policy Flag question: Question 39 Question 39 3 pts If a patient has an employer-based plan and Medicaid, which is primary and secondary? Group of answer choices Primary = Employer-Based; Secondary = Medicaid Primary = Medicaid; Secondary = Employer-Based Flag question: Question 40 Question 40 3 pts A patient has Medicare and Medicaid, which plan is secondary? Group of answer choices Medicare Medicaid The patient is self-pay Neither plan Flag question: Question 41 Question 41 3 pts Using 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 choices Mom Dad Neither Both are Primary Flag question: Question 42 Question 42 3 pts A 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 choices Timely Filing Timely Billing Module Billing Specified Filing Flag question: Question 43 Question 43 3 pts First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid "Coinsurance 20% of Allowed Amount" Patient Responsibility Jen Jones Aetna 99215-Evaluation & Management, established patient $ 175.00 $ 150.00 $ 55.00 $ - $ 76.00 $ ___?____ Patient Responsibility is: $ Flag question: Question 44 Question 44 3 pts First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid "Coinsurance 20% of Allowed Amount" Patient Responsibility Owen Hermit Medicare 66984-Cartract Extraction, Surgical $ 1,250.00 $ 656.27 $ - $ - $ 525.02 $ 131.25 $ ____?_____ Patient Responsibility is: $ Flag question: Question 45 Question 45 3 pts First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount Patient Responsibility Juan Ramos Medicaid 71010-Chest x-ray, 1 view $ 130.00 $ 100.00 $ - $ 25.00 $ ____?____ $ 40.00 Coinsurance 20% of Allowed Amount is: $ Flag question: Question 46 Question 46 3 pts First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid "Coinsurance 20% of Allowed Amount" Patient Responsibility James Weaver Cigna 99203-Evaluation & Management, new patient $ 205.00 $ 205.00 $ - $ 20.00 $ ___?____ $ - Insurance Paid: $ Flag question: Question 47 Question 47 3 pts First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount Patient Responsibility Pedro Tanner BCBS 99291-Critical Care first 30 Minutes $ 375.00 $ 270.00 $ 100.00 $ - $ 136.00 $ ____?_____ $ 134.00 Coinsurance 20% of Allowed Amount is: $ Flag question: Question 48 Question 48 3 pts First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid "Coinsurance 20% of Allowed Amount" Patient Responsbility James Weaver Cigna 99203-Evaluation & Management, new patient $ 205.00 $ 205.00 $ - $ 20.00 [G] $ - $ ____?____ Flag question: Question 49 Question 49 3 pts First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount is: $ Patient Responsibility Juan Ramos Medicaid 71010-Chest x-ray, 1 view $ 130.00 $ 100.00 $ - $ 25.00 $ ___?____ $ 40.00 Insurance Paid is: $ Flag question: Question 50 Question 50 3 pts First Name Last Name Insurance CPT Code Charges Allowed Amount Amount Applied to Deductible Copay Insurance Paid Coinsurance 20% of Allowed Amount Patient Responsibility Jen 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.