Question 1

Wrongfully keeping an overpayment is illegal and is called:

Accepted Answer

A)  conversion. 
B)  retention. 
C)  fraud. 
D)  embezzlement. 
A)  conversion. 
B)  retention. 
C)  fraud. 
D)  embezzlement. A

Question 2

According to ERISA, a carrier must provide a decision on an appeal within:

Accepted Answer

A)  60 days. 
B)  90 days. 
C)  120 days. 
D)  180 days. 
A)  60 days. 
B)  90 days. 
C)  120 days. 
D)  180 days. C

Question 3

The medical office specialist can learn about an insurance carrier's appeals process through:

Accepted Answer

A)  an administrative manual. 
B)  newsletters from the carrier. 
C)  phone calls to the carrier. 
D)  all of the above. 
A)  an administrative manual. 
B)  newsletters from the carrier. 
C)  phone calls to the carrier. 
D)  all of the above. D

Question 4

Credit balances and refunds are a result of an overpayment by the ________ or the insurance carrier.

Accepted Answer

The answer of Credit balances and refunds are a result...

Question 5

If a denial by a self-funded plan is upheld, 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 6

If a claim is denied as a noncovered service, the medical office specialist should:

Accepted Answer

A)  bill the patient. 
B)  write off the entire amount. 
C)  negotiate with the patient for partial payment. 
D)  file an appeal with the insurance carrier. 
A)  bill the patient. 
B)  write off the entire amount. 
C)  negotiate with the patient for partial payment. 
D)  file an appeal with the insurance carrier.

Question 7

Why is documentation important?

Accepted Answer

An unwritten rule states that if a servi

Question 8

Church and government health benefit plans are NOT regulated by ERISA.

Accepted Answer

A) True 
 B)False

Question 9

According to ERISA, a plan must pay a claim or respond regarding its status within:

Accepted Answer

A)  30 days. 
B)  60 days. 
C)  90 days. 
D)  1 year. 
A)  30 days. 
B)  60 days. 
C)  90 days. 
D)  1 year.

Question 10

The second level of appeal for a Medicare claim is handled by ________, who process reconsiderations.

Accepted Answer

qualified

Question 11

Most practices learn about the appeals policies of the insurance carriers they work with by referring to administrative manuals, contracts, and newsletters.

Accepted Answer

A) True 
 B)False

Question 12

List three situations in which the carrier may ask for rebilling.

Accepted Answer

Three situations in which the carrier ma

Question 13

Of the following, who may ask the state insurance commissioner for help in resolving a payment dispute?

Accepted Answer

A)  Patients and physicians only 
B)  Patients and insurance carriers only 
C)  Physicians and insurance carriers only 
D)  Patients, physicians, and insurance carriers 
A)  Patients and physicians only 
B)  Patients and insurance carriers only 
C)  Physicians and insurance carriers only 
D)  Patients, physicians, and insurance carriers

Question 14

A stamped provider signature or that of an authorized employee is acceptable on Medicare appeals.

Accepted Answer

A) True 
 B)False

Question 15

What is the difference between subjective information and objective findings?

Accepted Answer

Subjective information includes the chie

Question 16

Negative adjustments will ________ the balance, whereas positive adjustments will ________ the balance on a patient account.

Accepted Answer

The answer of Negative adjustments will ________ the balance, whereas...

Question 17

The government official whose office regulates the insurance industry and who serves as a liaison between patients and carriers, and physicians and carriers, is the state ________.

Accepted Answer

insurance

Question 18

The second 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

Using the SOAP format, the diagnosis made by the doctor 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 20

An appeal must be made in writing if:

Accepted Answer

A)  a billing error was made by the medical office assistant. 
B)  the carrier requested information from the patient that was not received. 
C)  the patient had a routine service covered by the policy. 
D)  the claim was for services related to an accident. 
A)  a billing error was made by the medical office assistant. 
B)  the carrier requested information from the patient that was not received. 
C)  the patient had a routine service covered by the policy. 
D)  the claim was for services related to an accident.

Wrongfully keeping an overpayment is illegal and is called:

According to ERISA, a carrier must provide a decision on an appeal within:

The medical office specialist can learn about an insurance carrier's appeals process through:

Credit balances and refunds are a result of an overpayment by the ________ or the insurance carrier.

If a denial by a self-funded plan is upheld, the medical office assistant should appeal to the:

If a claim is denied as a noncovered service, the medical office specialist should:

Why is documentation important?

Church and government health benefit plans are NOT regulated by ERISA.

According to ERISA, a plan must pay a claim or respond regarding its status within:

The second level of appeal for a Medicare claim is handled by ________, who process reconsiderations.

Most practices learn about the appeals policies of the insurance carriers they work with by referring to administrative manuals, contracts, and newsletters.

List three situations in which the carrier may ask for rebilling.

Of the following, who may ask the state insurance commissioner for help in resolving a payment dispute?

A stamped provider signature or that of an authorized employee is acceptable on Medicare appeals.

What is the difference between subjective information and objective findings?

Negative adjustments will the balance, whereas positive adjustments will the balance on a patient account.

The government official whose office regulates the insurance industry and who serves as a liaison between patients and carriers, and physicians and carriers, is the state ________.

The second level of Medicare appeals is a request for:

Using the SOAP format, the diagnosis made by the doctor is:

An appeal must be made in writing if:

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

Wrongfully keeping an overpayment is illegal and is called:

According to ERISA, a carrier must provide a decision on an appeal within:

The medical office specialist can learn about an insurance carrier's appeals process through:

Credit balances and refunds are a result of an overpayment by the ________ or the insurance carrier.

If a denial by a self-funded plan is upheld, the medical office assistant should appeal to the:

If a claim is denied as a noncovered service, the medical office specialist should:

Why is documentation important?

Church and government health benefit plans are NOT regulated by ERISA.

According to ERISA, a plan must pay a claim or respond regarding its status within:

The second level of appeal for a Medicare claim is handled by ________, who process reconsiderations.

Most practices learn about the appeals policies of the insurance carriers they work with by referring to administrative manuals, contracts, and newsletters.

List three situations in which the carrier may ask for rebilling.

Of the following, who may ask the state insurance commissioner for help in resolving a payment dispute?

A stamped provider signature or that of an authorized employee is acceptable on Medicare appeals.

What is the difference between subjective information and objective findings?

Negative adjustments will ________ the balance, whereas positive adjustments will ________ the balance on a patient account.

The government official whose office regulates the insurance industry and who serves as a liaison between patients and carriers, and physicians and carriers, is the state ________.

The second level of Medicare appeals is a request for:

Using the SOAP format, the diagnosis made by the doctor is:

An appeal must be made in writing if:

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

Negative adjustments will the balance, whereas positive adjustments will the balance on a patient account.