Question 1

When rebilling using paper claims, the second submission should be clearly identified as a(n) __________ billing.

Accepted Answer

The answer of When rebilling using paper claims, the second...

Question 2

The second level of Medicare appeals is a request for:
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.

Accepted Answer

review by

Question 3

Using the SOAP format, the patient's chief complaint and reason for the encounter as the patient told it to the doctor are:
A)subjective information.
B)objective information.
C)assessment information.
D)the plan.

Accepted Answer

subjective

Question 4

Under the Employee Retirement Income Security Act (ERISA), a carrier must respond to a claim that has been filed within 120 days.

Accepted Answer

A) True 
 B)False

Question 5

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

Accepted Answer

qualified

Question 6

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 7

Approximately 50% of all claims are overturned on the first or second appeal.

Accepted Answer

A) True 
 B)False

Question 8

The law that protects the interests of beneficiaries enrolled in private employee benefit plans is known as:
A)Title XXI of the Social Security Act.
B)HIPAA.
C)ERISA.
D)FECA.

Accepted Answer

The answer of The law that protects the interests of...

Question 9

The medical office specialist can learn about an insurance carrier's appeals process through:
A)an administrative manual.
B)newsletters from the carrier.
C)phone calls to the carrier.
D)all of the above.

Accepted Answer

The answer of The medical office specialist can learn about...

Question 10

Church and government health benefit plans are NOT regulated by the Employee Retirement Income Security Act (ERISA).

Accepted Answer

A) True 
 B)False

Question 11

When appealing disallowances resulting from low maximum allowable fees, the medical office assistant should include information:
A)from the patient medical record.
B)about payment from other carriers for the reported service.
C)about the physician's financial situation
D)about why the patient cannot afford to pay more.

Accepted Answer

about payment from o

Question 12

An examination and verification of claims and supporting documentation submitted by a physician is known as a(n):
A)appeal.
B)audit.
C)reconsideration.
D)review.

Accepted Answer

The answer of An examination and verification of claims and...

Question 13

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

Accepted Answer

A) True 
 B)False

Question 14

Some insurance carriers perceive automatic rebilling after 30 days to be aggressive and a:
A)requirement.
B)fraudulent practice.
C)sign of error on the part of the physician's office.
D)recommended practice.

Accepted Answer

fraudulent

Question 15

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

Accepted Answer

A) True 
 B)False

Question 16

The number one reason that appeals of Medicare Part B claims are returned is for not:
A)filing within the specified time limit.
B)including a valid signature.
C)including necessary documentation.
D)having patient consent.

Accepted Answer

including

Question 17

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...

Question 18

Using the SOAP format, medication ordered for the patient is:
A)subjective information.
B)objective information.
C)part of the assessment.
D)part of the plan.

Accepted Answer

The answer of Using the SOAP format, medication ordered for...

Question 19

A copy of an appeal letter sent to a carrier should also be sent to the patient.

Accepted Answer

A) True 
 B)False

Question 20

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

Accepted Answer

A) True 
 B)False

When rebilling using paper claims, the second submission should be clearly identified as a(n) __________ billing.

The second level of Medicare appeals is a request for: 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.

Using the SOAP format, the patient's chief complaint and reason for the encounter as the patient told it to the doctor are: A)subjective information. B)objective information. C)assessment information. D)the plan.

Under the Employee Retirement Income Security Act (ERISA), a carrier must respond to a claim that has been filed within 120 days.

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

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

Approximately 50% of all claims are overturned on the first or second appeal.

The law that protects the interests of beneficiaries enrolled in private employee benefit plans is known as: A)Title XXI of the Social Security Act. B)HIPAA. C)ERISA. D)FECA.

The medical office specialist can learn about an insurance carrier's appeals process through: A)an administrative manual. B)newsletters from the carrier. C)phone calls to the carrier. D)all of the above.

Church and government health benefit plans are NOT regulated by the Employee Retirement Income Security Act (ERISA).

An examination and verification of claims and supporting documentation submitted by a physician is known as a(n): A)appeal. B)audit. C)reconsideration. D)review.

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

Some insurance carriers perceive automatic rebilling after 30 days to be aggressive and a: A)requirement. B)fraudulent practice. C)sign of error on the part of the physician's office. D)recommended practice.

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

The number one reason that appeals of Medicare Part B claims are returned is for not: A)filing within the specified time limit. B)including a valid signature. C)including necessary documentation. D)having patient consent.

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

Using the SOAP format, medication ordered for the patient is: A)subjective information. B)objective information. C)part of the assessment. D)part of the plan.

A copy of an appeal letter sent to a carrier should also be sent to the patient.

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

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Understanding Managed Care: Medical Contracts and Ethics

Hipaa: Health Insurance Portability and Accountability Act of 1996

ICD-9-CM Medical Coding

ICD-10-CM Medical Coding

Introduction to Cpt and Place of Service Coding

Coding Procedures and Services

Hcpcs and Coding 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

Electronic Medical Claims Processing

Filters

Exam 17: Refunds and Appeals

When rebilling using paper claims, the second submission should be clearly identified as a(n) __________ billing.

The second level of Medicare appeals is a request for: 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.

Using the SOAP format, the patient's chief complaint and reason for the encounter as the patient told it to the doctor are: A)subjective information. B)objective information. C)assessment information. D)the plan.

Under the Employee Retirement Income Security Act (ERISA), a carrier must respond to a claim that has been filed within 120 days.

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

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

Approximately 50% of all claims are overturned on the first or second appeal.

The law that protects the interests of beneficiaries enrolled in private employee benefit plans is known as: A)Title XXI of the Social Security Act. B)HIPAA. C)ERISA. D)FECA.

The medical office specialist can learn about an insurance carrier's appeals process through: A)an administrative manual. B)newsletters from the carrier. C)phone calls to the carrier. D)all of the above.

Church and government health benefit plans are NOT regulated by the Employee Retirement Income Security Act (ERISA).

An examination and verification of claims and supporting documentation submitted by a physician is known as a(n): A)appeal. B)audit. C)reconsideration. D)review.

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

Some insurance carriers perceive automatic rebilling after 30 days to be aggressive and a: A)requirement. B)fraudulent practice. C)sign of error on the part of the physician's office. D)recommended practice.

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

The number one reason that appeals of Medicare Part B claims are returned is for not: A)filing within the specified time limit. B)including a valid signature. C)including necessary documentation. D)having patient consent.

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

Using the SOAP format, medication ordered for the patient is: A)subjective information. B)objective information. C)part of the assessment. D)part of the plan.

A copy of an appeal letter sent to a carrier should also be sent to the patient.

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

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Understanding Managed Care: Medical Contracts and Ethics

Hipaa: Health Insurance Portability and Accountability Act of 1996

ICD-9-CM Medical Coding

ICD-10-CM Medical Coding

Introduction to Cpt and Place of Service Coding

Coding Procedures and Services

Hcpcs and Coding 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

Electronic Medical Claims Processing

Filters