HCA 135 Final Exam

Question 1

A medical practice may choose to ____________ a rejected or partially paid claim.

Answer 1

either appeal or submit

Question 2

A payer may _________ a procedure which was not medically necessary at the level reported.

Answer 2

downcode

Question 3

True or False: An aging report groups unpaid claims/bills according to the length of time that they remain due.

Answer 3

True

Question 4

An insurance aging report lists:

Answer 4

unpaid claims

Question 5

Assignment of benefits authorizes:

Answer 5

the physician to file claims for a patient and receive direct payments from the payer

Question 6

CPT Level I modifiers are made up of how many digits?

Answer 6

2

Question 7

Claims that can be processed for adjudication by payers are called?

Answer 7

clean claims

Question 8

Collections from patients are classified as consumer collections and are regulated by state and ______ laws.

Answer 8

federal

Question 9

Durable medical equipment (DME), such as wheelchairs, is reported using:

Answer 9

HCPCS codes

Question 10

HCPCS Level II codes begin with:

Answer 10

an alphabetic character

Question 11

HCPCS Level II codes have:

Answer 11

5 characters

Question 12

How many CPT codes are required to report an immunization?

Answer 12

2

Question 13

How many steps are there in the Medicare appeal process?

Answer 13

5 steps

Question 14

How would a payer respond to a claim that does not contain at least one diagnosis code?

Answer 14

the payer will deny the claim

Question 15

If a claim is submitted with outdated procedure codes, payers will:

Answer 15

payers may deny a claim when outdated procedure codes are used

Question 16

If a patient has coverage under two insurance plans, the primary plan is the one that:

Answer 16

that has been in effect for the patient the longest

Question 17

If a payer determines that a code level assigned by a practice is too high for a reported service, the usual action is

Answer 17

downcode the reported procedure code

Question 18

If a retired patient has a Medicare plan and also has coverage under a working spouse’s plan, the primary plan is:

Answer 18

the spouse’s plan

Question 19

In CPT, a bullet (a solid circle) next to a code indicates:

Answer 19

a new code

Question 20

In CPT, a plus sign (+) next to a code indicates:

Answer 20

add on code

Question 21

In cycle billing, how often does the practice mail all patient statements?

Answer 21

at intervals during the month

Question 22

In what format can claim attachments be sent?

Answer 22

electronic and paper format

Question 23

Main term in the Alphabetic Index is:

Answer 23

the word that identifies a disease and appears in boldface

Question 24

Only the codes that ___________ should be reported.

Answer 24

are the ones supported by documentation

Question 25

The last step in the coding process is:

Answer 25

Determine the need for modifiers

Question 26

This process is used to locate a patient who owes an account balance to the practice:

Answer 26

skip tracing

Question 27

UCR is the abbreviation for:

Answer 27

usual, customary, and reasonable

Question 28

What are the consequences of inaccurate coding and incorrect billing?

Answer 28

denied claims and reduced payments, fines, prison sentences

Question 29

What does a provider complete during/after a patient’s visit to summarize their billing information?

Answer 29

encounter form

Question 30

What is NOT covered by workers’ compensation insurance?

Answer 30

injuries of self-employed individuals

Question 31

What is another term for prior authorization?

Answer 31

certification

Question 32

What is sent as additional data to support a claim?

Answer 32

attachments

Question 33

What is the most common method of claim transmission?

Answer 33

clearinghouse use

Question 34

What process is used to generate the amount a patient owes?

Answer 34

real-time adjudication

Question 35

What provision explains how insurance policies will pay if more than one policy applies?

Answer 35

coordination of benefits

Question 36

What type of coding uses a procedure code that provides a higher reimbursement rate than the correct code?

Answer 36

upcoding

Question 37

True or False: Disability compensation provides reimbursement for lost income for a disability, preventing the pt from working

Answer 37

True

Question 38

what will happen to a claim if the most specific code available is not used?

Answer 38

claim will be rejected

Question 39

Which modifier is used to show multiple modifiers?

Answer 39

99

Question 40

True or False: FDCPA and TCPA are responsible for regulating the hours during which collection calls may be made?

Answer 40

True

Question 41

Who may file the first report of injury?

Answer 41

employer or physician

Question 42

True or False: increased use of information technology as mandated by CMS and HIPAA makes sending paper less common.

Answer 42

True

Question 43

_____________ refers to a coding problem in which the age of the patient and the selected code do not match:

Answer 43

incorrect coding