H08V EXAM 7 ANSWERS - ASHWORTH

H08V EXAM 7 ANSWERS - ASHWORTH

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H08V Medical Coding II Exam 7 Answers (Ashworth)
Question 21

2.5 / 2.5 points
Submitting additional information to an insurance company after a denial is called a(n)
Question options:
a) 
appeal.

b) 
peer review.

c) 
SOAP.

d) 
QIC.

Question 22

2.5 / 2.5 points
Which one of the following choices isn’t a guarantee of payment and pertains only to medical necessity?
Question options:
a) 
Overpayment

b) 
Wrongful retention

c) 
Copayment

d) 
Preauthorization

Question 23

2.5 / 2.5 points
A patient has both primary and secondary insurance. Due to an office error, both insurances paid as primary. What should happen now?
Question options:
a) 
An appeal process should be started.

b) 
The patient should be notified.

c) 
The money should be refunded.

d) 
The patient should be billed.

Question 24

0 / 2.5 points
To issue a refund, the medical office specialist will access which screen of the patient’s online account record first?
Question options:
a) 
VOB

b) 
EOB

c) 
Transaction

d) 
Overpayments

Question 25

0 / 2.5 points
Which one of the following choices is considered the last level of the Medicare claim appeals process?
Question options:
a) 
Adjudication

b) 
Reconsideration

c) 
Redetermination

d) 
ALJ hearings

Question 26

2.5 / 2.5 points
Which one of the following choices serves as a liaison between the physician and the carrier as well as between the patient and the carrier?
Question options:
a) 
QIC

b) 
ALJ

c) 
Insurance commissioner

d) 
Peer reviewer

Question 27

2.5 / 2.5 points
What is probably the main reason that appeals aren’t completed properly or consistently?
Question options:
a) 
Claims are difficult to understand.

b) 
The appeals process is so time-consuming.

c) 
Many medical office specialists are improperly trained on appeals.

d) 
The proper documentation isn’t provided.

Question 28

2.5 / 2.5 points
The 120 days to file for a Medicare appeals review is known as
Question options:
a) 
peer review.

b) 
redetermination.

c) 
administrative review.

d) 
QIC.

Question 29

2.5 / 2.5 points
Patient Brown made a prepayment for service of $150 and is owed a refund of $87. You review the patient’s account and realize that the patient has an outstanding bill for $42. How much should the patient be refunded?
Question options:
a) 
$150

b) 
$87

c) 
$42

d) 
$45

Question 30

2.5 / 2.5 points
Which one of the following choices is a reason that an overpayment could occur?
Question options:
a) 
A diagnosis code was entered and billed twice.

b) 
An insurance company paid a claim that was already paid.

c) 
Preauthorization wasn’t obtained.

d) 
The physician provided services before the patient’s insurance went into effect.

Question 31

0 / 2.5 points
According to the law, Medicare carriers must process which one of the following choices within 30 days?
Question options:
a) 
Redetermination

b) 
Claims

c) 
ERAs

d) 
Rebilling

Question 32

2.5 / 2.5 points
Which one of the following choices refers to an overpayment that’s wrongfully kept by the healthcare provider?
Question options:
a) 
Disallowance

b) 
Conversion

c) 
Denial

d) 
Redetermination

Question 33

2.5 / 2.5 points
Partial payments made on claims because the claim is above the maximum allowable fee is known as a(n)
Question options:
a) 
denial.

b) 
redetermination.

c) 
disallowance.

d) 
rejection.

Question 34

2.5 / 2.5 points
A physician’s office has just received notification that an appealed claim received a “denial upheld” status. The physician’s office still believes that the claim is correct. What could the physician’s office do next?
Question options:
a) 
Retain legal counsel to handle the case.

b) 
Bill the patient.

c) 
Overturn the claim.

d) 
Issue a refund.

Question 35

0 / 2.5 points
What is the danger if a physician’s office doesn’t immediately process an insurance company’s request for refund for overpayment?
Question options:
a) 
The insurance company may bill the patient.

b) 
The insurance company may take the money out of other payments owed to the physician’s office.

c) 
The physician’s office loses the right to appeal the refund request.

d) 
The physician’s office may be unable to apply deductibles to future services for that patient.

Question 36

2.5 / 2.5 points
For an ERISA claim, within what timeframe must the insurance company respond regarding whether or not the claim will be paid or if more information is needed?
Question options:
a) 
30 days

b) 
60 days

c) 
90 days

d) 
120 days

Question 37

2.5 / 2.5 points
A physician’s office believes that an appeal denial involves a breach in claims processing procedures. What should the office probably do next?
Question options:
a) 
Ask the insurance carrier president to respond.

b) 
File a complaint with the Department of Labor.

c) 
Request an ALJ hearing.

d) 
Resubmit the claim.

Question 38

0 / 2.5 points
When appealing denied insurance claims, who has the burden to prove that the claim was processed correctly?
Question options:
a) 
Patient

b) 
Physician office

c) 
Insurance company

d) 
ALJ

Question 39

2.5 / 2.5 points
When there’s no contract language that covers refunds, how long does a patient have to request a refund for nongovernmental insurance?
Question options:
a) 
30 days

b) 
90 days

c) 
1 year

d) 
4 years

Question 40

2.5 / 2.5 points
Which one of the following choices is the most widely used patient record documentation format for physicians?
Question options:
a) 
ALJ

b) 
QIC

c) 
SOAP

d) 
ERISA



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