Question 1

If a patient presents with an acute or chronic illness that poses a threat to life or body function and requires emergency surgery, the level of risk involved with the medical decision making would be considered:
A)minimal.
B)low.
C)moderate.
D)high.

Accepted Answer

Emergency surgery for a life-threatening illness or injury involves high-risk medical decision making, as the potential consequences of the decision are significant and can have a lasting impact on the patient's health and well-being. Urgent action is needed to minimize the risk of harm to the patient and ensure the best possible outcome.

Question 2

An audit done within a medical practice to make sure it is compliant is an external audit.

Accepted Answer

An audit done within a medical practice to make sure it is compliant is an internal audit. An external audit is when an external auditor, who is not part of the organization, is appointed to assess the financial records and compliance of the organization.

Question 3

If the level of risk of mortality is very high, the medical decision making would be considered:
A)minimal.
B)low.
C)moderate.
D)high.

Accepted Answer

When the level of risk of mortality is very high, the medical decision making would be considered high as the stakes are high, and the decisions made can significantly impact the patient's survival.

Question 4

A medical office specialist can find clinical examples for documenting medical necessity in the:
A)CPT Index.
B)CPT Appendix A.
C)CPT Appendix C.
D)CPT Guidelines.

Accepted Answer

CPT Appendix C provides clinical examples that are helpful for documenting medical necessity.

Question 5

An internal audit will NOT be able to help a practice discover lost revenue.

Accepted Answer

An internal audit can help a practice identify areas of lost revenue, such as coding errors, inefficient billing practices, or undercharging for services.

Question 6

All third-party payers follow the same rules and policies for submitting a clean claim.

Accepted Answer

While many third-party payers may have similar rules and policies, they are not necessarily all the same. It is important to carefully review the specific guidelines and requirements for each payer in order to submit a clean claim.

Question 7

An example of an evaluation and management (E/M) code that requires three key components documented and a comprehensive history and comprehensive exam is:
A)a new patient office visit.
B)an established patient office visit.
C)critical care services.
D)subsequent in-hospital care.

Accepted Answer

The answer of An example of an evaluation and management...

Question 8

Clearinghouses charge providers based on which type of payment system?
A)A percentage of each claim's dollar value
B)A flat fee per claim
C)Per diem
D)Per membership per month

Accepted Answer

The answer of Clearinghouses charge providers based on which type...

Question 9

Medicare can deny or downcode an evaluation and management (E/M) service if it feels that the service provided exceeds the patient's documented needs.

Accepted Answer

Medicare has guidelines and criteria for E/M services, and if a provider documents more than what is necessary for the patient's condition or history, Medicare may deny or downcode the service. This is why it is important for providers to accurately document the level of service provided.

Question 10

If a medical office specialist does NOT agree with the payment determination made by an insurance company, the decision can be appealed.

Accepted Answer

A medical office specialist can appeal the payment determination made by an insurance company if they do not agree with it. This process is also known as a claims appeal.

Question 11

A prospective audit would typically be done on claims that require an attachment or more information.

Accepted Answer

A prospective audit is done before payment is made on a claim, usually for claims that require additional information or attachments. This helps to ensure that the claim is complete and accurate before processing the payment.

Question 12

If a medical office assistant is NOT sure about which evaluation and management (E/M) code to use, he or she should:
A)not code the procedure.
B)use the lowest possible code level.
C)use an intermediate level code for the service.
D)ask for help.

Accepted Answer

The answer of If a medical office assistant is NOT...

Question 13

A retrospective audit is conducted before sending claims to an insurance company.

Accepted Answer

A retrospective audit is conducted after claims have been submitted to an insurance company to ensure accuracy and compliance with policies and regulations.

Question 14

An audit tool utilizes number counts in different categories to determine if the correct evaluation and management (E/M) code was used in billing an insurance carrier.

Accepted Answer

An audit tool that utilizes number counts in different categories, such as history, examination, and medical decision making, can assist in determining whether the correct E/M code was used in billing an insurance carrier.

Question 15

The risk of significant complication, morbidity, and/or mortality is based on the risks of:
A)the presenting problems.
B)the diagnostic procedures.
C)the possible management options.
D)all of the above.

Accepted Answer

The risk of significant complication, morbidity, and/or mortality is based on all three factors: the presenting problems, the diagnostic procedures, and the possible management options. It is important for healthcare providers to carefully consider all these factors in order to minimize risk and provide the best possible care for their patients.

Question 16

Physician services that are more intense than the work of other evaluation and management (E/M) services and that involve frequent personal assessment by the physician would be coded as:
A)consultation.
B)critical care.
C)subsequent care.
D)initial hospital care.

Accepted Answer

The answer of Physician services that are more intense than...

Question 17

To consider time as the key factor in determining the level of evaluation and management (E/M) services, the counseling and/or coordination of care must make up:
A)10% of the encounter.
B)25% of the encounter.
C)50% of the encounter.
D)75% of the encounter.

Accepted Answer

The answer of To consider time as the key factor...

Question 18

If a physician who ordered a test personally reviews the results to supplement information from the physician who prepared the test report, the work would add to the level of the:
A)number of diagnoses or management options.
B)amount and/or complexity of data to be reviewed.
C)risk of significant complications, morbidity, and/or mortality.
D)all of the above.

Accepted Answer

When a physician personally reviews the results of a test, it adds to the amount and/or complexity of data to be reviewed, which would increase the level of work. It may also contribute to the number of diagnoses or management options, but this is not always the case. The risk of significant complications, morbidity, and/or mortality is not directly affected by personally reviewing test results.

Question 19

If a patient presents with one self-limited or minor problem, the level of risk involved with the medical decision making would be considered:
A)minimal.
B)low.
C)moderate.
D)high.

Accepted Answer

In medical decision making, the level of risk involved is based on the severity of the problem and the potential for harm. One self-limited or minor problem presents minimal risk and therefore the medical decision making involved would also be considered minimal.

Question 20

If a CPT code stated on a claim form represents a lower level of service than is documented in the medical record, the procedure has been downcoded.

Accepted Answer

Downcoding occurs when a procedure is billed at a lower level than what was actually provided or documented in the medical record.

Quiz 10: Auditing

If a patient presents with an acute or chronic illness that poses a threat to life or body function and requires emergency surgery, the level of risk involved with the medical decision making would be considered: A)minimal. B)low. C)moderate. D)high.

An audit done within a medical practice to make sure it is compliant is an external audit.

If the level of risk of mortality is very high, the medical decision making would be considered: A)minimal. B)low. C)moderate. D)high.

A medical office specialist can find clinical examples for documenting medical necessity in the: A)CPT Index. B)CPT Appendix A. C)CPT Appendix C. D)CPT Guidelines.

An internal audit will NOT be able to help a practice discover lost revenue.

All third-party payers follow the same rules and policies for submitting a clean claim.

An example of an evaluation and management (E/M) code that requires three key components documented and a comprehensive history and comprehensive exam is: A)a new patient office visit. B)an established patient office visit. C)critical care services. D)subsequent in-hospital care.

Clearinghouses charge providers based on which type of payment system? A)A percentage of each claim's dollar value B)A flat fee per claim C)Per diem D)Per membership per month

Medicare can deny or downcode an evaluation and management (E/M) service if it feels that the service provided exceeds the patient's documented needs.

If a medical office specialist does NOT agree with the payment determination made by an insurance company, the decision can be appealed.

A prospective audit would typically be done on claims that require an attachment or more information.

If a medical office assistant is NOT sure about which evaluation and management (E/M) code to use, he or she should: A)not code the procedure. B)use the lowest possible code level. C)use an intermediate level code for the service. D)ask for help.

A retrospective audit is conducted before sending claims to an insurance company.

An audit tool utilizes number counts in different categories to determine if the correct evaluation and management (E/M) code was used in billing an insurance carrier.

The risk of significant complication, morbidity, and/or mortality is based on the risks of: A)the presenting problems. B)the diagnostic procedures. C)the possible management options. D)all of the above.

Physician services that are more intense than the work of other evaluation and management (E/M) services and that involve frequent personal assessment by the physician would be coded as: A)consultation. B)critical care. C)subsequent care. D)initial hospital care.

To consider time as the key factor in determining the level of evaluation and management (E/M) services, the counseling and/or coordination of care must make up: A)10% of the encounter. B)25% of the encounter. C)50% of the encounter. D)75% of the encounter.

If a patient presents with one self-limited or minor problem, the level of risk involved with the medical decision making would be considered: A)minimal. B)low. C)moderate. D)high.

If a CPT code stated on a claim form represents a lower level of service than is documented in the medical record, the procedure has been downcoded.