Chapter 29 — Quiz
26 questions. Answers and explanations are in the instructor guide.
1. A denial differs from a rejection in that a denial:
- A. Never reached the payer
- B. Is an adjudication decision with appeal rights
- C. Has no reason code
- D. Cannot be corrected
2. A denial work queue fed only by remittances is missing:
- A. Nothing
- B. Rejections, which never generated a remittance line
- C. Appeals
- D. Contractual adjustments
3. How many of the seven denial categories are outside the coder's control?
- A. One
- B. Two
- C. Four
- D. All seven
4. A "duplicate" denial where nothing in your system matches usually means:
- A. A software error
- B. Another practice's claim
- C. A rejection
- D. A contractual adjustment
5. Hard versus soft describes:
- A. Whether the practice could have prevented it
- B. Whether the money can still be obtained
- C. The dollar amount
- D. The payer type
6. The most expensive quadrant is:
- A. Soft and preventable
- B. Soft and not preventable
- C. Hard and preventable
- D. Hard and not preventable
7. A soft denial becomes a hard denial because of:
- A. The dollar amount
- B. Time
- C. The payer
- D. The category
8. Therefore a denial queue should be sorted first by:
- A. Dollar amount, descending
- B. Deadline
- C. Payer
- D. Date of service
9. The root cause differs from the remedy in that the root cause is:
- A. What you did about this claim
- B. What produced the denial
- C. The reason code
- D. The group code
10. A missing-modifier denial has how many plausible root causes?
- A. One
- B. Two
- C. Five
- D. None; it is always the coder
11. (Chapter 20) Of the four reasons a valid code does not pay, how many are arguable?
- A. One
- B. Two
- C. Three
- D. All four
12. (Chapter 21) Of the six edit-triage branches, how many say do not appeal?
- A. One
- B. Two
- C. Three
- D. Five
13. A root-cause list should not contain:
- A. Credentialing
- B. Payer error
- C. A catch-all "other"
- D. Chargemaster
14. A credentialing denial routed to a biller will be:
- A. Resolved quickly
- B. Worked, resubmitted, and denied again indefinitely
- C. Appealed successfully
- D. Written off automatically
15. Twelve denials with the same reason code from the same payer are:
- A. Twelve units of work
- B. One investigation
- C. A duplicate
- D. A rejection
16. A denial with RARC MA130 should be:
- A. Appealed
- B. Closed, categorized, and removed from the queue
- C. Left open pending review
- D. Written off as contractual
17. A corrected professional claim uses item 22 with resubmission code:
- A. 1
- B. 7
- C. 8
- D. blank
18. An institutional void uses a frequency digit of:
- A. 1
- B. 4
- C. 7
- D. 8
19. Submitting a corrected claim when you meant to appeal may:
- A. Speed payment
- B. Forfeit the appeal rights attached to the original determination at some payers
- C. Have no effect
- D. Create a rejection
20. The two fields practices most often omit from a denial log are:
- A. Payer and provider
- B. Root cause and outcome
- C. Charge and allowed
- D. CARC and RARC
21. Denials resolved and denials worked are identical until:
- A. The volume increases
- B. A category is unwinnable
- C. The payer changes
- D. An appeal is filed
22. An averaged overturn rate conceals:
- A. The total dollar value
- B. A category with a zero-percent success rate
- C. The denial rate
- D. The rejection rate
23. Account 10-4471 has one denied line of four on one claim. The denial rate is:
- A. 25% by line and 100% by claim
- B. 25% either way
- C. 100% either way
- D. Not computable
24. In Northgate's month, registration and authorization together account for:
- A. 6.4% of denials
- B. 43% of denials
- C. 69% of denials
- D. 68% of denials
25. The line an edit may not cross is:
- A. Stopping a claim
- B. Answering the question it asks
- C. Checking units against an MUE
- D. Applying a payer's published requirement
26. Account 10-4471's denial is logged as preventable even though the claim was correct because:
- A. The coder made an error
- B. This payer denies this pairing predictably, and a process could have stopped it
- C. The modifier was unsupported
- D. The appeal was lost