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Coding Test
Everything you need to study for the Coding Test
Question | Answer |
---|---|
The amount that an insured person must pay for each office visit is called the copayment. | TRUE |
PPO is the abbreviation for plan/provider options. | FALSE |
A primary care physician is also referred to as a gatekeeper. | TRUE |
Adjudication is the process that third-party payers follow to determine payments for claims. | TRUE |
Diagnosis codes are used to record the patient's services and treatments on encounter forms. | FALSE |
EOB is the abbreviation for explanation of benefits. | TRUE |
Medically necessary treatments are appropriate and provided in accordance with generally accepted standards of medical practice. | TRUE |
New patients have not received any services from the provider, or another provider of the same specialty in the same practice,within the past three years. | TRUE |
The patient ledger is a record of all the charges and payments on a particular patient's account. | TRUE |
COB is the abbreviation for calculation of benefits. | FALSE |
A walkout receipt is given to patients who have made a payment after an encounter. | TRUE |
ERA is the abbreviation for electronic remittance advice. | TRUE |
In legal terms,abusive actions improperly use other/s resources. | TRUE |
Billing Medicare for the unnecessary use of a laboratory procedure is an example of abuse of government resources. | TRUE |
Facts that are privileged information must be kept confidential. | TRUE |
An implied contract has the same legality as a written contract. | TRUE |
Fraud is deception with intent to benefit from the fraudulent behavior. | TRUE |
Original documents from the patient medical record are not released. | TRUE |
Fax machines provide fast,efficient,and secure transmission of documents. | FALSE |
The annual addenda to the ICD-9-CM list new,revised,and deleted diagnostic codes. | TRUE |
In the ICD-9-CM,NEC is the abbreviation for not elsewhere classified. | TRUE |
Diagnosis codes must be selected by physicians. | FALSE |
If the physician's diagnostic statement for an encounter states "rule out suspected aortic neoplasm," a code for the carcinoma is used to report the condition. | FALSE |
When a patient has a closed fracture,the broken bone has broken through the skin and created an external wound. | FALSE |
All of the patient's conditions,including diseases or illnesses no longer active or present,must be considered in selecting the correct diagnosis code for an encounter. | FALSE |
In CPT-4 the term "consultation" describes services that a provider performs at the request of another provider after which the patient is returned to the requesting provider's care. | TRUE |
In CPT-4,evaluation and management codes cover anesthesia and most surgical procedures. | FALSE |
Fragmented billing refers to the incorrect seperate reporting of CPT-4 procedure codes that should be bundled under a single code. | TRUE |
HCPCS is the abbreviation for Health Care Financing Administration Common Procedure Coding System. | FALSE |
In the CPT-4 code 01320-P3 the "P3" is an example of a physical status modifier. | TRUE |
If a procedure that is designated a seperate procedure in CPT-4 is performed for a different purpose than ususally done it may be reported. | TRUE |
CPT-4's section guidelines appear at the end of each section. | FALSE |
CPT-4 codes have four digits | FALSE |
CPT-4 codes for initial hospital care can be reported for every 24 hours that a patient is hospitalized. | FALSE |
When a physician treats complications or recurrences that arise after surgery,these services are reported separately. | TRUE |
The term "code linkage" refers to the connection between a service that is provided and the patient's condition or illness. | TRUE |
The term "external audit" may refer to an audit conducted by a consultant that the medical practice has hired. | TRUE |
The Medicare Carriers Manual contains the code edits used by the Medicare program to screen reported procedure codes. | FALSE |
Retrospective audits are conducted by HCFA. | FALSE |
A provider who is found guilty of fraud and abuse against the Medicare program can be excluded from further participation as a provider in all government-sponsored health care programs. | TRUE |
In the United States,rising medical costs are due to: a:increased spending on drugs b:increased use of alternative treatments c:advances in technology d:all of the above | D: All of the above |
A capitated rate is called a: a:copayment b:coinsurance payment c:retroactive payment d:prospective payment | D: Prospective payment |
Under a capitated rate for each plan member, which of the following does a provider share with the third-party payer? a:payments b:risk c:services d:the premium | B: Risk |
Patients who enroll in an HMO may use the services of: a:only HMO network providers b:any affiliated provider c:only out-of-network providers d: any provider | A: only HMO network providers |
Patients who enroll in a point-of-service type of HMO may use the services of a:only HMO network providers b:any affiliated provider c:any provider d:HMO network or out-of-network providers | D: HMO network or out-of-network providers |
The four models of health maintenance organizations are: a: staff,group,IPA,and POS b:staff,group,IPA,and PPO c:staff,group,IPA, and PCP d: staff,group,network, and IPA | A: staff,group,IPA,and POS |
Which of the following charachteristics is most important when medical insurance specialists work with patients' records and handle finances? a:able to work as a team member b:honesty and integrity c:knowledge of medical terms d:communication skills | B: honesty and integrity |
When medical insurance specialists work with patient billing programs,they need a:computer skills b:communication skills c:knowledge of anatomy d:flexibility | A: computer skills |
The title of Certified Coding Specialist (CCS) and Certified Coding Specialist-Physician-based (CCS-P) is awarded by a:AAMA b:AAPC c:AMT d:AHIMA's Society for Clinical Coding | D: AHIMA's Society for Clinical Coding |
The statement that "coding professionals should not change codes,so that meanings are misinterpreted" is an example of: a:professional ethics b:professional services c:professional etiquette d:personal ethics | A: professional ethics |
The employment forecast for well-trained medical insurance and coding specialists is: a:decreasing opportunities b:opportunities staying the same as today c:increasing opportunities d:none of the above | C: increasing opportunities |
Which of the following is the correct order for documentation? a:diagnosis,treatment,history and exam,and CC b:treatment,CC,history and exam,and diagnosis c:history and exam,diagnosis,CC and treatment d:CC,history and exam,diagnosis,and treatment | D: CC,history and exam,diagnosis,and treatment |
Which of the following represents the correct format for recording dates on patient information and claim forms? a:DD/MM/YY b:MM/DD/CCYY c:MM/DD/YY d: CCYY/MM/DD | C:MM/DD/YY |
In which of the following claims-processing steps is the payer's decision about paying claims made? a:provider reimbursement calculations b:claims transmission c:claims preparation d:adjudication | D: adjudication |
Libel refers to which type of information? a:written b:oral c:confidential d:none of the above | A: written |
A court order to appear,testify,and bring specified documents or items is a: a:respondeat superior b:subpoena duces tecum c:subpoena d:none of the above | B: subpoena duces tecum |
Information about a patient must be kept confidential because: a:it is the physician's duty to do so b:the information is potentially harmful to the patient c: both a and b d:neither a nor b | C: both a and b |
The cross-reference See in the ICD-9-CM means that the coder: a:may look up a related term(s) that follows b:must refer to the term that follows c:either a or b d: neither a or b | B: must refer to the term that follows |
The term Blackfan-Diamond anemia is an example of a(n) a:etiology b:acute condition c:eponym d:combination code | C: eponym |
How many codes does the entry Cataract,myotonic 359.2[366.43] in the ICD-9-CM's Alphabetic index require? a: one code b:two codes c:three codes d:four codes | B: two codes |
A condition that arises because of an injury or illness in the patient's medical history is called a(n) a:adverse effect b:manifestation c:comorbidity d:late effect | D: Late effect |
An adverse effect is the result of: a:intentional poisoning b:unintentional poisoning c:traffic accident d: signs and symptoms | B: unintentional poisoning |
What is the main term in the diagnostic statement"localized salmonella infection,unspecified"? a:localized b:salmonella c:infection d:unspecified | B:Salmonella |
The diagnostic statement is"patient has found a mass in the upper quadrant of the left breast;carcinoma is suspected and an immediate workup is scheduled" What main term is coded? a:mass b:carcinoma | A: Mass |
In the diagnostic statement"tuberculous rheumatism" which is the main term? a: tuberculous b:rheumatism c: either a or b | C: either a or b |
In CPT-4,what procedure is bundled with the arthroscopy in the following entry? 29860 Arthroscopy,hip,diagnostic with or without synovial biopsy a: a diagnosis b:the hip site c:a synovial biopsy d: none of the above | C: a synovial biopsy |
Durable medical equipment (DME) such as wheelchairs covered by the Medicare program are reported using a:ICD-9-CM codes b: CPT-4 codes c: HCPCS codes d:local Medicare carrier codes | C: HCPCS codes |
Under CPT-4's definition,after a referral,who takes responsibility for the patient's care? a: the physician who referred the patient b:the physician to whom the patient is referred c:either a or b d: neither a nor b | B: the physician to whom the patient is referred |
Routine annual physical examinations are reported using CPT-4's a:Office Services codes b: Preventive Medicine Service codes c:Critical Care Service Codes d: Consultation codes | B:Preventative Medicine Service Codes |
What is required of the physician in order to report the professional component of a CPT-4 code from the Radiology section? a:reading the radiological examination b:writing a report of interpretation c: both a and b d: neither a or b | C: both a and b |
If a payer judges that too high a code level has been assigned by a practice for a reported service,the payer may a: reduce the fee attached to the reported code b:downcode the reported procedure code c:either a or b d: neither a nor b | B: downcode the reported procedure code |
What type of audit is performed internally before claims are reported? a:accreditation audit b:routine payer audit c:retrospective audit d:prospective audit | D: prospective audit |
What document is received before a retrospective audit of a claim is performed? a:NCQA guidelines b: explanation of benefits from the payer c:Medicare Carriers Manual d:Medicare CCI | B: Explanation of benefits from the payer |
Which member of the medical practice is ultimately responsible for proper documentation and correct coding? a:registered nurse b:medical coder c:physician d: all of the above | C: physician |
Some possible consequences of inaccurate coding and incorrect billing in a medical practice are: a:denied claims and reduced payments b:prison sentences c:fines d:all of the above | D: all of the above |
A provider billing the Medicare program for a cosmetic procedure intended to enhance the patient's appearance is a possible situation of a: downcoding b:upcoding c:prospective billing d: lack of medical necessity | A: downcoding |
Which is not a characteristic of correctly linked codes? a: the procedure codes match the diagnosis codes b:the procedure codes have correct modifiers c: the procedures are not elective,experimental d: the procedures are provided at an approp. level | B: the procedure codes have correct modifiers |
An important part of a compliance plan is commitment to keep both physicians and medical office staff current by providing a: external audits b:ongoing training c:OIG Fraud Advisories d: practice work plans | B: ongoing training |
A medical practice's signature log shows the legal name,credentials,and signature of each person who a: is employed by the practice b:makes entries in patient medical records c:handles the patient billing system d: communicates with third-party payers | B: makes entries in patient medical records |
The statement,"All entries in the medical record must contain the author's identification" is from the NCQA's a:Compliance Plan b:Work Plan c:Documentation Guidelines d:Overpayment Policy | C: Documentation Guidelines |
A policyholder's _________ include the spouse and children. | Dependents |
Capitation is a fixed prepayment to a provider for all necessary, _______________ medical services. | Contracted |
Under indemnity plans,the ________ is the amount that the insured must pay before benefits begin. | Deductible |
Verifying patient information in large medical practices is a task performed by ____________. | Medical Insurance Specialist |
Entries in a patient's medical record should be _________ or ________ by the responsible provider. | Signed or Initialed |
____________ contain all facts,findings,and observations about patient's health history. | Medical Records |
SOAP is a format for patient medical _____________. | Documentation |
Entries in patient medical documentation may be filed in either ascending or descending ____________ order. | Chronological |
Which parent's insurance plan is primary for a child is decided by following the______________. | Birthday Rule |
The universal claim form is the _______________. | CMS 1500 |
__________________ means using the care and expertise that under the circumstances could be reasonably expected of a medical professional with similar experience and training. | Medical Standards of Care |
The OIG, or ____________________, is responsible for enforcing laws relating to medical insurance fraud and abuse. | Office of Inspector General |
A physician's description of the main reason for a patient's encounter is called the diagnostic ________________. | Statement |
When diagnosis codes are reported, the code for the _______________ diagnosis is listed first,followed by the current coexisting conditions. | Primary |
In the CPT-4 entry 29909 Unlisted procedure,arthroscopy the words "Unlisted procedure,arthroscopy" are referred to as the ____________. | Descriptor |
In CPT-4,some codes have both a technical component and a _____________ component that represents the physician's skill,time, and expertise. | Professional |
Codes in the Anesthesia section of the CPT-4 are reimbursed according to ______________. | Time |
A complete procedure for codes in the Pathology and Laboratory section of CPT-4 includes performing the test and analyzing and _______________ on the test results. | Reporting |
The Medicare Correct Coding Inititive lists procedures that cannot be billed together for the same __________ on the same ____________. | Patient/ Day |
In addition to facilitating high quality patient care,an appropriately ______________ medical record serves as a legal document to verify services provided. | Documented |