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AHL 110 Final Exam

QuestionAnswer
What is "cash flow" in a medical practice? The actual money available to a medical practice.
What level of education is generally required for one who seeks employment as an insurance coder? Completion of an accredited program for coding certification.
Medical etiquette refers to: Consideration for others.
Medical ethics refers to: Standards of conduct.
The earliest written code of ethical principles for the medical profession is the: Code of Hammurabi.
Confidential information includes: Everything that is heard, read or seen regarding the patient.
What is the correct response when a relative calls asking about a patient? Ask the relative to put the request in writing and include the patient's signed authorization.
Nonprivileged information about a patient consists of the patient's: City of residence.
Exceptions to the right of privacy rule include: Gunshot wound cases.
Confidentiality is automatically waived in cases of: Gunshot wounds, child abuse, and extremely contagious diseases.
Most physician/patient contracts are: Implied.
When a patient carries private medical insurance, the contract for treatment exists between: The physician and the patient.
An emancipated minor is: A person younger than the age of 18 who lives independently.
The reason for a coordination of benefits statement in a health insurance policy is: To prevent duplication or overlapping of payments for the same medical expense.
Conditions that existed and were treated before the health insurance policy was issued are called: Pre-existing.
The SOAP in a patient medical record charting is defined as: S-subjective, O-objective, A-assessment, P-plan.
An established patient is one who: Has previously received professional services from a physician or another physician of the same specialty who belongs to the group practice within the past 3 years.
Parts of the small and large intestines, right ovary, right uterine tube, appendix, and right ureter are found in the: Right lower quadrant.
When is exclusion from program participation mandatory? Once an individual has been found guilty of committing a Medicare or Medicaid program-related crime.
All of the following cases should NOT use fax transmission: Transmission of documents relating to information on sexually transmitted diseases, any routine transmission of patient information, or transmission of documents relating to alcohol treatment.
What level of education is generally required for entry into an insurance billing or coding specialist accredited program? High school diploma or GED.
To ensure continuous cash flow, what is an ideal amount of time in which an insurance claim should be submitted? 48-72 hours.
What does the abbreviation MSHP designate? Multiskilled health practioner.
A physician's legal responsibility for his/her own actions as well as his/her employees' is called? Vicarious liability or respondeat superior.
Administrative medical office responsibilities include: Claims submission.
In 1980, the American Medical Association (AMA) adopted a modern code of ethics called: The Principles of Medical Ethics.
Medical ____________ are not laws, but generally accepted standards of conduct. Ethics.
One of the eight C's of effective caller service is Contagious. This means to: Model the behavior you want from your callers.
Compliance is the process of: Meeting regulations, recommendations and federal and state expectations.
Tracnsactions in which health care information is accessed, processed, stored, and transferred using electronic trechnologies are known as: E-health Information Management (eHIM).
An intentional misrepresentation of the facts to deceive or mislead another is called: Fraud.
What is the primary purpose of HIPAA Title I: Insurance Reform? To provide continuous insurance coverage for workers and their insured dependents when they change or lose jobs.
A third-party administrator who receives insurance claims from the physicians, performs, edits, and transmits claims to insurance carriers is known as a/an: Clearinghouse.
If a physician contracts with an outside billing company to manage claims and accounts receivable under HIPAA guidelines, the billing company is considered: A business associate.
A confidential communication realated to the patient's treatment and progress that may be disclosed only with the patient's permission is known as: Priviledged communication.
The Office of Civil Rights enforces: Privacy standards.
If you give, release, or transfer information to another entity, this is known as: Disclosure.
Telephone conversations by providers in front of other patients should be: Avoided.
What type of organization provides a wide range of comprehensive healthcare services for a specified group at a fixed periodic payment with an emphasis on preventive care? HMO.
Why was diagnostic coding developed? For medical research, evaluation of hospital use, and for the process of tracking diseases.
What must be paid each year by the policy holder before the insurance policy benefits begin? Deductible.
What is the consequence when a medical practice does not use diagnostic codes? It affects the physician's level of reimbursement for inpatient claims, claims can be denied, and fines or penalties can be levied.
A charge slip, fee ticket, and superbill are also known as: An encounter form.
The_______ is a concise statement describing the symptom, problem, condition, diagnosis, physician-recommended return, or other factor that is the reason for the encounter. A chief complaint.
The ICD-9-CM is updated______ and has _______ volume(s). Annually, 3.
The underlying disease is always coded: First.
The main reason for a patient encounter in a doctor's office or outpatient facility is termed the: Primary diagnosis.
The largest section in the CPT book is the: Surgery section.
Most states generally set a minimum time required for retention of medical records of: 7-10 years.
The key to substantiating procedure and diagnostic code selections for proper reimbursement is: Supporting documentation in the health record.
The chronologic recording of pertinent facts and observations about the patient's health is known as: Charting.
Reasons for documentation are: Defense of a professional liability claim and because insurance carriers require accurate documentation that supports procedure and diagnostic codes.
When a patient fails to return for needed treatment, documentation should be made: In the patient's medical record, in the appoitment book and on the financial record or ledger card.
How should an entry in a patient's medical record be corrected? Cross out the incorrect entry, substitute the correct information, date and the initial the entry.
A diseased condition or state is known as: Morbidity.
What does comorbidity mean? Underlying diseases or other conditions present at the time of visit.
A new patient is one who: Has not received any professional servies from the physician within the past 3 years.
Who may accept a subpoena? The prospective witness and another authorized person.
If it was documented, it was not ________ Done.
Diagnoses that relate to a patient's previous medical problem that have no bearing on the patient's present condition should be _______ when coding. Excluded.
A(n) ________ is a pathalogic reaction to a drugthat occurs when appropriate doses are given to humans for prophylaxis, diagnosis, and therapy. Adverse affect.
The main code book used for reporting clinical information is called the: International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM)
What type of code may be used when two diagnoses or a diagnosis with a secondary process is present? Combination code.
An E code may be used in which of these circumstances: Poisoning.
When is the principal diagnosis applicable? Inpatient hospital coding.
The volume(s) of the ICD-9-CM used in the physician's office to code diagnoses is/are: Volumes 1 and 2.
What is the table that contains a classification of substances for identifying poisoning states and external causes of adverse effects? Tabled of drugs and chemicals.
Carcinoma in situ is used to describe: Cancer that is confined to the site of origin.
Neoplasms are ________ , _________ , and _______ . New growths, may be malignant, and they may be benign.
The term "malignant" in relation to blood pressure means: Life-threatening.
In what case should a V code be used? Sterilization.
Diagnostic codes have from ___ to ___ digits. 3, 5.
Always code to the highest degree of: Specificity.
A private insurance company might adopt which of the following methods as a basis for its payment of outpatient claims? Fee schedule, usual, customary and reasonable, relative value of schedules.
In medical insurance coding, the acronym CPT stands for: Current Procedural Terminology.
The direct delivery by a physician(s) of medical care for a critically ill or injured patient is: Critical care.
Included in a global surgery policy and a surgical package is/are: Postoperative visits in and out of the hospital, and digital block or topical anesthesia.
A clean claim: Is subject to medical review with attached information or forwarded simultaneously with electronic medical claim records.
What type of clean calim is any Medicare claim that contains complete, necessary information but is illogical or incorrect? Invalid claim.
The CMS-1500 (08-05) insurance claim form is almost always accepted by: Private insurance carriers, Medicaid and Medicare, and worker's compensation.
What should you avoid using when typing a claim for scanning? "N/A and DNA".
A(n) _______ claim is submitted to the insurance carrier via a CPU, tape diskette direct data entry, direct wire, dial-in telephone, or personal computer via modem. Electronic.
When two insurance policies are involved in a claim, one is considered ___ and the other is ___> Primary, secondary.
OCR guidelines for the CMS-1500 claim form state: It should not be photocopied because it cannot be scanned.
To conform to CMS-1500 OCR guidelines: Do not fold insurance claim forms when mailing, do not use symbols with data on insurance claim forms, do not strike over errors when making a correction on an insurance claim form.
A health insurance claim form (CMS-1500) is known as the: Universal claim form.
An insurance claim form that contains no staples or highlighted areas and on which the bar code area has not been deformed is called: A physically clean claim form.
If you receive a request, accompanied with the correct authorization, asking to abstract medical information from a patient's medical record: Send only the information requested.
An insurance claim submitted with errors is referred to as: A dirty claim.
Office visits may be grouped on the insurance claim form if each visit: Is consecutive, uses the same procedure code, and results in the same fee.
How should blocks be treated on an OCR CMS-1500 claim form that do not need any information? Leave the blcok blank.
An electronic claims professor (ECP) is: An individual who converts to standardized electronic format and transmits electronic claims data.
The brain of the computer is called: CPU.
What should you do often to prevent losing data you have entered? Back up.
The most important function of a practice management system is: Accounts receivable.
The employer's identification number is assigned by: The Internal Revenue Service
A clearinghouse: Transmits claims to the insurance payer, performs software edits, and separates claims by carrier.
A modem is a device used to: Transmit electronic information over a dedicated phone line.
The Health Insurance Portability and Accountability Act (HIPAA) does not establish guidelines for: Insurance claims.
Another name for the multipurpose billing form is: Superbill.
The insurance claim was rejected because of an incorrect modifier, so: Verify and submit valid modiiers with the correct procedure codes for which they are valid.
A group of insurance claims sent at the same time from on facility is known as a: Batch.
Insurance claims transmitted electronically are usually paid in: 2 weeks or less.
Back-up copies of office records should be stored: Away from the office.
Assigning a code to represent data is known as: Encryption.
A combination of letters, numbers, or symbols that each individual is assigned to access the computer system is called a/an: Password.
The diagnosis listed first in submitting insurance claims for patients seen in a physician's office is the: Primary diagnosis.
When is the principal diagnosis applicable? Inpatient hospital coding.
When coding x-ray films taken of both knees, list: The proper x-ray code twice and use the modifiers RT (right) with the first code and LT (left)with the second code.
The health insurance claim form (CMS-1500) is known as the: Universal Claim Form.
The CPT publication is updated: Annually.
An insurance claim form that contains no staples or highlighted areas and on which the bar code area has not been deformed is called. A physically clean claim.
If you receive a request, accompanied with the correct authorization, asking to abstract medical information from a patient's record, Send only the th information requested.
A group of insurance claims sent at the same time from one facility is known as a: Bundle.
A clearinghouse is a/an: Entity that receives transmission of insurance claims, separates the claims, and sends each one electronically to the correct insurance payer.
The most important function of practice management is: Accounts receivable.
If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the: State insurance commissioner.
If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow is to: Ask if there is a backlog of claims at the insurace office.
What should you do if an insurance cattier requests information about another insurace carrier Provide the information.
When downcoding occurs, payment will: Be less.
The first level of appeal in the Medicare program is: Redetermination.
How many levels of review exist for TRICARE appeal procedures? Three.
What should be done to inform a new patient of office fees and payment policies? Send a patient information brochure, send a confirmation letter, and discuss fees and policies at the time of the initial contact.
The patient is likely to be the most cooperative in furnishing details necessary for a complete registration process: Before any services are provided.
The reason for a fee reduction must be documented in the patient's: Medical record.
Professional courtesy means: Writing off the balance of an account after an insurance company has paid its portion.
When collecting fees, your goal should always be to: Collect the full amount.
Accounts receivable are usually aged in time periods of: 30, 60, 90, and 120 days.
Messages included on statements to promote payment are called: Dun messages.
A significant contribution to HMO development was the: Health Maintenance Organization Act of 1973
How does an HMO receive payment for the services its physicians provides? Prepaid health plan.
How are physicians who work for a prepaid group practice model paid? Salary paid by independent group.
In an independent practice association (IPA), physicians are: Not employees and are not paid salaries.
An organization that gives members freedom of choice among physicians and hospital provides a higher level of benefits if the providers listed on the plan are used is called a/an: Preferred Provider Organization (PPO).
When a physician sees a patient more thatn is medically necessary, it is called: Churning.
Referral of a patient recommended by one specialist to another specialist is known as: Tertiary care.
What is the correct procedure to collect a copayment on a managed care plan? Collect the copayment when the patient arrives for the office visit.
When an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person, this is known as: Capitation.
Practitioners in an HMO program may come under peer review by a professional group called a: Quality improvement organization.
Medicare part A is run by: The Centers for Medicare and Medicaid services.
Medicare is a: Federal health insurance program.
Medicare provides a one-time baseline mammographic examination for women ages 35 to 39 and preventive mammogram screenings for women 40 years and older. Once a year.
The frequency of pap tests that may be billed for a Medicare patient who is low risk is: Every other year.
Some senior HMOs may provide services not covered by Medicare, such as: Eyeglasses and prescription drugs.
A Medicare prepayment screen: Identifies claims to review for medical necessity, and monitors the number of times given procedures can be billed during a specific time frame.
A claims assistance professional (CAP: May act on the Medicare beneficiary's behalf as a client representative.
When a remittance advice (RA) is received from Medicare, the insurance billing specialist should: Post each patient's name and the amount of payment on the day sheet and the patient's ledger card.
If a check is received from Medicare and it is obvious that it is an overpayment, the insurance billing specialist should: Deposit the check and then write to Medicare to notify them of the overpayment.
The letter "D" following the identification number on the patient's Medicare card indicates a: Widow.
The Social Security Act of 1935. Set up the public assistance programs.
The federal Emergency Relief Administration made funds available to pay for: Medical expenses of the needy unemployed.
The medically needy aged: Require help in meeting costs of medical care.
The federal aspects of Medicaid are the responsibilty of the: CMS.
Medicaid is administered by the: State government with partial federal funding.
State children's health insurance programs (SCHIPs) Operate with federal grant support under the Title V of the Social Security Act.
Medicaid is available to needy and low-income people such as: The blind, the diabled, the aged (65 and older).
If a physician accepts Medicaid patients, the physician must accept: The medicaid-allowed amount.
To control escalating health care costs by curbing unnecessary emergency department visits and emphasizing preventive care, Medicaid reform has involved. Managed care programs.
TRICARE, formerly known as CHAMPUS, is funded through: Congress.
The health maintenance organization provided for dependents of active duty military personnel is called: Tricare PRIME.
Created by: dynadoll610 on 2010-06-29



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