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NHA Test

medical billing & coding

QuestionAnswer
Three, four and five digit codes are considered? Categories, subcategories and subclassification codes
Terms indented two spaces to the right below the main term are called? Sub terms
The Neoplasm table found in the Index under main term "Neoplasm" and is organized by anatomic site, what are the categories of neoplasm? malignant, primary benign, secondary benign, specified, uncertain, carcinoma in situ
How many sections does the Alphabetic Index contain? Index to diseases, table of drugs and chemicals, index to external causes of injuries
What does HCPCS stand for? Healthcare common procedure coding system
Level I HCPCS codes are? five position numeric codes
A bullet (.) represents? new procedure or service was added since the last edition
Evaluation and Management begins with? section 99
Radiology begins with? section 77
Eligibility of Medicaid is divided into two classifications? medically needy and categorically needy
Five types of benefits offered to workers compensation beneficiaries? medical treatment,temporary and permanent disability, vocational rehabilitation and death benefits for survivors
Champva was created to provide medical benefits to? spouses and children of veterans with total, permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service related disability
What is the encounter form? is called the superbill, it is a listing of the diagnosis,procedures,and charges for a patients visit
What does -algia mean? means Pain
What does -megaly mean? means Enlargement
What does -itis mean? means inflammation
What does -ectomy mean? means removal
What are HCPCS? A collection of codes for procedures, supplies,products, and services that may be provided to insurance beneficiaries.
Level II HCPCS codes are? Five position alpha-numeric codes
Level II HCPCS codes starts with? A letter followed by four numbers
The CPT manual is composed of eight sections? evaluation & management, anesthesia, surgery, radiology, pathology & laboratory, medicine, category II codes and category III codes
When are category II codes published (CPT)? January 1 and July 1
Category I codes are? represents services and procedures widely used by health professionals
Category II codes are? supplemental codes used for performance measurements
Category III codes are? temporary codes for emerging technology, services and procedures
A triangle in () represents? change in the code description since the last edition
Two triangular symbols(><) represents? changes in the text or definition between the triangles
Pathology and Laboratory codes begins with 80
Surgery code begins with? 10
Advance Beneficiary Notice is a? a document provided to a Medicare beneficiary prior to service being rendered and letting them know of his/her responsibility to pay if the claim is denied.
Tricare is? a regionally managed care program for active duty and retired members.
What is coordination of benefits (COB) is when two insurance companies work together to pay benefits
Coinsurance is? a percentage of the cost of covered services that a policyholder or a secondary insurance pays.
What does -emia mean? means Blood condition
What does -pathy mean? means Disease Process Condition
What does -oma mean? means Tumor
What does -pexy mean? means surgical fixation
What does -stomy mean? means opening
What does -tomy mean? means incision
What does -plasty mean? means surgical repair
What does Hemat mean? means Blood
What does Hemi mean? means partial
What does arth mean? means cartilage
What does alping mean? means fallopian tube
What does my mean? means muscle
What does gastro mean? means stomach
What does oste mean? means bone
What does cardi mean? means heart
What does hyster mean? means uterus
What does polyp mean? means benign growth in the mucous membrane
What does ulcer mean? means open sore
What does multigravida mean? means a pregnant woman who has had at least one previous pregnancy
Which fee schedule method is used mostly in reference to fee-for-service reimbursement? fee schedule method used is "Usual, customary and reasonable"
A policy that will cover incidents originating on or after the policy retroactive date is known as? Claims made insurance
A type of managed care plan regulated under insurance statutes combining features of health maintenance organizations and preferred provider organizations that employers agree not to contact with any other plan is known as? Physician provider group
Medical services that are not included in a managed care contract's capitation rate but that may be contracted for separately are referred as? Co-payments
HMO's and preferred provider organizations consisting of a network of physicians & hospitals that provide & insurance company or employer with discounts on their services are referred to collectively as? POS
Condition that do not qualify children for the Maternal Child Health Program in all states participating in Medicaid include? Epilepsy
The process of discovering whether a treatment is covered under a patients contract called? Preauthorization
What must be paid each year by the policy holder before the insurance policy benefits begin? deductible
A physician who controls patient access to specialists and diagnostic testing services is called a? gatekeeper
Peer review is? an evaluation of the quality and efficiency of services provided by a physician
Which is the combining form meaning "ear"? OT/O
A patient lying horizontally on his back is in what position? supine
Which is a combining form, not a prefix or suffix? PATHO is, not OPSY, CENTESIS or RETRO
The physician whose specialty is to diagnose and treat diseases and disorders involving the bones, joints, and muscles is the? Orthopedist
Which of the following terms below means "through"? the term is "Per"
The terms ac, al, ary and ic are all? adjective suffixes meaning "pertaining to"
What should you do if the date of a reported injury is not listed on a claim form? Call the patient's physician to obtain the date of injury
What type of claim is any Medicare claim that contains complete, necessary information but is illogical or incorrect? Invalid claim
The collection ratio is? the relationship of the amount of money owed and the amount of money collected
What is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury? Disability Insurance
What is a policy that covers losses to a third party caused by the insured, by an object owned by the insured, or on premises owned by the insured? Liability Insurance
What is the organ that secretes hormones, epinephrine and steroids? Adrenal gland
Under Medicare's RBRVS schedule, a procedure's relative value consist of what elements? Work cost is the amount of time, intensity of effort, & medical skill required of the physician. Overhead cost represents the practice costs related to the performing of the service. Malpractice cost represents the cost of medical malpractice insurance
Code 11 listed on the claim form is for? place of service
A policy that will respond to incidents originating from the coverage period regardless of when the claim was reported is known as? claims made insurance
Assignment of benefits is? reimbursement is directly sent from the payer to the provider
Accept assignment means? means the provider agrees to accept what the insurance company approves as payment in full for the claim
A deductible is? a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company
A premium is? is the cost of the insurance coverage paid annually, semi-annually or monthly by the policy holder before benefits will be paid
What is the process of converting diagnosis, procedures, and services into numeric and alphanumeric characters? coding
A document that contains dates of service, list of detailed charges, co-payments and deductibles paid, date insurance was filed, adjustments and account balances is a(n)? itemized statement
Under the RBRVS method of reimbursement, conversion factors could be described as? as a dollar amount
A patient developed rashes after taking a properly prescribed medication. The E code to be used to indicate how the rashes happened is referenced from which E code column in the Table of Drugs and Chemicals? Therapeutic Use
Information required to show that insurance was billed should include? Date of service, amount billed, insurance company name
What code contains the full description of the procedure for the code? stand-alone codes
Supplementary classification of external causes of injury and poisoning are codes used to describe the reason or external cause of injury, poisoning and other adverse effect are? E Codes
Supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances of problems is? V Codes
Free moving joints surrounded by joint capsules is? Synovial joint
There are three layers to the skin? Epidermis, dermis, subcutaneous
The ICD-9 manual is updated? every year in the month of October
Terms indented two spaces to the right below the main term are called? sub-terms
The three key components of E/M are? history, physical exam, medical decision making
HCFA became the? Centers for Medicare and Medicaid services (CMS)
What are the 4 various terms used to describe the stat of submitted form as it pertains to Medicare claims? clean, dirty, invalid, rejected
A "clean claim" means? possible quick reimbursement, no errors or omissions on the claim, and following of ins.-claim formatting procedures
In E/M coding, selection of a code, this is only considered as supplementary? time, counseling, and nature of presenting problem
The hypertension subcategories are? malignant, benign and unspecified
In the CPT manual, a triangle in () means? the description for the code has been changed
What are the 3 key components of an E/M code? history, examination, medical decision making
To correct documentation in a patients file, you would? cross it out with a single line, initial & date it and neatly write the correct information
Intentionally deceiving or misrepresenting by either provider or beneficiaries to obtain payment for services is referred to? Fraud
If a patient has seen a physicians partner 24 months ago then the patient would be considered a? An established patient
In the ICD-9CM volume 2, a subterm that is contained within parenthesis () indicate? indicates that the descriptors within the parenthesis do not change or effect the code
The term "carcinoma in situ" refers to? malignancies that are confined and noninvasive
Peer review is an evaluation of? quality and efficiency
In the CPT, what does the (+) symbol represent? represents add-on codes
ICD-9-CM (volume 2) indicates? a disease, injury or condition
The alphabetical index contains three sections? index to diseases, table of drugs and chemicals, index to external causes of injury (E codes)
The neoplasm table has six subcategories, they are? primary, secondary, carcinoma in situ, uncertain behavior, unspecified nature
To code accurately, it is essential to always code a ICD-9CM code ultimately from? Volume 2
In the CPT, what does the bullet symbol (.) mean? means New Codes
What does HCPCS stand for? means "Healthcare Common Procedure Coding System"
Within HCPCS, how many levels are there? 2 levels
HCPCS are? a collection of codes for procedures, supplies, products and services that provides to insurance beneficiaries
Level I HCPCS codes are? 5 position numeric codes
Level II HCPCS codes are? 5 position alpha-numerical codes
CPT manual is composed of how many sections? 6 sections
The organization that initiated the development of the ICD codes is? WHO
One who has not visited the physician in more than 3 years? New Patient
Which statement sent by the payer to the covered individual contains reimbursement amounts and an explanation in an easy-to-read format? Explanation of Benefits (EOB)
The patients birthday on the CMS-1500 form is entered in which of these formats? MM/DD/YYYY
A document that contains dates of service, list of detailed charges, co-payments & deductibles paid, date insurance claim was filed, adjustments & acct balances is called? An itemized statement
ICD-9-CM is the? International Classification of Disease, 9th Revision, Clinical Modification
Those who qualify for Medicaid include all of the following, except? High Income earners
A respirator used by a Medicare patient is an example of? Durable Medical Equipment
The CPT coding system is utilized for reporting? Serivce and procedure based
Which insurance policy is never primary when the insured has more than one policy? Medicaid
What is a pre-existing condition? an illness or condition present before insurance coverage begins
All of the following are correct regarding add-on codes, except? they are exempt from modifier -51
A situation that is considered "abuse" and not "fraud" is? Churning or performing several diagnostic tests when only a few are necessary
A disease or procedure named for the person who discovered it is called a/an? Eponym
when coding for Durable Medical Equipment, you would use this book to code from? HCPCS, Level II
"CCI" stands for? Correct Coding Initiatives
In the medical field, medical ethics are considered? Standards of conduct
A "Medigap" policy indicates? A policy that covers the deductible and co-payments typically not covered under Medicare
If a Medicaid patient requires care outside of their home state, most states offer? Reciprocity
The act that was passed to protect individuals who stop to render aid to an accident victim is called? good samaritan act
The number 95-7653555 is an example of? an employer ID number (EIN)
A patient develops a rash after taking a properly prescribed medicatin. The E code to be used to indicate how the rash happened is referenced from which E code column in the Table of Drugs and Chemicals? Therapeutic
For each enrollee, the physician is paid a fixed amount, each month, whether or not the enrollee is seen for medical services. This is called? Capitation
When looking up a diagnosis code, you will first begin with? the main term in Volume 2
Under the RBRVS method of reimbursement, conversion factor could be described as? A dollar amount
Which of the following describes a combining form? A word root and an "o"
Who created the Health Care Fraud and Abuse control program? HIPPA
What is the removal of the large intestine called? colostomy
Federal Law that prohibits submitting a fraudulent claim or making a false statement in connection with a claim is? The False Claim Act
Who developed the national correct coding methodologies and to control improper coding that leads to inappropriate payment? Centers for Medicare and Medicaid Services (CMS)
What does hysterectomy mean? removal of uterus
A physician who studies the nervous system is known as? Neurologist
E codes are supplementary classification codes used to? describe the reason or external cause of injury, poisoning, and other adverse effect
Free moving joints surrounded by capsules? Synovial joint
There are three layers to the skin? Epidermis, dermis, subcutaneous
Alphabetic Index sections are? Index to diseases, table of drugs and chemicals, index to external causes of injury
Contains the full description of the procedure for the code? Stand-alone codes
Block 24J, on the CMS-1500 contains? The physicians national provider ID number
Supplementary classification codes uses to identify healthcare encounters for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances of problems are? E codes
Assignment of Benefits is? reimbursement is directly sent from the payer to the provider
Accept assignment means? the provider agrees to accept what the insurance company approves as payment in full for a claim
A policy that will respond to incidents originating from the coverage date regardless of when the claim was reported is known as? claims made insurance
A claim that has all required fields accurately filled out, contains no deficiencies and passes all edits? clean claims
Nutrient rich blood is returned back to the atrium through the? pulmonary vein
The maxilla, cranium, and axille is all part of the? head
Interneurons connect senssory and motor neurons within the? brain and spinal cord
What modifier would be used when the same procedure is performed on a mirrored part of the body? modifier 50
When physicians, hospitals and other healthcare providers contract with one or more HMO's or directly with an employer to provide care, this is called? Physician-hospital organization (PHO)
Generally the least costly but at the same time is more restrictive? HMO
Charges a higher premium in exchange for more flexibility? PPO
A policy that will cover incidents originating on or after the policy retroactive date is known as? Claims made insurance
Under Medicare's RBRVS schedule, a procedure's relative value consists of what elements? work cost representing the amt of time, intensity of effort, and medical skill required of the physician, overhead cost representing the cost related to the performing of svcs, malpractice cost representing the cost of medical malpractice insurance
Code 11 listed on a claim form is for? place of service
The two triangles in parenthesis (><) represents? changes in the text or definition between the triangles
circle with slash represents exemption from? use of modifier 51
What is the organ that secretes hormones, epinephrine and steroids? adrenal gland
Which of the following refers to a patient that is without pain? asymptomatic
A Otorhinolaryngolist specializes in the diagnosis and treatment of the? ears, nose and throat
What are the 4 various terms used to describe the state of submitted forms? clean, dirty, invalid, rejected
A Medicare claim that contains complete and necessary information but is illogical or incorrect is? invalid claim
HCFA became the? American Health Organization
Terms that are indented two spaces to the right below the main term are called? subterms
Clinic College has a contract with health net, therefore, they are considered? Participating provider
Indented codes are? listed under stand-alone codes
Two digit add-ons attached to regular codes to tell the third party payer of circumstances in which the service or procedure has been altered are known as? Modifiers
Information required to show that insurance was billed should include? date of service, amount billed, name of insurance company
Employer Liability is when physicians are legally responsible for their own? Protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service
To ensure that you have chosen the correct code, you must first? Locate the code in the alphabet Index and then cross-reference the code in Volume I
Created by: JMB923 on 2012-06-12



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