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