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Practice Exam Q's 1
| Term | Definition |
|---|---|
| The following describes the reason for a claim rejection because of Medicare NCCI edits | Improper coding combinations |
| The following action should be taken if an insurance company denies a service as not medically necessary | Appeal the decision with a provider's report |
| A coroner's autopsy is compromised of the following examination | Gross examination |
| The following condition is associated with microcephaly | Down's syndrome |
| The following term describes the process used to challenge a payer's decision to deny, reduce, or downcode a claim | Appeal |
| When completing a CMS-1500 paper claim form you should do this | use 10-pitch PICA font |
| In the CPT manual, an esophagectomy can be found in the following subsection | Excision |
| A nurse is reviewing a patient's lab results prior to discharge an elevated glucose level. The following health care providers should be alerted before the nurse can proceed with discharge planning | The attending physician |
| The following section of the CPT manual lists the appropriate code for WBC (white blood cell) with differential, automated | Path and Lab |
| To assign a diagnosis code to the highest level of specificity, a billing and coding specialist should | check for a fourth or fifth digit |
| A patient suffers a second-degree burn of the left axilla and a third-degree burn of the left wrist. Twelve percent was burned, with 3% of the burns designated as third-degree. Which of the following demonstrates the proper coding sequence | Third-degree burn of wrist, second-degree burn of axilla, burn involving 10 to 19% of the body surface with less than 10% of that being third-degree burns |
| The following terms describe when a plan pays 70% of the allowed amount and the patient pays 30% | Coinsurance |
| Representatives from the following accrediting agencies can visit office labs to review manuals and interview staff | CLIA (Clinical Lab Improvement Amendments) |
| CLIA | Establish quality standards for all lab testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test was performed |
| JCAHO | Joint Commission, a non-profit organization that accredits and certifies health care organizations and programs in the US. It is a symbol of quality that reflects on an organizations commitment to meeting certain performance standards |
| NAACLS | National Accreditation Agency for Clinical Lab Sciences; the accreditation agency for educational programs |
| Medicine | A patient undergoes hemodialysis. The code for this procedure is found in the following section of the CPT manual |
| Family history | V codes are used as the first-listed diagnosis to indicate |
| Reporting test results to a family member via phone | The following scenario describes a HIPAA violation |
| Private third-party payers | Medigap coverage is offered to Medicare beneficiaries by the following |
| Endocrinologist | A patient has a new onset of diabetes mellitus. The following specialist should be referred to by the primary care provider (PCP)for further treatment |
| Inform the supervisor | A billing and coding specialist observes a coworker drinking alcohol during work hours. The following actions should be taken |
| Health care clearinghouses | The following is a covered entity affected by HIPPA security rules |
| The claim is overdue for payment | The following describes a delinquent claim |
| Aorta | The following transports oxygenated blood form the heart |
| NPI | According to HIPPA standards, the following identifies the rendering provider on the CMS-1500 claim form in Block 24J |
| Military identification | All dependents 10 years of age or older are required to have the following for TRICARE |
| Subsection of integumentary system | The following describes the location for the appropriate code selection for the removal of a malignant lesion of the arm |
| Coding conventions and instructions | The following takes precedence over ICD-9-CM chapter-specific guidelines |
| Block 24D contains diagnosis code | A claim can be denied or rejected for the following reason |
| Submit an appeal to the carrier with the supporting documentation | The following actions should be taken when a claim is billed for a level four office visit and paid at a level three |
| Invalid | A claim is submitted a transposed insurance member ID number and returned to the provider. The following best describes the status that should be assigned to the claim by the carrier |
| Coccyx | Area of the body referred to when a patient presents for an incision and drainage of a pilonidal cyst |
| When a claim contains unlisted procedure codes | Circumstance where a paper claim should be submitted to the insurance carrier |
| accept the policies and procedures regarding how PHI is handled | What is indicated when a patient signs an Acknowledgement of Notice of Policy Practice |
| anesthesia | Time reporting is used as a guideline in this section |
| Incomplete information | The following is a reason for claim rejection |
| HIPAA | The following protects patient confidentiality |
| Moderate (conscious) sedation | Codes indicated with a bulls eye symbol denotes |
| The number is needed to identify the provider | Claims that are submitted without and NPI number will delay payment to the provider because |
| Medicaid | A patient's health plan is referred to as the "payer of last resort" which means the patient is covered by this insurance |
| encounter form | A form that contains charges, DOS, CPT codes, ICD-9-CM, fees, and copayment information is on this form |
| Privacy officer | To be complaint with HIPAA every office needs this |
| HCPCS Level II(2) #forkim National Codes | HIPAA requires standard transactions and code sets include the following |
| Urinary | The following system in the surgical section of the CPT manual lists the correct code for ablation of renal cysts by laparscopy |
| 6 | This many behavior classifications are included in the Table of Neoplasms |
| This block on the CMS 1500 form requires the patient's authorization to release medical information to the process a claim. For Medicare claims this block acts as assignment of benefits. | 12 |
| This code includes a comprehensive history, examination, and medical decision making of high complexity. | 99205 |
| implied contract | does not require written of verbal consent. Example: patient schedules appointment with a new provider's office |
| this should be obtained from a Medicare patient when services for a diagnostic test is not covered | ABN form (advanced beneficiary notice) |
| these are valid ICD-9-CM principles (guideline) | code signs and symptoms in the absence of an established diagnosis code the first-listed diagnosis, followed by additional diagnoses Code to the highest level of specificity code to the highest level of certainty; never code inconclusive diagnoses |
| CMS-1500 | claim form used to submit professional outpatient services and procedures |
| if an insurance company denies a claim the appropriate way to communicate this with the patient is | inform the patient of the reason for the denial |
| solid circle | symbol for new CPT code |
| nephrolithiasis | condition of having stones in the kidneys |
| A provider charged $500 to a claim that had an allowable amount of $400. In which of the following columns should the billing and coding specialist apply the non-allowed charge? | adjustment column of the credits |
| this encourages claims to be submitted electronically | HIPAA guidelines |
| It is not appropriate to submit an electronic claims when | submitting to a secondary payer claim is submitted to a third-party liability payer when an accident or injury has occurred claim contains an unlisted procedure **Note these all situations all require attachments to a paper claim to be sent) |
| this valve controls the opening between the right atrium and the right ventricle | tricuspid valve |
| congenital condition in which the urethra opens on the lateral aspect of the penis | paraspadias |
| coordination of benefits | provision of health insurance that specifies which coverage is considered primary or secondary |
| financial record source generated by a providers office | patient ledger account |
| patient develops a rash after taking a medication his provider prescribes for him. what type of code should be assigned to the reaction? | E code |
| protein associated with a PSA screening test | protein produced by prostate gland. **PSA stands for Prostate Specific Antigen test |
| -right to: considerate and respectful care-relevant, current, and understandable information- make decisions about the plan of care -refuse treatment -have advance directives- every consideration of privacy- right to "every consideration of privacy" | Patient Bill of Rights (1) |
| Right to: -expect confidentiality -be informed of hospital policies that relate to patient care | Patient Bill of Rights (2) |
| medical term for fainting | syncope |
| medical term for the body's inability to compensate for position change | orthostatic hypotension |
| these are used in electronic claims transmission for provider services | CPT |
| first section of the small intestine | duodenum |
| skin, hair, nails, and glands | parts of the integumentary system |
| Accepts electronic and paper claims on behalf of Medicare | MAC's (Medicare Administrative Contractors) |
| patella | kneecap |
| an appropriate diagnosis for the application of a long leg cast is | patella fracture |
| when a patient is being seen for chemotherapy treatments, should the biller sequence the relevant cancer code first or the V code for chemotherapy? | V code for chemotherapy. V58.11 |
| What color format is acceptable on the CMS-1500 claim form | red |
| organization that developed and updated the CPT code book annually | AMA |
| modifier required by CLIA when billing Medicare for a waived laboratory test | QW |
| horizontal triangles symbolize this in CPT (HCPCS Level I) | new or revised text |
| When assigning CPT code for wounds how do you calculate total size of wound | add together all measurements on same body part |
| Claim control number | can be used to expedite (speed up) a phone appeal or claim question when speaking to the insurance company |
| category code | 3 digits to the left of the decimal |
| On a patient's remittance advice, a deductible of $100 has been applied. The provider has requested the patient account personnel to write it off. This action is considered. | fraud |
| What font is required for claims to be processed via OCR (optical character recognition) | 12 pitch PICA |
Created by:
tina.reynolds
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