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Mod H Unit 2
Review
| Question | Answer |
|---|---|
| Part _____ of Medicare helps pay for physician and outpatient charges | B |
| The Medicaid program is administered by the | CMS |
| There are ______ parts to the Medicare Program | 4 |
| Individuals who receive medical assistance because their income falls within the poverty or FPL guidelines or as a result of SSI eligibility are considered | Categorically Needy |
| The act that provides for a federal system of old age, survivors, disability, and hospital insurance is the | FICA |
| When a Medicaid beneficiary has no other health care coverage, the type of claim to be submitted is called a | Medicaid Simple Claim |
| A federal insurance program, established in 1966, for people 65 years old and older and certain other qualifying individuals is | Medicare |
| The act that established quality standards for all laboratory testing to ensure safety, accuracy, reliability, and timeliness is | CLIA |
| Part _____ of Medicare helps pay for prescription drugs | D |
| Medicare payments can be automatically deposited into a provider’s designated bank account using | Electronic Funds Transfers |
| The duration of time during which a Medicare beneficiary is eligible for Part A benefits for inpatient hospital or skilled nursing facility charges is called | Benefit Period |
| There are _______ levels to the Medicare appeals process | 5 |
| Medicare Part D began in | 2006 |
| Beneficiaries who are not satisfied with the amount of a claim reimbursement may file a | Appeal |
| Insurance coverage that is typically primary to Medicare includes | Group, Workers Comp, Automobil liability |
| The legal obligation of other insurance policies/programs to pay all or part of the expenditures for patients eligible for Medicaid is called | Third Party Liability |
| The acronym for the federal-state cash assistance program for poor families, typically headed by a single parent is | TANF |
| The time limit for filing Medicaid claims | Varies by state |
| Under what federal act was the Medicaid program established | Social Security |
| One common method for verifying Medicaid eligibility is to use a | Automated voice response |
| In 1972, federal law established the supplemental security income (SSI) program, which provides assistance to | qualified age/disabled poor |
| What qualifies under federally approved optional services for which federal funding is available | diagnostic services |
| Under federal statutes, which of the following groups is eligible in all states for assistance through the Medicaid program | categorically needy |
| In January of 1999, the Balanced Budget Act (BBA) of 1997 went into effect expanding the role of private plans to include | managed care organization |
| Is Medicaid always the payer of last resort | YES |
| Section 2 of Volume 2 of the ICD-9-CM Manual consists of | TABLE OF DRUGS/CHEMICALS |
| The definition of a diagnosis is | presence of illness/determination of care |
| Nonessential modifiers are | terms in parentheses following main terms |
| Morbidity is the presence of illness or disease, whereas mortality is | deaths that occure from disease |
| What modifies main terms describing different sites, the cause or origin of disease, and different clinical types | essential modifiers |
| The part of the ICD-9 manual that serves as a basic foundation for diagnostic coding and aids in assigning diagnostic codes correctly | introductory pages |
| An eponym is | disease, procedure,or syndrom, named after who discovered it |
| What would the instructions below indicate to the health insurance professional?_______________________________________ 330 rebral degenerations usually manifest in childhood,Use additional code to identify, Associated mental retardation | additional codes should be used |
| Codes representing external causes of injury and poisoning are referred to as | E codes |
| The main term for acute depressive reaction | reaction |
| Transforming verbal descriptions of a diagnosis into numbers or a combination of alphanumeric characters is referred to as | coding |
| The Supplementary Classification of External Causes of Injury and Poisoning are referred to as | E codes |
| Most ICD-9-CM manuals use a specific type of coding in Volume 1 to alert the coder to special edits and important issues, which is called | color coding |
| Terms such as aftercare, examination, and problem with are indicators that what type of code is needed | V code |
| There are three types of codes in Volume 1 of ICD-9-CM. What are they | 5 digit manifestation codes |
| The typeface used for main terms in the Alphabetic Index (Volume 2) and all codes and titles in a tabular list is | Boldface |
| The external causes of adverse effects resulting from ingestion or exposure to drugs or other chemical substances can be found in the | table of drugs and chemicals |
| The determination of the nature of a cause of disease,” is a definition for | diagnosis |
| The Alphabetic Index to Diseases contains two tables, which are | conditions/ diseases |
| The “CM” in ICD-9-CM stands for | clinical modification |
| The updated volume of the ICD-9-CM is published | annually |
| Physicians and outpatient clinics use the _______________ diagnosis, while the ______________ diagnosis is used by hospitals and institutional facilities | primary/principle |
| When more than one otherwise individually classified disease is combined with another disease and one code is assigned for both, a _____________ code is assigned | combination |
| When an individual who is not sick visits the medical facility for a specific purpose, such as receiving a vaccination, which codes are used | V code |
| If a patient's condition has not been specifically diagnosed, the health insurance professional must code the | signs & symptoms |
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