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Billing and Coding
Study guide
| Question | Answer |
|---|---|
| The authorization for an insurance carrier to pay the physician or the medical practice directly is the ____. | assignment of benefits |
| The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ____. | deductible |
| Patients who belong to a managed care health plan, such as an HMO, are responsible for a small per-visit fee collected at the time of the visit. This fee is commonly called a(n) ____. | copayment |
| Which of the following is a characteristic of Medicaid? | is a health cost assistance program |
| A patient's diagnosis as established by the physician ____. | describes the primary condition for which the patient is receiving treatment |
| ICD codes are updated ____. | annually |
| The Alphabetic Index is organized by ____. | the symptoms displayed by the patient |
| Of the federal programs providing healthcare, the largest is ____, which provides health insurance for citizens aged 65 and older. | Medicare |
| Who most frequently files insurance claims and handles insurers' payments for a medical practice | Medical assistant |
| In most cases, the insured person pays an annual cost or ____ for healthcare insurance | premium |
| An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ____. | review for allowable benefits |
| Which of the following is what the patient owes after the insurance company has paid? | Patients liability |
| To be covered under Medicare Part B, patients must ____. | qualify for part A, but sign up for B |
| The most frequently used CPT codes are the ____. | E&M codes |
| Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property? | liability |
| When unbundling is done intentionally to receive more payment than is allowed, the claim is likely to be considered | fraudulent |
| Which of the following conventions is used in ICD-9 and ICD-10 to indicate that the entries following it further define the content of a preceding entry? | Includes |
| The person whose name the insurance is carried under is called the ____. | subscriber |
| In a typical medical practice, insurance claims are filed | a few business days after the date of service |
| The most likely outcome of an insurance claim submitted with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be ____. | rejected |
| A patient who has been hospitalized up to 90 days for each benefit period is covered under | Medicare Part A |
| The benefit period for Medicare begins the day a patient goes into the hospital and ends when that patient has not been hospitalized for ____ days. | 60 |
| Patients under the age of 65 who are blind or widowed or who have serious long-term disabilities, such as ____, may be entitled to Medicare. | kidney failure |
| Which of the following is included in Medicare benefits for respite care? | The terminally ill patient is moved to a care facility for the respite. |
| The Healthcare Common Procedure Coding System (HCPCS) was developed for use in coding services for ____. | Medicare patients |
| A plus sign (+) is used to indicate ____. | add-on codes |
| HCPCS Level I codes ____. | are aka cpt codes |
| Modifiers to CPT codes indicate ____. | that some special circumstance applies to the service |
| Inaccuracy in linking diagnostic codes and procedural codes will result in all of the following except | internal coding audits |
| National codes issued by CMS that cover many supplies and durable medical equipment are | HCPCS Level II codes |
| Which of the following is not one of the six main sections in the CPT manual? | Physical therapy |
| The CPT is updated and new codes are provided for use beginning | annually on January 1 |
| find information regarding prefixes and suffixes used in the CPT manual, you would look in the | Introduction to the manual |
| Which of the following best describes the CPT code format | 5-digit numeric codes |
| Which of the following is an implication for the patient if the patient pays by credit card? | If the patient doesn't pay the credit card balance in full, interest accrues on the unpaid balance |
| The most likely outcome of an insurance claim submitted with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be ____. | denied because the treatment was not medically necessary based on the diagnosis |
| If a medical practice accepts credit card payments, the American Medical Association (AMA) suggests the use of which guideline? | Do not advertise this. |
| If your medical practice does not have an authorization device for credit card payment, ____. | call the credit card company for authorization |
| Which of the following patients would a physician most likely treat as a matter of professional courtesy? | Other healthcare professionals |
| Which of the following statements applies to a physician who agrees to accept Medicaid patients? | The physician can bill the patient for services that Medicaid does not cover |
| Which of the following ICD-9-CM conventions is used around synonyms, alternative wordings, or explanations? | [ ] |
| When do most smaller practices send out their statements | At the end of the month |
| A common billing system that bills each patient only once a month but spreads the work of billing over the month is ____. | cycle billing |
| The Alphabetic Index is organized by ____. | diagnosis or condition description |
| In a typical medical practice, insurance claims are filed | a few business days after the date of service |
| The Tabular List is mainly organized by ____. | the body system involved |
| Which convention is used in ICD-9 and ICD-10 to indicate that an entry is not classified as part of the preceding code? | Excludes |
| Analysis of the connection between the diagnostic and procedural information on a claim is called | code linkage |
| The person whose name the insurance is carried under is called the ____. | subscriber |
| __________is not one of the six main sections in the CPT manual? | Physical Therapy |
| How much will a medical practice generally receive if a physician charges $100 for services and the patient pays by credit card? | $95-$99 |
| Most of a physician's long-standing patients have a(n) ____. | open-book account |
| An initial letter of inquiry is generally sent when an account is ____ days past due | 60 |
| A written-contract account is ____. | one in which the physician and patient sign an agreement for payment installments |
Created by:
ECulversonFryer