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Medical Billing Codi
Medical Billing and Coding
| Question | Answer |
|---|---|
| Dr. Smith doesn't want to handle the claims process at her office. Instead, she'll probably use a | CBO |
| Physicians and nurses comprise ______ percent of all healthcare providers | 40 |
| If a receptionist and medical biller are cross-trained for different positions, they probably work for a | private practice |
| Which one of the following certifications states that the person is qualified to verify completeness of patient medical records? A) RHIT B) CCA C) NCMOA D) CPC-H | A) RHIT |
| Which one of the following choices may be an offsite service that handles a hospital's claims and accounts receivable? A) PPO B) HCA C) PAS D) CBO | D) CBO |
| One of your jobs is to make contractual adjustments to patient accounts. You may work as a | payment poster |
| Which one of the following choices is an organization that awards professional certifications? A) RHIT B) OSHA C) PAS D) NCCT | D) NCCT |
| Part of your job is to ensure that you determine the patient's responsibility for charges before the patient receives treatment. You may work as a(n) | Insurance verification representative |
| Which of the following certifications would be good for a student coming out of college and entering the coding field? A) CCA B) CCS-P C) CCS D) CPC | A) CCA |
| Which one of the following professionals probably has the most face to face contact with patients? A) Privacy compliance officer B) Refund specialist C) Admitting clerk D) Insurance Verification representative | C) Admitting clerk |
| Which one of the following choices is an important reason to become a member in a professional organization? A) it guarantees highter pay B) you'll receive a professional credential C) it gets you published in a professional publication D) it helps ke | D) It helps keep you current in your field |
| A patient's family has a question about a DNR order. Most likely, the family would speak to the hospital's | Privacy compliance officer |
| Which one of the following certifications is awarded through AHIMA? A) CPC-A B) CMRS C) CMAA D) CCS-P | D) CCS-P |
| Which one of the following choices was an outcome of managed care for physicians? A) Financial stress B) Less Staff C) Higher payments D) Decrease in patients | A) Financial Stress |
| You're a hospital medical coder who passed a certified medical coder exam, but you have no experience. What certification might you be awarded? | CPC-H-A |
| A specialist who is the general cashier who must have a complete understanding of the Explanation of Benefits documents? | Payment poster |
| It's recommended that you join at least ____ professional membership(s) in your field to indicate that you're involved and dedicated to the profession. | One |
| Which one of the following terms refers to monitored health care? A) HIPPA B) Multispecialty practice C) Verification representation D) Managed Care | D) Managed care |
| You pay additional expenses to cover the huge medical expenses that aren't covered by your normal policy. Which type of insurance do you have? | Major medical |
| When multiple doctors become employees of a group practice and contract with an MCO to deliver health care to members of the network, they're probably participating in an ___ model | Group |
| Delivering high-quality care that manages costs is a goal of ? | Managed care |
| When a physician agrees to accept a payment directly from the patient's insurer, it's called? | assignment of benefits |
| Healthcare plans administered by a TPA are typically which type of plan? | Self-insured plan |
| The specified amount of out of pocket medical expenses that the insured pays annually before the health insurance policy provides coverage is called the? | Deductible |
| You have to pay $250 before your insurance begins. This amount is known as the? | Deductible |
| In UCR fees, the portion that's based on what doctors with similar training charge in a specific area is known as the ___ fee | customary |
| Options available through managed care organizations include the preferred provided organization (PPO), the point of service plan (POS), and the _____ | health maintenance organization (HMO) |
| Which one of the following types of insurance is considered some of the least expensive insurance? A) Medical B) Surgical C) Special Risk D) Catastrophic | D) Catastrophic |
| Which one of the following outcomes was a result of physicians being excessively sued? A) Ordering of extra tests and treatments so the physician could protect himself B) The creation of copayments C) Lower premiums to prove that physicians were ethica | A) Ordering of extra tests and treatments so the physician could protect himself |
| In 1982, which one of the following choices made it easier for HMOs to work with Medicare? A) HIPPA B) HMO Act C) NCQA D) TEFRA | D) TEFRA |
| Which one of the following choices can increase costs in managed care? A) Point of sercive care B) Referrals C) Preauthorizations D) Coinsurance | C) Preauthorizations |
| A regularly scheduled payment made to purchase an insurance policy is known as the ____ | Premium |
| Which one of the following choices is a disadvantage of managed care? A) MCO may suggest a plan of care that differs from the physicians plan B) MCOs make extensive use of healthcare professionals C) Data gathered from the MCO is analyzed for clinical | A) MCO may suggest a plan of care that differs from the physician's plan |
| When an MCO keeps a percentage of a physicians revenue until year end, it's referred to as | pay for performance |
| How do you determine how much a carrier is responsible for paying? | Subtract the unpaid deductible or copay from the write off amount |
| A policyholder may also be called a | Member |
| Under a capitated agreement, the primary care provider is compensated based on | |
| Managed care contracts contain a list of medical services covered in the contract under the | Schedule of benefits |
| You work in a health care organization where you see the Privacy Rule repeatedly being violated. You can file a complaint with the | OCR |
| Which one of the following choices may use PHI to better understand and review product recall situations? A) CMS B) HIPPA C) HITECH D) FDA | D) FDA |
| Requires than an MCO plan being reviewed for accreditation demonstrates that it has done a thorough credentialing process for providers? | NCQA |
| Identifies employer-sponsored health insurance? | EIN |
| What is the key element of any managed care contract? | Compensation for services |
| The primary intent of HIPPA is to provide better access to health insurance, to reduce administrative costs, and to | limit fraud and abuse |
| Each managed care contract has its own authorization and claims requirements, as well as its own | list of participating providers |
| As a medical office specialist, you may be required to | review MCO contracts |
| Procedures that document how to handle security breaches of patient information are an example of | administrative safeguards |
| Resources that are required for adequate health care are referred to as | medically efficient |
| One of the ways that medical office specialists can demonstrate ethical behavior is to | document, sign, and date all conversations with the patient immediately |
| Which part of an MCO contract should contain a list of CPT codes and the rate for those services? | Covered medical expenses |
| If someone obtains PHI under false pretenses, he or she may receive a penalty of up to | $50,000 |
| You had an appointment with Dr. Smith for an illness, but Dr. Smith isn't a provider within the MCO. Dr. Smith is known as a(n) | non-PAR |
| A hospital has just signed a contract with a managed care organization. The hospital is known as the | PAR |
| What is the main reason that privacy complaints are filed? | A patient can't gain access to his or her record |
| After the provider credentialing process, the MCO | decides, if it wants to contract with the provider |
| Assign only a ____ code when that code fully identifies the diagnostic conditions involved | combination |
| You're looking up the code for congenital hydrocephalus in ICD-10-CM so you can assign the code. You notice this note below the code: "Excludes 1: Acquired Hydrocephalus". What does this note tell you? | Never code congenital and acquired hydrocephalus together |
| You're reviewing ICD-10-CM dignosis codes and see a "-" at the end of the alphabetic index entry. You know that this means you must | add the required additional characters to the end of the code |
| The ____ instruction following a main term in the Alphabetic Index indicates that another term must be referenced | "see" |
| When researching the diagnosis, condition, or symptom, the main term will be _____ followed by a code | in boldface type |
| ____ are the terms in parantheses following the main term entry | Nonessential modifiers |
| You just assigned the code A02.21 for acute myleoid leukemia in remission. Which coding classification system are you using? | ICD-10-CM |
| When a treatment or diagnostic statement from a physician is too general or does not match the descriptions in the ICD-10_CM manual, the coder need to | investigate and get the information necessary to code correctly |
| You're using the ICD-10-PCS to code procedures for patients. You probably work in a(n) | hospital |
| The abbreviation ______ is the equivalent of unspecified | NOS |
| What punctuation mark is used after an incomplete phrase or term that requires one or more of the modifiers indented under it to make it assignable to a given category? | : |
| The code next to the main term is called the _____ code | default |
| The term ____ should be interpreted to mean "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. | "with" |
| The term ___ is used for all settings, including hospital admissions | encounter |
| Adherence to ICD-10-CM guidelines is required by | HIPPA |
| A code is considered ____ if it has not been coded to the full number of characters required. | invalid |
| When coding with ICD-10-CM, which step should you perform first? | Identify the reason for the encounter |
| The ____ provides the proper code based upon the histology of a neoplasm and anatomical site | Neoplasm Table |
| In ICD-10-CM, when are three-character codes used? | When there are no further subdivisions |
| The code for excision of thoracic vertebral disc starts with | 0RB9 |
| In code 02703ZZ for PTCA of one coronary artery, which character tells us that there was no device and no qualifier for this procedure? | ZZ |
| The first digit of an ICD-10-PCS code always reflects the | category |
| The first three digits of the code for a hysterectomy that was a resection of the uterus is | 0UT9 |
| In the code 0T910ZX, which character tells us that it is a code about the urinary system? | T |
| In code 0SRB04Z, what type of substitute was used? | Ceramic on Polyethylene |
| The code for laparoscopic (percutaneous endoscopic approach) appendectomy is | 0DTJ4ZZ |
| A code that begins with 0HT tells us that the procedure | is a medical or surgical resection of the skin or breast |
| An ICD-10-PCS code that starts with "0" tells the coder that | the procedure is a medical or surgical procedure |
| A coder needs to provide the updated ICD-10-PCS code for an ICD-9-CM code. What should the coder use? | Mapping Software |
| Referring to the index of the coding book, what page references specifically left breast repair? | 763 |
| What other terms could a coder use for graft when using the ICD-10-PCS coding book index | Replacement |
| A coder looked up the phrase ligation of hemorrhoids in the coding book. What's another valid way to look up this procedure in the coding book? | Occlusion, lower veins, hemorrhoidal plexus |
| A patient has carpel tunnel syndrome on her right hand. She had a release of the carpal via a percutaneous approach. The correct ICD-10-PCS diagnosis code is probably | 0PNM4ZZ |
| In code 02703ZZ for PTCA, which of the following characters tells us that it was a percutaneous approach? | 3 |
| In the code 0T910ZX, which character tells us that the procedure is on the left kidney? | 1 |
| What is the correct code for destruction of the prostate via natural opening? | 0V507ZZ |
| A patient had a closed percutaneous liver biopsy for the purpose of helping diagnose a disease. Which code should be assigned? | 0FB03ZX |
| What group was required to have ICD-10-PCS implemented by October 1, 2015? | HIPPA covered entities |
Created by:
AKoger