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NCCT Nancy practice
| Question | Answer |
|---|---|
| 1. What is an advance beneficiary notice or ABN? | a consent that identifies services not covered by patients insurance in which they will be responsible for payment |
| 2. Which is established in advance and based on reported health care charges from which a predetermined per diem rate is determined? | Prospective cost-based rate |
| 3. which is a form required by medicare for all outpatients and physician office procedures /services that are not covered by the medicare program? | advance beneficiary notice |
| 4. | Employee is injured when picking up reports for the office at the local hospital |
| 5. Which is associated with "last resort" health insurance for individual who cannot obtain coverage due to a serious medical condition? | high-risk pool |
| 6. The primary benefit of an __ filing system is that it distributes files evenly over given spaces. | numeric |
| 7. Which is the special group that requires states to pay medicare part B premiums for individuals with incomes between 120 percent and 175 percent for the federal poverty level? | Qualifying Individual |
| 8. A health maintenance organization is an alternative to traditional group health including coverage and provides comprehensive health care services to voluntarily enrolled members on a ____ basis. | prepaid |
| 9. Which consist of routine pediatric checkups provided to all children enrolled in medicaid, including dental, hearing, vision, and other screening services to detect potential problems. | Early and periodic screening diagnostic and treatment |
| 10. Which include sponsors and dependents of sponsors? | |
| 11. Which program pays for inpatient hospital critical care access, skilled nursing facility stays hospice care, and some home health care? | Medicare Part A |
| 12. A managed care network of physician and hospital the that joined together to contract with insurance companies, employers, or other organizations to provide health care to subscribers for a discounted fee is called an | preferred provider organization |
| 13. Which is the former name for Tricare standard ? | CHAMPUS |
| 14. Which party sign a contract with a health insurance company and thus, owns the health insurance policy? | Policyholder |
| 15. a new HIM director was recently hired at a hospital. she was advised her health insurance benefits become available in 90 days. which of the following is correct regarding her health insurance? | she will be able to keep her current medical insurance from her previous job through COBRA |
| 16. TRICARE _____ are uniformed service personnel who are either active duty, retired or deceased. | sponsors |
| 17. A patient does not need to provide signed consent for the medical office to release information about: | a public health risk |
| 18. what is an authorization for release of medical information? | a consent to release medical information to third party payers |
| 19. which is a quasi-public agency that provides workers compensation insurance coverage to private and public and acts as an agent in state workers compensation cases involving state employees? | State Insurance (or Compensation) Fund |
| 20. The triple option plan can also be known as the cafeteria plan or a ______. | Flexible benefit plan |
| 21. Which part of the SOAP note contains the diagnosis statement and may include the physician's rationale for the diagnosis? | Assessment |
| 22. When using the EHR to schedule a patient visit, which of the following screens should be used to complete the scheduling process? | patient search screen |
| 23. Which of the following is an objective statement? | The patients heart rate is elevated at 120 beats per minute |
| 24. What is the ninth step in the billing revenue cycle? | Generate patient statements |
| 25. What is the sixth step in the billing revenue cycle? | Billing compliance |
| 26. Which part of the SOAP note contains the chief complaint and the patients description of the presenting problem? | Subjective |
| 27. Which part of the SOAP note contains documentation of measurable observations made by a health care provider during the physical examination and diagnostic testing? | Objective |
| 28. when filing alphabetically: | Hyphenated surnames and Hyphenated firm names are indexed as one unit |
| 29. When reviewing the charges for a patient procedure using computer assisted coding software (CAC) the insurance and coding specialist should first _____. | review the chart for needed information |
| 30. The main disadvantage of single-booking is that: | if patients problems are easily addressed, there may be gaps in the schedule |
| 31. Which of the following contains a patients name, services rendered, charge, payment and balance? | Ledgers |
| 32. got it alreadt | $4,624.71 |
| 33. The administrative medical assistant is responsible for preparing deposits and reconciling ________. | Bank statements |
| 34. Computerized accounting systems: | Automatically update records as information is entered into the system |
| 35. When an entry is made on the dayshift, it is called? | Journalizing |
| 36. Funds containing small amounts of cash used for minor expenses is called the _______. | Petty cash |
| 37. Which of the following must be verified to process a credit card transaction? | -Account number -Credit card number -Security codes |
| 38. The insurance and coding specialist calls a carrier to verify a patients insurance and the representative states that the patient insurance was canceled was three months ago. which of the following should the insurance and coding specialist do first? | Ask the patient for another form of insurance coverage |
| 39. Which of the following processes makes a final determination for payment in an appeal board? | Adjudication |
| 40. Which of the following items must be included in patient financial policies? | -Expectation of payment due at time of service -statement that responsibility for payment lies with patient -collection process |
| 41. There are two main types of bookkeeping single method entry and _____ method? | double |
| 42. To help a patient develop a payment plan for elective surgery, the medical assistant should: | Review insurance coverage with the patient |
| 43. When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claims? | physician's office fee |
| 44. A ___ indicates that the amount paid is less than the total due? | debit balance |
| 45. Which of the following is an appropriate way to open the discussion when explaining practice fees to a patient? | "do you have any questions about the cost of todays visit? |
| 46. Define accounts payable? | The total amount owned by the practice to suppliers and other service providers for regular business operating expenses. |
| 47. Which of the following fees posted to the patients account is an example of "usual customary, and reasonable" | Allowed amount |
| 48. Which is the insurance responsible for paying health care insurance claims first? | Primary insurance |
| 49. A new patient is one who has not received any professional services the physician, or from another physician of the same specialty who belongs to the same group practice, within the past ______ years | Three |
| 50. Where is the first-listed diagnosis reported on the CMS-1500 claim? | Block 21A |
| 51. Based on the CMS manual system, when updating pr maintaining the billing code date-based. which of the following does the "R" denote? | Revised |
| 52. A physician performed a bilateral L4/L5 laminectomy on a patient in an ambulatory surgical center. which of the following place of service codes should be used on the CMS 1500? | 24 |
| 53. An insurance and coding specialist is reviewing a patients encounter form that is documented in the record prior to completing a CMS-1500 form.she notices that the physician uncoded the encounter form. the specialist has the ethical obligation to 1st | Query the physician |
| 54. When should a provider have a patient sign an ABN? | When the items may denied and prior to performing the service |
| 55. What is the most common medical documentation format? | SOAP |
| 56. Diagnosis pointer A-L are repainted in block 21 of the CMS-1500 claim to allow for entry of ___ codes, and they are reported in Block 24E. | ICD-10-CM |
| 57. Medical practice and health care facilities should routinely participate in an auditing process, which involves reviewing patient records and CMS-1500 or UB-04 claims to_____. | assess coding accuracy and completeness of documentation |
| 58. The most effective method to manage patient statement and other financial invoices as well as avoid payment delays is to _______. | Collect fees at time of service |
| 59. Which is associated with a particular category of patient and is established by the payer prior to the provision of health care services? | prospective price-based rate |
| 60. The procedure or services provided is linked with the ____ that provided medical necessity for performing the procedure or service. | Diagnosis |
| 61. if a provider refuses to accept assignment , when must the patient pay for service? | Upon denial of insurance payment |
| 62. What does the abbreviation CHEDDAR stand for? | C-chief complaint H-history of previous illness, E-everyday duties, D-details of problems and complaints, D-drugs and dosages, A-assessment, R-Referrals |
| 63. What is the ICD-10-CM code for a patient that has a personal history of breast cancer? | Z85.3 |
| 64. what is the ICD-10-CM code for benign neoplasm of the skin of the left leg? | D23.72 |
| 65. What category does the most common joint disorder, osteoarthritis, fall under? | M15-M19 |
| 66. What is the ICD-10-CM code for diverticulosis with diverticulitis ? | K57.90, K57.92 |
| 67. When the word and appears in ICD-10-CM tabular list category titles and code descriptions, it is interpreted as meaning? | and/or |
| 68. What is the ICD-10-CM code for a fever, unspecified? | R50.9 |
| 69. in the ICD-10-CM chapter 13: disease of the musculoskeletal and connective, tissue, what does a 7th extension used to report? | The phase of the treatment for a pathological fracture |
| 70. The patient diagnosis is vesicoureteral reflux with nephropathy and chronic obstructive pyelonephritis due to E-coli infraction. which of the following ICD-10-CM codes should be assigned? | N13.729,N11.1,B96.20 |
| 71. The patient returned to the operative suite 10 days postoperative for an I&D due to a postoperative infection. the final lab results discover the organism is pseudomonas mallei. which is the following is the appropriate ICD-10_CM code? | T81.4XXA, A24.0 |
| 72. What symbol , or placeholder is used a code that requires a 7th character to fill in any empty characters? | An "X" |
| 73. What are the two sections of the ICD-10-CM? | The Alphabetic and the Tabular list |
| 74. A patient is diagnosed with diverticulitis of the small intestine , with perforation and abscess with bleeding, what is the appropriate ICD-10-CM code? | K57.01 |
| 75. Which ICD-10-CM category describe migraines? | G43 |
| 78. What is considered the first trimester of pregnancy? | Less than 14 weeks 0 days |
| 79. ICD-10-CM codes require up to ____ characters are entirely alphanumeric and have unique coding conventions such as excludes 1 and excludes 2. | Seven |
| 80. When Coding burns, what must a coder do? | Sequence first code the reflect the highest degree of burn when more than one burn is present |
| 81. Eighteen hours following the delivery of her baby, a female patient who has been discharged suffers atonic hemorrhage. which ICD-10-CM code should be assigned? | O72.1 |
| 82. A 43. year old established patient presented to the office for his annual visit. the physician performed a comprehensive history and exam. the physician wrote a refill for chronic condition od diabetes mellitus and hypertension. which code? | 99396,Z00.00, E11.9 |
| 83. What is the CPT or HCPCS level II modifier for "surgical team? | 66 |
| 84. HCPCS level II modifiers are attached to any CPT and/Or HCPCS level II codes to? | Justify the procedure |
| 85. What is the correct code for : Nebulizer with compressor | This code Is unlisted |
| 86. What is the CPT and HCPCS level II modifier for : "Decision for surgery" | 57 |
| 87. HCPCS level II ___ codes reported when a DMEPOS dealer submits a claim for a product or service for which there is no existing HCPCS level II code. | miscellaneous |
| 88. What is the correct code : power wheelchair accessory , lithium based batter each | E2336 |
| 89. What is the CPT code for Gross examination ? | 88300 |
| 90. What is the CPT code for reporting once for the testing of up to three separate specimens? | 82270 |
| 91. What is the CPT code for incision and drainage of an infected thyrodglossal duct cyst? | 60000 |
| 92. What is the CPT E/M code for initial inpatient neonatal critical care, per day, for the evaluation and management of a critical ill neonate , 20 days of age or younger? | 99468 |
| 93. What is the correct code for the fine needle aspiration of the breast without imaging? | 10021 |
| 94. What are the category codes of the CPT manual? | Category I, category II, category III |
| 95. The intestinal procedures in the CPT section do NOT represents which body organ that is also in the digestive system ? | |
| 96. What two items are needed to correctly code for the local treatment of a burn | Percentage of body surface area and depth of burn |
| 97. Which type of procedure or service code is assigned when the provider performs a procedure or service for which there is no CPT code? | unlisted code |
| 98. What do many pathology and laboratory CPT codes describe? | A panel of tests |
| 99. What does the acronym :"SNF" stand for? | Skilled Nursing Facility |
| 100. What is observation care? | When patients need to be monitored closely to determine discharge status |
| 101. What does quantitative testing determine? | Presence of a drug, as well as exact amount present |
| 102. A thoracotomy procedure was performed for a repair of hemorrhage and lung tear, what is the CPT code? | 32110 |
| 103. What is the E/M code for an established patient, with an expanded problem focused history, and expanded problem focused examination, and MDM of low complexity? | 99213 |
| 104. Most CPT procedures and services are classified as __ codes which include a compete description of the procedure or service | Stand-alone |
| 105. what is the CPT code for foreskin manipulation for the penis | 54450 |
| 106. if a routine chest x-ray is performed with a preventative medicine exam what is the situation coded with? | Z code |
| 107. When using an unlisted code for a procedure what must accompany a claim? | special report |
| 108. which modifier can most likely trigger and adult? | (-22) |
| 110. what is the CPT codes for intubation of a newborn? | 31500 |
| 111. Which of the following is an example of abuse? | billing non covered service / procedure as covered service/procedures |
| 112. The shark law was enacted to govern the practice of? | Physician referrals to facilities that she has a financial interest in |
| 113. Physician offices should bond employees who have which responsibility? | financial |
| 114. Workers compensation laws protect the employer by | Limiting the award an injured employee can recover from an employer |
| 115. In the context of communication __ may be considered as the awareness of ones one feelings and the feeling of others | perception |
| 116. Who perform audits and investigates fraudulent activities to protect the integrity of the medicare and medicaid programs? | OIG, office of inspector general |
| 117. Breach of confidentiality information to the patients insurance company. | Discussing patient healthcare information with unauthorized source |
| 118. When patients arrive at the office, the administrative medical assistant should: | explain all instructions thoroughly |
| 119. During a telephone screening you should not: | Paraphrases the callers description of his or her symptoms |
| 120. Which of the following is an example of fraud? | Falsifying certificates of medical necessity plans of treatment |
| 121. The fair debt collection practices act restricts debt collectors from engaging in conduct that includes: | Calling before 8:00AM or After 9:00 PM. unless permission is given |
| 122. What act states that are obligated to provide emergency medical access to all regardless of their ability to pay? | Emergency medical treatment and labor act |
| 123. Laws that are implemented as guidelines written by administrative agencies such as CMS are called: | regulations |
| 124. Veterans who died on duty with less than 30 days of active service | CHAMPVA |
| 125. which of the folioing Is commonly considered a positive gesture? | Giving the thumbs up |
Created by:
Lech8670