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Lesson 14
Auditing
Question | Answer |
---|---|
1. Which one of the following choices would probably flagged during an audit? | Wrong not A |
2. You're performing an audit on patient record after the provider has already received payment. This procedure is known as a(n) | A.Retrospective |
3. Which one of the following choices is a reason that physicians offices should regularly perform internal audits | B. To ensure accuracy of documentation |
4. A private payer has denied a physician offices billing claim but did not provide a reason. What should happen next? | C. The physician office should file an appeal |
5. A patient presents with a cold. What level of risk will probably be assigned to this case? | A. minimal |
6. The medical assistant is documenting a chronological description of the development of the patients current illness. The medical assistant is probably documenting the | D. History of present illness |
7. Federal law requires that all claims paid by Medicare | B. Be medically reasonable and necessary |
8. A government investigator is performing an audit a t a physicians office to ensure that documentation and codes are complete. This procedure is known as | D. and external audit |
9. To ensure records are coded correctly, compliance plans focus on training physicians to | D. effectively use "Documentation Guidelines for Evaluation and Management Services". |
10. Which one of the following choices required compliance programs including audits, for healthcare organizations? | B. PPACA |
11. With low complexity medical decision making, how much data must be received? | B. Limited |
12. Which type of history requires a problem oriented review of systems? | B. Expanded problem focused |
13. Which one of the following choices refers to the complex of establishing a diagnosis &/or selecting a management option? | D. Medical decision making |
14. Which of the following types of history requires a pertinent social or family history | C. Detailed |
15. With a high complexity of medical decision making, what amount of data must be reviewed? | D. Extensive |
16. A patient presents in unstable condition. A code 99233 is assigned. What will probably happen with this claim? | B. It will be denied by the insurer |
17. Which codes are the ones most likely to trigger an audit? | B. E/M |
18. A medical assistant is asking the patient a series of questions to help identify the patients signs and symptoms. The medical assistant is probably documenting | C. Review of symptoms |
19. "CC: sore throat. ROS: Positive for left side throat redness and swelling". This is an example of which type of review of system? | D. problem pertinent |
20. In a single organ system psychiatric examination, what is the minimum number of detailed elements that must be identified? | C. 9 |
21. Which one of the following codes requires three key components to be documented, along with a comprehensive history and comprehensive examination? | A. 99201 |
22. If audits aren't performed on a regular basis, | C. Offices wont know if services provided are appropriate |
23. A manager wants to assess the knowledge of the coders working in the office. Which type of audit may be helpful for the manager? | A. Internal |
24. An audit performed before the billing claim has been submitted is known as | B. prospective |
25. Pertinent and complete are both examples of | D. PFSH |
26. An independent medical record review should be performed a minimum of ___________________ to identify coding and documentation errors. | C. Twice yearly |
27. Which one of the following choices is one purpose of an audit | A. to see of the healthcare organization lost money |
28. Which one of the following choices is an audit that's conducted after a claim has been paid to ensure that providers have accurately billed for a procedure or visit? | C. Retrospective |
29. "Patient complains of sore throat for the last 24 hours" is an example of | A. brief HPI |
30. A patient presents with multiple traumas and having seizures. Which level of risk will probably be assigned to this case? | D. High |
31. Which one of the following choices would probably be flagged during an audit? | WRONG not B. |