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EHR week/4
Week/4 EHR assignment questions.
| Question | Answer |
|---|---|
| How many time is a patient entered into the Patient List or Master Patient index? | Only once, which accounts for documentations for each office visit. |
| What identifying information differentiates one patient from another and is collected as part of administrative information? | Demographics |
| The common abbreviation for chest x-ray is? | CXR |
| If a fracture is not documented as closed or open, it is always coded as? | Closed |
| What is meant by "code to the highest level of specificity?" | Using the most specific code possible. |
| A code that reports more than one diagnoses in one code is called a _________________ code? | Combination |
| The biggest advantage of voice recognition software over manual transcription is? | The speed of documentation. |
| There must be a ________________ to preform any test or treatments. | Order by the care provider |
| The use of ePrescribing is part of ;the requirement for? | Hippa |
| Notes about a prescription ordered for a patient would appear in the ____________ of a SOAP note. | Plan |
| On a prescription bottle, the 'SIG" is which part of the prescription? | The instructions on taking the medication. |
| Who manages a personal health record (PHI)? | The individual |
| In using an EHR, the word "cloning" refers to? | Copy and pasting notes from the patient's previous visits into the current progress notes. |
| What contains codes for certain products, supplies and services that do not appear in the CPT manual? | HCPCS |
| Codes that identify the procedures performed for a patient are called? | CPT codes |
| The first three factors a coder must consider when coding are patient status, pace of service and ? | Type of service |
| The anesthesia section in the E/M codes is used for the following types of anesthesia: local, regional and ______________ anesthesia. | general |
| Providers who had not adopted an EHR system by 2014 were subject to? | Financial penalties |
| What is a legal doctrine which holds that medical services rendered must be reasonable and necessary to generally accepted clinical standards? | Medical Necessity |
| Which of the following CPT conventions indicates the code description is revised? | Blue Triangle |
| Multigravida is a term associated with? | Pregnancy |
| A log that contains information about the prescription order and is used to document the administration of the medication to the patient is called? | Medication Administration Record |
| What is essential to proper E/M code assignment? | Documentation |
| Most often refers to (care) in a hospital, where patients are treated with urgent problems, that cannot be handled otherwise is called? | Acute care |
| What refers to treatment without admission to a hospital? | Ambulatory care |
| Where are patients listed/entered only once with allows for the documentation of all office visits? | Master Patient Index (MPI) |
| What is the method of scheduling a patient for a specific appointment time? | Fixed appointment scheduling |
| What is the method of scheduling patients around the same block of time? | Cluster scheduling |
| What method is it when patients are scheduled for the first half of each hour, and each patient is seen in the order they arrive? | Wave scheduling |
| What part of the SOAP note is it added to when a care provider gathers information from performing a physical exam? | ASSESSMENT |
| What is it called when offices charge fees based on a patient's financial ability? | Sliding Fee Scale |
| An element of the user interface on which the user can click to execute a command such as confirm, cancel or exit? | Button |
| For whatever reason, what must be documented in the patients medical record? | Making corrections in/on the appointment schedule |
| An EHR specialist will call the insurance company prior to what? | Scheduling hospital services and admissions. |
| The EHR specialist must ensure that each part of the ____________ is accurate, and up to date. | Medical record |
| Family members covered by parents insurance plan is called what? | Dependents |
| A condition named for a person-such as Hodgkin's disease is? | Eponym |
| Conditions that remain after a patient's acute illness or injury has ended, could be called residual effects or late effects. | Sequelae |
| Physicians, hospitals and other suppliers that furnish care or supplies to patients are called? | Providers |
| What does a beneficiary pay? | deductible, premiums, co-insurance (20%) non-covered services |
| Medicare pays | Covered services 80% |
| What are EHRC specialist job duties? | Submitting insurance claim forms, patient check in and check out, insurance verification and scheduling appointments. |
| what information is essential for an EHR specialist to collect at the time of an appointment? | Correct spelling of patients full name, address, telephone number, reason for visit and type of insurance. |
Created by:
Healthtrade