The periodic payment the insured is required to make to keep a policy in effect

HIPAA identifies three types of covered entities

Health plans, clearinghouses, and providers

Which of the following conditions must be met before payment is made under an indemnity plan?

Payment of premium, deducible, and coinsurance

All of the following are good tips for selecting good passwords EXCEPT

Keep you password secret and never change it

Under HIPAA, patients' PHI may be shared for _________without their authorization.

Treatment, payment, and health care operations

Identify the advantages offered to patients in managed care plans, as compared to indemnity insurance

Lower premiums, charges, and deductibles

Health care claims report data to payers about __________ and ________

the patient; the services provided by the physician

Verifying insurance is part of which revenue cycle step?

Step 2, establish financial responsibility for the visit.

Review the choices below and select the most appropriate definition for health plan benefits, as defined by American's Health Insurance Plans (AHIP)

Payments for covered medical services

Describe the role of a primary care physician (PCP) in an HMO

Coordinating patients' overall care

Centers for Medicare & Medicaid Services

How is coinsurance defined?

The percentage of each claim that the insured pays

Which of the following makes it possible for physicians and health plans to exchange electronic data using a standard format?

HIPAA Electronic Transactions and Code Sets

Pick the most accurate definition of certification.

Recognition of a superior level of skill by an official organization

Name the two components of a consumer-driven health plan (CDHP)

A health plan and a special "savings account"

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MEAS 137

Mid-term {chapter 1-5}

Question	Answer
Which of the following laws prohibits submitting a fraudulent claim?	FCA
E/M is the abbreviation for	Evaluation and management
What is a premium	The periodic payment the insured is required to make to keep a policy in effect
Which of the following is a systematic, logical, and consistent recording of a patient's health status in a medical record?	Documentation
Which of the following is required when an HMO patient is admitted to the hospital for nonemergency treatment?	Preauthorization
The key receiving coverage and payment from a payer is the payer's definition of	Medical Necessity
HIPAA identifies three types of covered entities	Health plans, clearinghouses, and providers
Which of the following conditions must be met before payment is made under an indemnity plan?	Payment of premium, deducible, and coinsurance
Which of the following conditions requires a specific authorization from the patient other than for TPO	Drug abuse
All of the following are good tips for selecting good passwords EXCEPT	Keep you password secret and never change it
An indemnity policy states that the coinsurance rate is 80-20. Which of the following is the payer's portion?	80
Where do medical insurance companies summarize the payments they may make for medically necessary medical services?	Schedule of benefits document
Determine which of the following types of services a health plan will not pay for.	Noncovered services
Under HIPAA, patients' PHI may be shared for _________without their authorization.	Treatment, payment, and health care operations
Which of the following are number of predetermined length and structure, such as people's Social Security numbers?	Identifiers
NPI is the abbreviation for	National Provider Identifier
Identify the advantages offered to patients in managed care plans, as compared to indemnity insurance	Lower premiums, charges, and deductibles
What is typically required of professional organizations?	Continuing education sessions
What type of insurance reimburses income lost because of a person's inability to work?	Disability insurance
The Health Care Fraud and Abuse Control Program was created by	HIPAA
EHR is the abbreviation for	Electronic Health Record
HIPAA contains how many provisions (titles) that focus on various aspects of health care?	5
Identify the type of HMO cost-containment method that requires providers to use a formulary.	Controlling drug costs
The responsibility of licensed health care professionals to observe state medical standards of care is called	Medical professional liability
The document notifying an individual of a breach is called a	Breach notification
When a provider injures a patient due to failure to follow medical standards of care, it is called	Malpractice
Which of the following programs cover people who cannot otherwise afford medical care?	Medicaid
The most important characteristic for a medical insurance specialist to possess is	Professionalism
Health care claims report data to payers about __________ and ________	the patient; the services provided by the physician
Verifying insurance is part of which revenue cycle step?	Step 2, establish financial responsibility for the visit.
Scheduling appointments is part of which revenue cycle step?	Step 1, preregister patients
DRS is the abbreviation for	Designated Record Set
Identify another name for a point-of-service (POS) plan	open HMO
Under an indemnity plan, typically a patient may use the services of	Any provider
Review the choices below and select the most appropriate definition for health plan benefits, as defined by American's Health Insurance Plans (AHIP)	Payments for covered medical services
Which of the following is an action that misuses money that the government has allocated.	Abuse
The activity of copying files to another medium so that they will be preserved in case the originals are no longer available is	Backing up
When personal identifiers have been removed, protected health information is called	de-identified
Describe the role of a primary care physician (PCP) in an HMO	Coordinating patients' overall care
CMS stands for	Centers for Medicare & Medicaid Services
Which of the following is required for releasing protected health information for reasons other than treatment, payment, or health care operations?	Patient's signed authorization
The process of encoding information in such a way that only the person (or computer) with the key can decode it is	Encryption
How is coinsurance defined?	The percentage of each claim that the insured pays
Which of the following makes it possible for physicians and health plans to exchange electronic data using a standard format?	HIPAA Electronic Transactions and Code Sets
In what ways can insurance policies be written?	An individual or group
Which of the following require(s) CEs to establish safeguards to protect PHI?	HIPAA Security Rule
Pick the most accurate definition of certification.	Recognition of a superior level of skill by an official organization
What group is charged with detecting health care fraud and abuse?	OIG
Which of the following are organizations that work for covered entities but are not themselves covered entities?	Business associates
CE is the abbreviation for	Covered entity
Name the two components of a consumer-driven health plan (CDHP)	A health plan and a special "savings account"
What term is used to describe the action of satisfying official requirements?	Compliance
Which of the following terms means using the expertise reasonably expected of a medical professional?	Medical standards of care
In a preferred provider organization (PPO) plan, referrals to specialists are	Not required
When are covered entities required to give patients their Notice of Privacy Practice?	At the first contact or encounter
A __________ is an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of PHI	Breach
If a POS HMO member elects to receive medical services from out-of-network providers they usually	Pay an additional cost
Under a written insurance contract, the policyholder pays a premium, and the insurance company provides	Payments for covered medical services
What describes conditions that remain after a patient's acute illness or injury has ended?	Sequelae
Identify the person/entity that must authorize providers to release a patient's PHI for TPO purpose.	None of these; they do not need authorization
Under what rule is a child's primary coverage determined based upon which parent's day of birth is earlier in the calendar year?	Birthday Rule
A new patient is defined as one who has NOT seen the provider within the last	Three years
Not otherwise specified codes are used	When no other information is available for assigning the disease a more specific code.
Which of the following entities would be given a referral number by the patient?	The referred physician
In ICD-10-CM which of the following describes a subterm?	A word or phrase that describes a main term in the Alphabetic Index
Ms. Lowell arrives for an appointment on February 8, 2019. She last visited the practice on May 14, 2018, and is scheduled to see the same physician. What should you, the medical office receptionist, ask Ms. Lowell to do upon arrival?	Review and update the information on file, in case there are changes.
An alphanumeric code used to identify the external cause of an injury or poisoning	External Cause Code
Refers to a code that should be used for an incompletely described condition	Unspecified
Annual updates to the ICD-10-CM diagnostic coding system	Addenda
A three-digit code that covers a single disease or related condition	Category
An alphanumeric code used for an encounter that is not due to illness or injury	Z code
The characteristic signs or symptoms associated with a disease	Manifestation
A condition or procedure that is named for the physician who discovered it	Eponym
Typographic technique or standard practice that provides visual guidelines for understanding printed material	Convention
The medical term that identifies a disease or condition in the alphabetic index	Main term
A nonessential word or phrase that helps define a diagnosis code	Supplementary
In ICD-10-CM, the term conventions means	Typographic techniques that provide visual guidance
Which ICD-10-CM code follows that main term in the Alphabetic Index?	Default code
Which of the following is another common term for encounter forms?	All of these answers are correct {routing slips, super bills. charge slips}
What type of number is assigned to a HIPAA 270 electronic transaction?	Trace number
In ICD-10-CM, combination code is a single code that describes both	The etiology and manifestation
Which of these documents will the patient not complete?	Encounter form
In ICD-10-CM coding, when a code needs a seventh character and no sixth character exists, you need to	use a placeholder "x" in the sixth character
Which of the following provides code numbers for neoplasm based on their anatomical site and divided by the description?	Neoplasm Table
Nonessential or supplementary terms use what type of punctuation?	Parentheses
What are the procedures that ensure billable services are recorded and reported for payment called?	Charge capture
A category in ICD-10-CM is how many characters?	Three
A valid code in ICD-10-CM must have at least how many characters?	3
Updates to ICD-10-CM are called	Addenda
[Coding Step] Locate the main terms in the alphabetic index.	4
[Coding Step] Abstract the medical conditions from the visit documentation	2
[Coding Step] Review complete medical documentation	1
[Coding Step] Identify the main term for each condition	3
[Coding Step] Check compliance with any applicable official guidelines and list codes in appropriate order	6
[Coding Step] Verify the code in the tabular list	5
When a diagnosis is not established at the first visit and follow-up visits are required before determining a primary diagnosis, what should the coder do?	Code the signs and symptoms
In "Niacin deficiency [pellagra]", what do the brackets represent?	That the word PELLAGRA is a synonym, alternative word, or explanation
A provider who directly treats a patient is called a(n)	Direct provider
What does an Acknowledgment of Receipt of Notice of Privacy Practices state?	That the patient understands how the provider intends to protect their rights to privacy under HIPAA
When you see a colon (:) in the ICD-10-CM book, it informs you that	You have an incomplete term
To correctly code a situation where the counter is for circumstances other than a disease or injury you would use a(n)	Z code
Where are Inclusion notes located in ICD-10-CM?	Tabular List
What type of code is used to further define the etiology, site, or manifestation?	Subcategory
What Medicare form is used to show charges to patients for potentially non-covered services?	Advance Beneficiary Notice
The practice's rules for payment for medical services are found in their	Financial Policy
What is another name for the HIPAA Eligibility for a Health Plan transaction?	X12 270/271
Sometimes the use of a third payer is necessary after two health plans have made payments on a claim. This type of insurance is known as	Tertiary Insurance
Patients may have fill-in-the-gap insurance called	Supplemental Insurance
ICD-10-CM has ________ chapters	22
Which of the following is a definition of etiology?	Cause of origin of a disease or condition
Assignment of benefits authorization	The physician to file claims for a patient and receive direct payments from the payer.
Patients who elect to pay a higher copayment, greater coinsurance, or both, are most likely visiting a	nonPAR
You are working at a practice and have been asked to document some payer communications. Determine where the Communications should be recorded.	Financial Record
In ICD-10-CM coding the first character is a	Letter
Morvan's disease is an example of a(n)	Eponym
If a provider has agreed to accept assignment, he/she will	Accept the pater's allowed charge has payment in full.
You are working to a practice and a patient arrives fro an appointment on November 20, 2019; the patient last visited the practice on March 5, 2014, and is scheduled to see the same physician. Determine what you should ask the patient to do upon arrival.	Complete all required forms before their first encounter with the provider
ICD-10-CM diagnosis coding has a little as ________ and as many as _______ characters	three; seven
Which of the following is an index of drugs and chemicals?	Table of Drugs and Chemicals
In ICD-10-CM, what does Excludes 1 mean?	Used when two conditions could not exist together
If a patient authorizes a provider to accept assignment, what can the provider now do on their behalf?	File claims for the patient and receive payments directly from the payer
The initial step in establishing financial responsibility is to	Verify the patient's eligibility for insurance benefits
A subcategory code in ICD-10-CM is how many characters?	four to five
If a see cross reference appears after a main term, the coder	Must look up the term that follows the word see in the index
What does a provider complete during or just after a patient's visit to summarize their billing information?	Encounter Form
You are working at a practice and need to get prior approval from a payer. Which of the following HIPAA transactions would you use to do so?	Referral Certification and Authorization
As of October 1, 2015, the diagnosis codes that must be used in the United States are based on which of the following revisions of the International Classification of Diseases (ICD)?	10th Revision
Under CPT's definition, who takes responsibility for the patient's care after a referral?	The physician to whom the patient is referred
In CPT, E/M is the abbreviation for Evaluation and	Management
The term __________ refers to using a single payment for two or more related procedure codes.	Bundling
Routine annual physical examinations are reported using which type of E/M codes?	Preventive medicine service codes
Which of the following regulates which tests can be completed in an in-office laboratory setting?	CLIA
Which of the following is the best process to correctly select CPT codes?	Determine the procedures and services to report, identify the correct codes, and determine the need for modifiers
Which of the following is used with an anesthesia code to indicate to a patient's health status?	Physical status modifiers
Under CPT guidelines, all services related to a surgical procedure are not additionally reimbursed	During the global period
Which of the following are used to report services not completely described by any code within a section?	Unlisted procedure codes
What was set up to give health care providers a coding system that describes specific products, supplies, and services that patients receive?	HCPCS
When selecting an E/M for the Emergency Department the coder needs to know	None of these are determining factors in E/M emergency department coding [If the patient is established, what time the patient came to the emergency department, if the patient is new]
How many CPT codes are required to report an immunization?	Two
A __________ is a procedure that is usually part of a surgical package but may also be performed separately	Separate procedure
When listing multiple procedures, the coder should	List the most complex code first
In CPT, a single code grouping laboratory tests is called a(n)	Panel
Unbundling is	Separately reporting anything that is included in the bundled code
Durable medical equipment (DME), such as wheelchairs, is reported using	HCPCS Code
How many digits are in Category I codes?	Five
In CPT, a plus sign (+) next to a code indicated a(n)	Add-on-code
Which of the following is the HIPAA Mandated code set for physician's procedures and services?	CPT
Codes in CPT's Anesthesia section generally cover	All of these are correct [Routine postoperative care, Care during the procedure, Preoperative evaluation and planning]
CPT codes from the Anesthesia section have what two type of modifiers?	Standard modifiers and physical status modifiers
When selecting an Evaluation and Management code, three components are considered: the type of history, the physical examination, and the	Medical Decision Making
How many parts do radiological procedures have?	Two
In CPT, what do Category III codes report?	Emerging technology, services, and procedures
The last step in the coding process is	Determine the need for modifiers
The E/M coding method came from the	Joint effort of CMS and AMA
In CPT, a lightning bolt symbol next to a code indicates a(n)	Code pending FDA approval
Of the four type of examinations that a physician can perform, which level is the most complete?	Comprehensive
In CPT, some codes have both a technical component and another component representing the physician's skill, time, and expertise. What is the name of the other component?	Professional
Which of the following is not a main term in the CPT index?	All of theses are main term [Anatomical site of the procedure, Eponyms, Abbreviations]
With E/M coding, physicians must	All of these are needed [Gather information, Analyze, Make decision]
Level I codes in the Health Care Common Procedure Coding System (HCPCS) are	Current procedural terminology (CPT) codes
In what order should these codes be reported? 11100 for a skin biopsy and +11101 for the biology of an additional lesion	11100, +11101
CPT codes are used to report the following	All of these are reported by CPT [Surgical procedures, Diagnostic procedures, Medical services]
CPT is a publication of the	American Medical Association (AMA)
A complete procedure includes all the following except	Postoperative Complications
In CPT, what do Category II codes report?	Services to track performance measurements
In CPT, what do facing triangles that appear in front of a code indicate?	New/revised text other than a code descriptor
CPT Level I modifiers are made up of how many digits?	Two digits
Which symbol is used to designate a code's descriptor has changed?	A triangle
In CPT, what type of code is described by the following entry? +33884 each additional proximal extension (List separately in addition to code for primary procedure).	Add-on code
In CPT, the term _________ describes services that a provider performs at the request of another provider after which the patient is returned to the requesting provider's care.	Consultation
What kinds of services support treatment, like rehabilitation, occupational therapy, and nutrition therapy?	Ancillary Service
STEPS OF CODING PROCESS 1	Review the documentation of the patient's visit
STEPS OF CODING PROCESS 2	Append a modifier to the code as necessary
STEPS OF CODING PROCESS 3	Identify a main term for each procedure reported on the claim
STEPS OF CODING PROCESS 4	Review the possible code assignments and verify the correct assignment for the claim
STEPS OF CODING PROCESS 5	Locate the procedures in the index of CPT
STEPS OF CODING PROCESS 6	Determine which procedures may be reported and charge to the patient account
REVENUE CYCLE 1	Preregister patients
REVENUE CYCLE 2	Establish financial responsibility
REVENUE CYCLE 3	Check-in patients
REVENUE CYCLE 4	Review coding compliance
REVENUE CYCLE 5	Review billing compliance
REVENUE CYCLE 6	Check-out patients
REVENUE CYCLE 7	Prepare and transmit claims
REVENUE CYCLE 8	Monitor pater adjudication
REVENUE CYCLE 9	Generate patient statements
REVENUE CYCLE 10	Follow-up payment and collections
Which symbol is used to indicate a new procedure code?	A bullet or solid circle
Which symbol is used to enclose new revised text other than the code's descriptor?	Facing triangles
Which symbol is used next to a code in the main text?	A plus sign
Which symbol is used to indicate telemedicine?	A star
Which symbol is used for vaccines that are pending FDA approval?	Lightning bolt
Which symbol is used to indicate a resequenced code?	Number sign
P1	Normal healthy patient
P2	Patient with mild systemic disease
P3	Patient with severe systemic disease
P4	Patient with severe systemic disease that is a constant threat to life
P5	Moribund patient who is not expected to survive
P6	Declare brain-dead patient

Created by: Mariana_Flores22

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