Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
MED112 CODE/BILL
MED112 PRACTICE FOR FINAL (MULT CHOICE)
| Question | Answer |
|---|---|
| MED112 PRACTICE FINAL | |
| A billing service sending a claim is likely to be the: A. destination payer B. referring provider C. billing provider D. pay-to provider | C. billing provider |
| What type of coding uses a procedure code that provides a higher reimbursement rate than the correct code? A. truncated coding B. assumption coding C. upcoding D. downcoding | C. upcoding |
| What is the primary cause of rising medical costs in the United States? A. an aging population B . increase use of alternative treatments C. advances in drug therapies D. too many network providers | A. an aging population |
| Which of the following entities does not make up the trillion-dollar healthcare industry? A. insurance companies B doctors C. hospitals D. banks | D. banks |
| In a medical practice, cash flow is required to A. pay for office expenses B. pay for hospital supplies C. pay for nursing home employees D. pay for the staff of an insurance company | A. pay for office expenses |
| Spending on healthcare is A. rising B. decreasing C. staying in the same coverage D. self-insured coverage | A. rising |
| What type of insurance reimburses income lost because of a person's inability to work? A. disability insurance B. standard medical insurance C. medically necessity coverage D. self-insured coverage | A. disability insurance |
| Out-of-pocket expenses must be paid by: A. the provider B. the insured C. the health plan D. the insurance company | B. the insured |
| Calculate the amount of money a patient would owe for a covered service costing $1,200 if their indemnity policy has a coinsurance rate of 75-25, and they have already met their deductible. A. $0 B. $300 C. $900 D. $1,200 | B. $300 |
| Calculate the amount of money a patient would owe for a non-covered service costing $900 if their indemnity policy has a coinsurance rate of 80-20, and they have already met their deductible A. $0 B. $180 C. $720 D. $900 | D. $900 |
| Calculate the amount of money a patient would owe for a covered service costing $1,800 if their indemnity policy has a $400 deductible (which has not been met) and their coinsurance rate is 80-20. A. $280 B. $680 C. $1,400 D. $1,800 | B. $680 |
| How is coinsurance defined? A. the periodic payment the insured is required to make to keep a policy in effect B. the amount that the insured pays on covered services before benefits begin C. the percentage of each claim that the insured pays D. a prepayment covering provider's services for a plan member for a specified period | C. the percentage of each claim that the insured pays |
| What is a premium? A. the periodic payment the insured is required to make to keep a policy in effect B. the amount that the insured pays on covered services before benefits begin C. the percentage of each claim that the insured pays D. a prepayment covering provider's services for a plan member for a specified period | A. the periodic payment the insured is required to make to keep a policy in effect |
| Healthcare claims report data to payers about _____ and _____. A. the patient; the physician B. the patient; the services provided by the physician C. the physician; the services provided by the physician D. the service; the deductible | B. the patient; the services provided by the physician |
| In what format are healthcare claims sent? A. only electronic B. only hard copy C. electronic and hard copy D. claims do not need to be sent | C. electronic and hard copy |
| A progress report documents a patient's A. chief complaint B. history of present illness C. past medical history D. type of treatment still needed and duration | A. chief complaint |
| An encounter is defined as a A. face-to-face meeting between a provider and a patient B. meeting between an clinician and a patient C. face-to-face meeting between an administrator and a patient D. phone call between a provider and a patient | A. face-to-face meeting between a provider and a patient |
| In a SOAP format, which of the following is information from the patient? A. subjective B. objective C. assessment D. plan | A. subjective |
| HIPAA contains how many provisions (titles) that focus on various aspects of healthcare? A. 2 B. 3 C. 4 D. 5 | D. 5 |
| SOAP is the abbreviation for which of the following? A. subjective/objective/analysis/plan B. subjective/objective/assessment/plan C. subjective/operative/analysis/plan D. subjective/operative/assessment/plan | B. subjective/objective/assessment/plan |
| E/M is the abbreviation for: A. examination and management B. evaluation and management C. examination and medical history D. evaluation and medical history | B. evaluation and management |
| EHR is the abbreviation for A. electronic health record B. emergency health record C. elective health record D. examined health record | A. electronic health record |
| Electronic health records are considered to have significant advantages including all of the following except: A. clinical decision support B. electronic communication C. patient support D. reduces cost | A. clinical decision support |
| CMS stands for A. Centers of Medical Services B. Center of Medicare Services C. Centers for Medicare & Medicaid services D. Center for Medicaid Services | C. Centers for Medicare & Medicaid Services |
| HIPAA is the abbreviation for the A. Health Insurance Portability and Accountability Act B. Health Insurance Privacy and Accountability Act C. Health Insurance Portability and Access Act D. Health Insurance Privacy and Access Act | A. Health Insurance Portability and Accountability Act |
| A(n) _______ can be used by providers to transmit claims in the proper format for carriers. A. business associate B. clearinghouse C. electronic data interchange D. health plan | B. clearinghouse |
| _____ make(s) it possible for physicians and health plan to exchange electronic data using a standard format. A. HIPAA electronic transactions and code set B. HIPAA privacy rule C. HIPAA security rule D. HIPAA | B. HIPAA privacy rule |
| _______ regulate(s) the use and disclosure of patient's protected health information. A. HIPAA electronic transactions and code set B. HIPAA privacy rule C. HIPAA security rule D. HIPAA | A. HIPAA electronic transactions and code set |
| PHI is the abbreviation for A. patient health information B. patient history information C. protected health information D. protected history information | C. protected health information |
| When leaving a message on a patient's answering machine, what is to be followed? A. no message should be left B. compliance plans policy C. minimum necessary standard D. data record set restrictions | B. compliance plans policy |
| A _____ is a person who makes an accusation of fraud or abuse. A. qui tam B. relator C. stark D. whistle-blower | A. qui tam |
| An established patient is defined as one who has seen the provider within the last A. one year B. two years C. three years D. four years | C. three years |
| A new patient is defined as one who has NOT seen the provider within the last A. one year B. two years C. three years D. four years | C. three years |
| You are working in a practice and a patient arrives for an appointment on February 8,2016; the patient last visited the practice on May 14,2013 and is scheduled to see the same physician. Determine what you should ask the patient to do upon arrival. A. complete many forms before their encounter with the provider B. review and update the information that is on file about them C. the patient may see the physician without reviewing their information D. call insurance company to verify coverage | B. review and update the information that is on file about them |
| Another term for the insured is: A. subscriber B. established patient C. new patient D. parent | A. subscriber |
| A patient arrives for an appointment and you need to locate his insurance information. You would use which of the following documents to find it? A. notice of privacy practices B. acknowledgment of receipt for privacy practices C. patient information form D. medical history form | C. patient information form |
| A patient's insurance card usually shows: A. the name of the payer's representative B. the former employee's name C. the data the policyholder first paid a premium or copayment D. member identification number | D. member identification number |
| Which of these documents will the patient not complete? A. assignment of benefits B. medical history C. patient information form D. encounter form | D. encounter form |
| What type of information is not found on an insurance card? A. member name B. member identification number C. group identification number D. the date the policyholder first paid a premium | D. the date the policyholder first paid a premium |
| Determine how a policyholder can authorize physicians to submit claims on their behalf and receive payments directly from payers. A. signing and dating an assignment of benefits statement B. completing the patient information form C. providing a copy of their insurance card D. providing a copy of their driver's license | A. signing and dating an assignment of benefits statement |
| What does an acknowledgment of receipt of notice of privacy practices state? A. that the patient understands how the provider intends to protect their rights to privacy under HIPAA B. that the doctor will contact the patient if insurance company wants medical records C. that the patient understands the practice's financial policy D. that medical records cannot be released without consent for any reason | A. that the patient understands how the provider intends to protect their rights to privacy under HIPAA |
| Who should the front desk at a medical office ask abut whether any of their pertinent personal or insurance information has changed? A. new patients B. established patients C. referring providers D. direct providers | B. established patients |
| Eligibility for Medicaid may change as quick as: A. daily B. weekly C. monthly D. yearly | C. monthly |
| A patient presents for an appointment, and you must locate the information about their health plan. Determine where this information should be located. A. patient's information form and insurance card B. patients insurance card only C. patient's signed acknowledgement of receipt of notice of privacy practice D. patient's health survey and patient information form | A. patient's information form and insurance card |
| If an employed patient has coverage under two insurance plans, one from a current employer and one from a previous employer, the primary plan is: A. the current employer's plan B. the plan in effect for the patient the longest C. the previous employer's plan D. either plan, depending on coverage | C. the previous employer's pan |
| If a patient has coverage under two insurance plans, one under which the patient is the policyholder and one under which the patient is a dependent, the primary plan is: A. the spouse's plan B. the plan in effect for the patient the longest C. the patient's plan D. either plan, depending on coverage | C. the patient's plan |
| If an employed patient has coverage under two issuance plans, one the employer's plan and the other a government plan, the primary plan is: A. the government plan B. the plan in effect for the patient the longest C. the plan with the lowest premium D. the employer's plan | D. the employer's plan |
| If a retired patient with Medicare also has coverage under a working spouse's plan, the primary plan is: A. Medicare B. the plan in effect for the longest C. the plan with the lowest premium D. the spouse's plan | D. the spouse's plan |
| Under what rule is a child's primary coverage under the father's plan when both parents have coverage? A. birthday rule B. gender rule C. parent plan D. custody plan | A. birthday rule |
| What does COB stand for in medical insurance forms? A. collection of benefits B. coordination of benefits C. coordination of businesses D. collection of businesses | B. coordination of benefits |
| ICD-10-CM diagnosis coding has as little as _____ and as many as _____ characters. A. 1 to 5 B. 3 to 7 C. 1 to 7 D. 3 to 5 | B. three to seven |
| What of the following is a listing of the disease alphabetically? A. Tabular List B. Index to External Causes C. Alphabetic Index D. Convention | C. Alphabetic Index |
| Which of the following is made up of 21 chapters of disease descriptions and their codes? A. Tabular List B. Index to External Causes C. Alphabetic Index D. Neoplasm Table | A. Tabular List |
| Which of the following is a table format of to identify poisoning and external causes of adverse effects? A. Hypertension Table B. Neoplasm Table C. Index to External Causes D. Table of Drugs and Chemicals | D. Table of Drugs and Chemicals |
| The physician's description of the main reason for a patient encounter is called: A. chief complaint B. typographic technique that provides visual guidance C. diagnostic statement D. a convention | C. diagnostic statement |
| In order to correctly code a disease or diagnosis you must first look in the _____ index and then confirm in the ____ index. A. alphabetic; tabular B. tabular: alphabetic C. index to external cause; tabular D. neoplasm; alphabetic | A. alphabetic; tabular |
| Which member of the medical practice is unlimited responsible for proper documentation and correct coding? A. registered nurse B. medical coder C. physician D. all of these are correct | D. all of these are correct |
| What type of coding uses a lower level code? A. truncated coding B. assumption coding C. upcoding D. downcoding | C. upcoding |
| Routinely waiving deductibles and copayments is: A. legal B. illegal C. common practice D. okay for medicare patients only | B. illegal |
| You need to send a claim to a payer who does not accept who does not accept electronic claims. Identify the claim from you would use to send a paper claim. A. 837 claim B. CMS-1500 claim C. HIPAA claim D. EDI claim | B. CMS-1500 claim |
| Which describes the meaning of transaction "837P" A. hospital B. any provider C. professional D. insurance companies | C. professional |
| Under HIPAA, payers may not. A. refuse to accept the standard transactions B. restrict what clearinghouse used C. restrict what the PMP office uses D. delay payment of a non-compliant claims | A. refuse to accept the standard transactions |
| You are completing a CMS-1500 and realize that a husband had additional coverage under his wife's policy. Determine where you would record the wife's name on the CMS-1500 for the additional insurance. A. Item number 8 B. item number 9 C. item number 10a-10c D. item number 11d | B. item number 9 |
| The insured's ID number is the A. identification number of the policy holder B. physician's NPI C. payer's identification number D. physician's legal number | A. identification number of the policy holder |
| Section 24 of the CMS-1500 records service line info, which contains the A. diagnoses made by the physician B. procedures performed for the patient C. patient's name and address D. referring provider NPI number | B. procedures performed for the patient |
| Determine where you would report a service that was performed by an outside laboratory on the CMS-1500. A. item number 19 B. item number 20 C. item number 21 D. item number 22 | B. item number 20 |
| Medicaid beneficiaries must meet A. minimum federal requirements B. state requirements C. both minimum federal requirements as well as any additional state requirements D. either the federal or state requirements | C. both minimum federal requirements as well as any additional state requirements |
| A person eligible for for medicaid in a given state is A. also eligible in all states that border that state B. also eligible in any of the other 50 states C. not necessarily eligible in all other states D. medicaid is a federal program so each state does not matter | C. not necessarily eligible in all other states |
| Categorically needy people int the Medicaid program usually have A. low incomes B. high incomes C. low debt D. high debt | A. low incomes |
| CHIP is the abbreviation for A. children's health insurance plan B. children's health insurance program C. children's helping insurance plan D. children's helping insurance program | B. children's health insurance program |
| TANF is the abbreviation for A. temporary assistance for needy families B. transitory assistance for needy families C. temporary aid for needy families D. transitory aid for needy families | A. temporary assistance for needy families |
| The temporary assistance for needy families provides which of the following? A. free prescriptions to beneficiaries B. free medical supplies C. financial assistance to beneficiaries D. transportation to medical appointments | D. transportation to medical appointments |
| The affordable care act is expected to add how many million people into the Medicaid program? A. 1 million B. 5 million C. 10 million D. 16 million | D. 16 million |
| Children under _____ years old who meet TANF requirements must be offered state Medicaid benefits. A. 18 B. 14 C. 12 D. 6 | D. 6 |
| Which of the following is NOT offered under the Medicaid program? A. comprehensive health insurance coverage, cosmetic procedures, and free prescription are offered to pregnant women whose family income is below 133 percent of the poverty level B. people who receive foster care under title IV-E of the Social Security Act C. infants born to Medicaid-eligible pregnant women D. people who are age sixty-five and over who receive supplemental security income | A. comprehensive health insurance coverage, cosmetic procedures, and free prescription are offered to pregnant women whose family income is below 133 percent of the poverty level |
| The welfare reform act of ____ tightens Medicaid eligibility requirements. A. 1990 B. 1996 C. 2000 D. 2008 | B. 1996 |
| Under the medicaid program which of the following is true? A. categorically needy and medically needy have the same meaning B. categorically needy refers to people with high medical expenses C. medically needy means people have low income D. categorically needy and medically needy do not have the same meaning | D. categorically needy and medically needy do not have the same meaning |
| Patients with end-stage renal disease are entitled to Medicare benefits until: A. they reach the age of 30 B. they reach the age of 65 C. after reaching the age 65 D. they can be any age as long as they receive dialysis | D. they can be any age as long as they receive dialysis |
| ______ adults may be eligible for Medicare benefits. A. disabled B. homeless C. lower income D. incarcerated | A. disabled |
| Hospital benefits are provided under: A. Medicare part A B. Medicare part B C. Medicare part C D. Medicare part D | A. Medicare part A |
| Outpatient hospital benefits are provided under: A. Medicare part A B. Medicare part B C. Medicare part C D. Medicare part D | B. Medicare part B |
| Hospice care is covered under: A. Medicare part A B Medicare part B C. Medicare part C D. Medicare part D | A. Medicare part A |
| Home healthcare is covered under: A. Medicare part A B. Medicare part B C. Medicare part C D. Medicare part D | A. Medicare part A |
| The deductible for Medicare part A is: A. there is not a deductible B. set each year C. based on the national debt D. tied to the benefit period | B. set each year |
| The deductible for Medicare part B is: A. there is not a deductible B. set each year C. based on the national debt D. tied to the benefit period | B. set each year |
| Which of the following is also called supplemental medical insurance? A. Medicare part A B. Medicare part B C. Medicare part C D. Medicare part D | C. Medicare part C |
| Which Medicare part offers a prescription drug plan? A. Medicare part A B. Medicare part B C. Medicare part C D. Medicare part D | D. Medicare part D |
| How many preventive physical exams does Medicare cover? A. one initially B. one annually C. one every two years D. this is not covered exam | C. one every two years |
| A screening service is defined as one that is: A. done when the patient has a long history of disease that is being screened B. done to discover if a patient has a diagnosed disease that is progressing C. done to discover if a patient has an undiagnosed disease D. to check for family history | C. done to discover if a patient has an undiagnosed disease |
| How many CMS regional offices are there? A. eight B. ten C. twelve D. fourteen | B. Ten |
| Which of the following is excluded from Medicare coverage? A. glaucoma screening B. HIV testing C. routine dental examinations D. tobacco cessation counseling | C. routine dental examinations |
| Which of the following is excluded under Medicare? A. bone mass measurements B. cosmetic surgery C. screening for alcohol misuse D. influenza vaccination | B. cosmetic surgery |
| Which of the following is excluded under Medicare? A. cardiovascular disease screening blood tests B. counseling for obesity C. medical nutritional therapy for beneficiaries with diabetes D. routine medical appliances | D. routine medical appliances |
| ABN is the abbreviation for: A. absolute beneficiary notification B. advance beneficiary notification C. annual beneficiary notification D. applicable beneficiary notification | B. advance beneficiary notification |
| Which of the following statements is true? A. Physicians who do not participate in the Medicare program agree to accept the Medicare Fee Schedule charge amount as full payment for services B. Physicians who do no participate in the Medicare program do not accept the Medicare Fee Schedule charge amount as full payment for services. C. Physicians must accept Medicare patients, per federal state | B. Physicians who do no participate in the Medicare program do not accept the Medicare Fee Schedule charge amount as full payment for services. |
| Which of the following statements is correct? A. Physicians who do not participate in the Medicare may decide whether to accept assignment on a claim-by-claim basis. B. Physicians who participate in Medicare may decide whether to accept assignment on a claim-by-claim basis. C. Physicians will receive the same amount of reimbursement regardless if they participate in the Medicare program or not D. Physicians must accept the Medicare patients, per federal statute | A. Physicians who do not participate in the Medicare may decide whether to accept assignment on a claim-by-claim basis. |
| The Medicare program: A. directly pays the claims submitted by providers B. directly pays the Medicare beneficiary C. employs MACs to pay the claims submitted by providers D. employs MACs to pay the Medicare beneficiary | C. employs MACs to pay the claims submitted by providers |
| Supplemental insurance plans for Medicare beneficiaries provide additional coverage for an individual receiving benefits under which Medicare Part? A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D | C. Medicare Part C |
| What type of coding uses a lower level code? A. truncated coding B. assumption coding C. upcoding D. downcoding | D. downcoding |
Created by:
C to the C
Popular Medical sets