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 BILLING AND CODING FINAL QUESTIONS
| Question | Answer |
|---|---|
| MED112 PRACTICE CODING BILLING FINAL | |
| What is the definition of revenue cycle? | all administrative and clinical functions which ensure that sufficient monies flow into the practice to pay bills |
| What is a premium | the periodic payment the insured is required to make to keep a policy in effect |
| Health care claims report data to payers about _______ and _______. | the patient; the services provided by the physician |
| If a POS HMO member elects to receive medical services from out-of-network providers, they usually pay | an additional cost. |
| Under a capitated rate for each plan member, which of the following does a provider share with the third-party payer? | risk |
| Patients who enroll in a point-of-service type of HMO may use the services of: | HMO network or out-of-network providers |
| A progress report documents a patient's | Type of treatment still needed and duration |
| HIPPA contains how many provisions (titles) that focus on various aspects of health care? | 5 |
| The electronic equivalent of a business document is called a(n) | transaction |
| _________ make(s) it possible for physicians and health plans to exchange electronic data using a standard format. | HIPPA Electronic Transactions and Code Sets |
| The abbreviation for treatment, payment, and health care operation is | TPO |
| Which agency advises against using a patients name in the body of a medical report? | association for health care documentation integrity (AHDI) |
| The _________ make(s) it illegal to knowingly offer incentives to induce referrals. | antikickback statute |
| According to the OIG compliance plans should contain how many elements? | seven |
| The federal agency that runs Medicare and Medicaid is | CMS |
| When personal identifiers have been removed, protected health information is called | de-identified |
| What makes it possible for physicians and health plans to exchange electronic data using a standard format and standard code sets? | the HIPPA electronic health care trans actions and code sets (TCS) |
| Which law makes it illegal for physicians to have financial relationships with clinics to which they refer patients? | stark rules |
| Where is an assignment of benefits statement filed? | patient medical records and patient billing records |
| The initial step in establishing financial responsibility is to | verify the patient's eligibility for insurance benefits |
| What is another name for the HIPPA eligibility for a health plan transaction? | X12 270/271 |
| You are working at a practice and need to get a prior approval from a payer. Which of the following HIPPA transactions would you use to do so? | referral certification and authorization |
| 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 | the patients plan |
| 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: | the employer's plan |
| What information must be documented in the patient's financial record when communicating with payer? | the representatives name, date of communication, and outcome |
| What type of questions should physicians be asked regarding billing and coding issues? | essential |
| What must patients who are members of CDHPs do before their health plan makes a payment? | meet a large deductible |
| Updates to ICD-10-CM are called | addenda |
| The alphabetic index is organized by | condition |
| What does the instruction "use additional code" tell the coder? | the order of the codes must be the same as shown in the alphabetic index |
| Chronic diseases treated on an ongoing basis may be coded | as many times as the patient receives treatment |
| The final step in coding would be to | check compliance with official guidelines |
| What is required of the physician in order to report the professional component of a CPT code from the radiology section? | reading the radiological examination and writing a report of interpretation |
| What kinds of services support treatment, like rehabilitation, occupational therapy, and nutrition therapy? | ancillary services |
| How many CPT codes are required to report an immunization? | two |
| The evaluation and management section was first introduced in what year? | 1992 |
| Under a contracted fee schedule, the allowed amount and the provider's charge are | the same |
| The ____ lists the types of medical billing and reporting practices that the office of inspector general intends to investigate in the coming year | OIG work plan |
| Which term refers to the payer's review and reduction of a procedure code? | downcoding |
| Medical practices use ______ aids to help them in the billing and coding process. | job reference |
| Which three factors are built into the resource-based fee structure? | difficulty of procedure, office overhead, risk of procedure |
| Assume that three providers are indicated for a claim for lab services. A clearinghouse is the billing provider and the physician practice is the pay-to provider. What type of provider is the laboratory? | the rendering provider |
| Name the POS code used to indicate a procedure occurred in an on campus-outpatient hospital. | 22 |
| What is the payer's responsibility sequence number for the payer of last resort? | T |
| When nonspecific procedure codes such as unlisted CPT codes are used, the claim must contain: | service-line level description of the work drug/dosage |
| Self-funded health plans pay premiums to | no one because they assume the risk |
| What is the electronic format used to verify benefits? | HIPPA 270/271 |
| Patients with end-stage renal disease (ESRD) are entitled to Medicare benefits until | as long as they receive dialysis or a renal transplant |
| The deductible for Medicare Part B is | set each year |
| Medicare Part B beneficiaries pay a monthly premium that is calculated based on | Social Security benefit rates |
| CWF is the abbreviation for | Common Working File |
| NCD is the abbreviation for | National Coverage Determination |
| Under the Affordable Care Act, when must Medicare Part B providers file their claims? | within one calendar year after the date of service |
| Anyone over age 65 who receives Social Security benefits is automatically enrolled in ____ and eligible for ____. | Medicare Part A; Medicare Part B |
| Services supervised by the physician but provided by non-physician practitioners are billed under | incident-to rules |
| Patients receive a _____ that details the services they were provided over a thirty-day period, the amounts charged, and the amounts they may be billed. | Medicare Summary Notice |
| EPSDT is the abbreviation for | Early and Periodic Screening, Diagnosis, and Treatment |
| The _____ established the Temporary Assistance for Needy Families program. | Welfare Reform Act |
| Medicaid's spenddown program is in effect on a ____ basis. | state-by-state |
| Restricted status refers to a category of: | Medicaid beneficiary |
| A Medi-Medi beneficiary is an individual eligible for _____. | coverage from both Medicaid and Medicare |
| NMEH is the abbreviation for | National Medicaid EDI HIPAA Workgroup |
| Under which program does Medicaid provide preventive services to children under age 21? | EPSDT |
| In ____ status, the patient is required to see a specific physician and/or use a specific pharmacy. | restricted |
| Most states are moving to electronic verification of Medicaid eligibility under ____. | Electronic Medicaid Eligibility Verification System (EMEVS) |
| Name the Department of Defense's health insurance plan for military personnel and their families. | TRICARE |
| Where are most CHAMPVA claims submitted? | the centralized CHAMPVA claims processing center |
| After discharging a workers' compensation for a patient to go back to work, the provider must file | a final report |
| Who requests an IME? | the state workers' compensation office |
| FDCPA is the abbreviation for | Fair Debt Collection Practices Act |
| The ________ processes is used to locate a patient who owes an account balance to the practice. | skip tracing |
| The practice's policy about keeping records is summarized in a ____, a list of the items from a record that are retained and for how long. | retention schedule |
| OPPS is the abbreviation for | Outpatient Prospective Payment System |
| The UB-04 form is also identified as the ___ form. | CMS-1450 |
| Which term describes the patient's condition upon hospital admission? | admitting diagnosis |
| In an HMO with a gatekeeper system, a(n) __________ coordinates the patient's care and provides referrals. | PCP |
| What combines a health plan that has a high deductible and low premiums with a special "savings account" that is used to pay medical bills before the deductible has been met? | CDHP |
| Health plans pay for _____ services. | Covered |
| In an HMO, securing _____ may be required before services are provided. | Preauthorization |
| A self-insured health plan may use its own | Funds |
| Unlike an HMO, a PPO permits its members to use ____ providers, but at a higher cost. | Out of Network |
| The major government-sponsored health programs are | TRICARE, CHAMPVA, Medicare, and Medicaid |
| Coinsurance is calculated based on | A percentage of charge |
| If a patient's payment is later than permitted under the financial policy of the practice, the ____ may be started. | Collection process |
| Patients' PHI may be released without authorization to | Employers in workers compensation cases |
| A Notice of Privacy Practices is given to | A practice's patients |
| Which government group has the authority to enforce the HIPAA Privacy Rule? | OCR |
| Health information that does not identify an individual is referred to as | De-identified health information |
| The authorization to release information must specify | The entity to whom the information is to be released. |
| The main purpose of the HIPAA Security Rule is to | Control the confidentiality and integrity of and access to protected health information |
| A compliance plan contains | Consistent written policies and procedures. |
| A patient's group insurance number written on the patient information or update form must match | The number on the patient's insurance card |
| What information does a patient information form gather? | The patient's personal information, employment data, and insurance information |
| If a husband has an insurance policy but is also eligible for benefits as a dependent under his wife's insurance policy, the wife's policy is considered __________ for him. | Secondary |
| A certification number for a procedure is the result of which transaction and process? | Referral and authorization |
| A practice's rules for payment for medical services are found in its | Financial policy |
| The encounter form is a source of ___ information for the medical insurance specialist. | Billing |
| Under Medicare, what must a provider receive before it is permitted to collect a deductible or any other payment? | Data on how the claim is going to be paid |
| Which charges are usually collected at the time of service? | Copayments, noncovered or overlimit fees, charges of nonparticipating providers, and charges for self-pay patients |
| The tertiary insurance pays | After the first and second payers. |
| The ____ provides an index of the disease descriptions that are found in the second major part of ICD-10-CM. | Alphabetic Index |
| The ICD-10-CM updates released by the National Center for Health Statistics are called ____ | Addenda |
| The ICD-10-CM code set contains approximately ____ codes, making it much larger than ICD-9-CM. | 70,000 |
| _______ are used to report encounters for circumstances other than a disease or injury in ICD-10-CM. | Z codes |
| ICD-10-CM uses _____ to indicate an incomplete term. | Colons |
| Which of the following is not a further breakdown of a disease that may be provided by a subcategory? | Sequela |
| Typographic techniques that provide visual guidance for understanding information and help coders to understand rules and select the right code are known as _____ in ICD-10-CM. | Conventions |
| Tay-Sachs disease is an example of a(n) ______. | Eponym |
| The abbreviation ______ is used with a term when there is no code that is specific for the condition. | NEC |
| Identify the correct structure of Category II codes in CPT | four digits followed by an alphabetical character |
| When a physician asks a patient questions to obtain an inventory of constitutional symptoms and of the various body systems, the results are documented as the | review of systems. |
| Temporary codes for drugs and medical equipment are what type of HCPCS codes? | Q codes |
| The three key factors in selecting an Evaluation and Management code are | history, examination, and medical decision making. |
| CPT code 99382 is an example of | a preventive medicine service code |
| When a Surgery section code has a plus sign next to it, | it cannot be reported as a stand-alone code. |
| When a panel code from the Pathology and Laboratory section is reported | all the listed tests must have been performed. |
| In calculations of RBRVS fees, the three relative value units are multiplied by | their respective geographic practice cost indices. |
| Medicare typically pays for what percentage of the allowed charge? | 80 percent |
| If a participating provider's usual fee is $400 and the allowed amount is $350, what amount is written off? | $50 |
| Physicians establish a list of their usual fees for | the procedures and services they frequently perform |
| An encounter form containing E/M codes should list | the complete ranges of codes for each type or place of service listed |
| Identify the correct structure of Category II codes in CPT. | four digits followed by an alphabetical character |
| The NPI is used to report the __________ on a claim. | provider identifier |
| On HIPAA claims, a required data element | must be supplied. |
| The HIPAA X12 276/277 Health Care Claim Status Inquiry/Response transaction is used to | ask about the status of claims that have been transmitted. |
| How many diagnosis code pointers can be assigned to a procedure code? | four |
| The largest employer-sponsored health program in the United States is | Federal Employees Health Benefits program. |
| In employer-sponsored health plans, employees may choose their plan during the | open enrollment period. |
| If a nonparticipating provider's usual fee is $400, the allowed amount is $350, and balance billing is not permitted, what amount is written off? | $50 |
| The content of claims and the healthcare provider taxonomy codes are set by | NUCC. |
| The number of the HIPAA Professional claim transaction is | X12 837P. |
| If a physician practice sends claims directly to a payer and receives payments directly, which of these entities does not need to be additionally reported? | pay-to provider |
| The POS code for a military treatment facility is | 26 |
| Which laws govern the portability of health insurance? | COBRA and HIPAA |
| Self-funded health plans are regulated by | ERISA |
| BlueCross BlueShield Association member plans offer | all major types of health plans. |
| Emergency surgery usually requires | precertification (preauthorization) within a specified time after the procedure |
| Providers who participate in a PPO are paid | Discounted fee-for-service |
| Under a capitated HMO plan, the physician practice receives | a monthly enrollment list. |
| What document is researched to uncover rules for private payers' definitions of insurance-related terms? | participation contract |
| Consumer-driven health plans have what effect on a practice's cash flow? | A high-deductible payment from the patient takes longer to collect than does a copayment. |
| Medicare Part A covers | hospital services |
| The Original Medicare Plan requires a premium, a deductible, and | coinsurance. |
| Which modifier indicates that a signed ABN is on file? | GA |
| Under Medicare's global surgical package regulations, a physician may bill separately for | diagnostic tests required to determine the need for surgery. |
| On claims, CMS will not accept signatures that | use signature stamps |
| Under Medicare Advantage, a PPO ___ an HMO | is less restrictive than |
| Under the Medicare Part B traditional fee-for-service plan, Medicare pays ____ percent of the allowed charges. | 80 |
| Medicare Part D covers | prescription drugs |
| Medicare medical review is conducted by | MAC |
| Applicants who have high medical bills and whose incomes exceed state limits may be eligible for health care coverage under a state ____ program. | medically needy |
| Under the Federal Medicaid Assistance Program, the federal government makes payment directly to | states. |
| Most individuals receiving TANF payments are limited to a ___-year benefit period. | five |
| Under Medicaid, optional services commonly include | prosthetic devices |
| People classified as restricted status | must see a specific provider for treatment |
| If family planning services are provided to a patient, what data element is affected? | family planning indicator |
| If services were provided in an emergency room, what place of service code is reported (Hint: Refer to Appendix A)? | 23 |
| The Medicaid Alliance for Program Safeguards | oversees states' fraud and abuse efforts |
| The national committee to coordinate Medicaid data elements on health care claims is called | NMEH |
| To provide services to Medicaid recipients, physicians must sign a contract with the | HHS |
| The TRICARE plan that is an HMO and requires a PCM is | TRICARE Prime. |
| _______ receive priority at military treatment facilities. | Active-duty service members |
| A TRICARE For Life beneficiary must be at least ____ years old. | sixty-five |
| TRICARE Prime is available to those eligible within _____ miles of a Primary Care Manager. | 100 |
| A person enrolled in CHAMPVA is responsible for____ percent of covered charges. | 25 |
| Once an application for Social Security Disability Insurance (SSDI) is filed, there is a _____ waiting period before benefits begin. | five month |
| Nonparticipating TRICARE providers cannot bill for more than _____ percent of allowable charges. | 115 |
| Active-duty service members are automatically enrolled in | TRICARE Prime. |
| For individuals enrolled in TRICARE For Life, the primary payer is | Medicare. |
| Decisions about an individual's eligibility for TRICARE are made by the | branch of military service. |
| A _____ is a denial of employer liability issued by the workers' compensation insurance carrier. | Notice of Contest |
| An individual with a disability described as precluding heavy work has lost _____ of the capacity to push, pull, bend, stoop, and climb. | 50 percent |
| Before an injured employee can return to work, a physician must write | a final report. |
| _____ provides workers' compensation insurance coverage to employees of the federal government. | Federal Employees' Compensation Act (FECA) |
| The classifications of pain used in workers' compensation claims are | minimal, slight, moderate, severe. |
| A disability that limits a worker to jobs that are performed in an upright or walking position and that require no more than minimal effort is classified as | limitation to light work. |
| Vocational rehabilitation programs provide _____ for individuals with job-related disabilities. | training in a different job |
| For a widow or widower age fifty years or older who is disabled to qualify for Social Security Disability Insurance (SSDI), his or her spouse must have paid into Social Security for at least | ten years. |
| An employee who believes the work environment to be dangerous may file a complaint with the | Occupational Safety and Health Administration. |
| A payer's initial processing of a claim screens for | basic errors in claim data or missing information. |
| Some automated edits are for | patient eligibility, duplicate claims, and noncovered services |
| A claim may be downcoded because | the documentation does not justify the level of service |
| Payers should comply with the required | claim turnaround time |
| What is the next step after the primary payer's RA has been posted when a patient has additional insurance coverage? | billing the second payer |
| Appeals must always be filed | within a specified time |
| Determine what should be verified after an RA has been checked for the patient's name, account number, insurance number, and date of service. | all billed CPT codes are listed |
| If a patient has secondary insurance under a spouse's plan, what information is needed before transmitting a claim to the secondary plan? | RA data |
| What type of codes explain Medicare payment decisions? | (Memorandum of Agreement (MOA) |
| When talking with someone other than the patient about an overdue bill, collections specialists will | not discuss the patient's debt. |
| The day sheet produced by the practice management program shows | the payments and charges that occurred on that date. |
| During collections, most practices use | letters and calls |
| Credit bureaus keep records about a patient's | credit information |
| Collection calls are regulated by the guidelines set by | FDCPA. |
| Accounts might be considered uncollectible when a patient | files for bankruptcy. |
| Skip tracing increases the practice's chances of | locating a patient with an overdue bill. |
| The practice will need to pay patient refunds if it has | overcharged the patient for a service. |
| The patient aging report is used to | collect overdue accounts from patients. |
| Bad debt is defined as | uncollectible A/R. |
| When the hospital staff collects data on a patient who is being admitted for services, the process is called | registration. |
| Patient charges in hospitals vary according to | their accommodations and services |
| What rule governs the reporting of hospital inpatient services on insurance claims? | UHDDS |
| Conditions that arise during the patient's hospital stay as a result of surgery or treatments are called | complications. |
| In inpatient coding, the initials CC mean | Comorbidities and Complications |
| The code 02103D4 is an example of which type of code? | ICD-10-PCS |
| Under a prospective payment system, payments for services are | set in advance. |
| The UB-04 form locator 4 requires the | type of bill. |
| Under Medicare rules for patients in car accidents, the automobile insurance is | primary. |
Created by:
C to the C
Popular Medical sets