AHL 110 Final Exam
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| What is "cash flow" in a medical practice? | show 🗑
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| What level of education is generally required for one who seeks employment as an insurance coder? | show 🗑
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| show | Consideration for others.
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| Medical ethics refers to: | show 🗑
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| The earliest written code of ethical principles for the medical profession is the: | show 🗑
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| Confidential information includes: | show 🗑
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| What is the correct response when a relative calls asking about a patient? | show 🗑
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| Nonprivileged information about a patient consists of the patient's: | show 🗑
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| show | Gunshot wound cases.
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| Confidentiality is automatically waived in cases of: | show 🗑
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| show | Implied.
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| show | The physician and the patient.
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| show | A person younger than the age of 18 who lives independently.
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| show | To prevent duplication or overlapping of payments for the same medical expense.
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| Conditions that existed and were treated before the health insurance policy was issued are called: | show 🗑
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| show | S-subjective, O-objective, A-assessment, P-plan.
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| An established patient is one who: | show 🗑
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| show | Right lower quadrant.
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| When is exclusion from program participation mandatory? | show 🗑
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| All of the following cases should NOT use fax transmission: | show 🗑
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| show | High school diploma or GED.
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| show | 48-72 hours.
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| What does the abbreviation MSHP designate? | show 🗑
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| A physician's legal responsibility for his/her own actions as well as his/her employees' is called? | show 🗑
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| Administrative medical office responsibilities include: | show 🗑
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| show | The Principles of Medical Ethics.
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| Medical ____________ are not laws, but generally accepted standards of conduct. | show 🗑
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| show | Model the behavior you want from your callers.
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| Compliance is the process of: | show 🗑
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| show | E-health Information Management (eHIM).
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| show | Fraud.
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| show | To provide continuous insurance coverage for workers and their insured dependents when they change or lose jobs.
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| show | Clearinghouse.
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| If a physician contracts with an outside billing company to manage claims and accounts receivable under HIPAA guidelines, the billing company is considered: | show 🗑
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| show | Priviledged communication.
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| The Office of Civil Rights enforces: | show 🗑
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| If you give, release, or transfer information to another entity, this is known as: | show 🗑
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| show | Avoided.
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| What type of organization provides a wide range of comprehensive healthcare services for a specified group at a fixed periodic payment with an emphasis on preventive care? | show 🗑
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| show | For medical research, evaluation of hospital use, and for the process of tracking diseases.
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| show | Deductible.
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| show | It affects the physician's level of reimbursement for inpatient claims, claims can be denied, and fines or penalties can be levied.
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| A charge slip, fee ticket, and superbill are also known as: | show 🗑
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| The_______ is a concise statement describing the symptom, problem, condition, diagnosis, physician-recommended return, or other factor that is the reason for the encounter. | show 🗑
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| The ICD-9-CM is updated______ and has _______ volume(s). | show 🗑
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| show | First.
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| The main reason for a patient encounter in a doctor's office or outpatient facility is termed the: | show 🗑
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| The largest section in the CPT book is the: | show 🗑
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| show | 7-10 years.
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| The key to substantiating procedure and diagnostic code selections for proper reimbursement is: | show 🗑
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| show | Charting.
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| show | Defense of a professional liability claim and because insurance carriers require accurate documentation that supports procedure and diagnostic codes.
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| show | In the patient's medical record, in the appoitment book and on the financial record or ledger card.
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| How should an entry in a patient's medical record be corrected? | show 🗑
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| show | Morbidity.
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| show | Underlying diseases or other conditions present at the time of visit.
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| A new patient is one who: | show 🗑
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| Who may accept a subpoena? | show 🗑
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| If it was documented, it was not ________ | show 🗑
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| show | Excluded.
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| A(n) ________ is a pathalogic reaction to a drugthat occurs when appropriate doses are given to humans for prophylaxis, diagnosis, and therapy. | show 🗑
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| show | International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM)
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| show | Combination code.
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| An E code may be used in which of these circumstances: | show 🗑
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| When is the principal diagnosis applicable? | show 🗑
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| show | Volumes 1 and 2.
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| What is the table that contains a classification of substances for identifying poisoning states and external causes of adverse effects? | show 🗑
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| Carcinoma in situ is used to describe: | show 🗑
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| show | New growths, may be malignant, and they may be benign.
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| show | Life-threatening.
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| show | Sterilization.
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| Diagnostic codes have from ___ to ___ digits. | show 🗑
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| Always code to the highest degree of: | show 🗑
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| A private insurance company might adopt which of the following methods as a basis for its payment of outpatient claims? | show 🗑
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| show | Current Procedural Terminology.
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| The direct delivery by a physician(s) of medical care for a critically ill or injured patient is: | show 🗑
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| show | Postoperative visits in and out of the hospital, and digital block or topical anesthesia.
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| show | Is subject to medical review with attached information or forwarded simultaneously with electronic medical claim records.
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| What type of clean calim is any Medicare claim that contains complete, necessary information but is illogical or incorrect? | show 🗑
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| show | Private insurance carriers, Medicaid and Medicare, and worker's compensation.
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| What should you avoid using when typing a claim for scanning? | show 🗑
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| show | Electronic.
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| When two insurance policies are involved in a claim, one is considered ___ and the other is ___> | show 🗑
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| OCR guidelines for the CMS-1500 claim form state: | show 🗑
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| To conform to CMS-1500 OCR guidelines: | show 🗑
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| A health insurance claim form (CMS-1500) is known as the: | show 🗑
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| show | A physically clean claim form.
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| If you receive a request, accompanied with the correct authorization, asking to abstract medical information from a patient's medical record: | show 🗑
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| show | A dirty claim.
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| Office visits may be grouped on the insurance claim form if each visit: | show 🗑
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| How should blocks be treated on an OCR CMS-1500 claim form that do not need any information? | show 🗑
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| show | An individual who converts to standardized electronic format and transmits electronic claims data.
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| show | CPU.
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| What should you do often to prevent losing data you have entered? | show 🗑
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| The most important function of a practice management system is: | show 🗑
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| show | The Internal Revenue Service
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| A clearinghouse: | show 🗑
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| A modem is a device used to: | show 🗑
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| show | Insurance claims.
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| Another name for the multipurpose billing form is: | show 🗑
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| The insurance claim was rejected because of an incorrect modifier, so: | show 🗑
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| show | Batch.
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| Insurance claims transmitted electronically are usually paid in: | show 🗑
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| Back-up copies of office records should be stored: | show 🗑
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| Assigning a code to represent data is known as: | show 🗑
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| A combination of letters, numbers, or symbols that each individual is assigned to access the computer system is called a/an: | show 🗑
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| The diagnosis listed first in submitting insurance claims for patients seen in a physician's office is the: | show 🗑
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| show | Inpatient hospital coding.
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| show | The proper x-ray code twice and use the modifiers RT (right) with the first code and LT (left)with the second code.
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| show | Universal Claim Form.
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| show | Annually.
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| show | A physically clean claim.
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| show | Send only the th information requested.
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| show | Bundle.
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| A clearinghouse is a/an: | show 🗑
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| show | Accounts receivable.
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| If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the: | show 🗑
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| If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow is to: | show 🗑
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| What should you do if an insurance cattier requests information about another insurace carrier | show 🗑
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| show | Be less.
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| The first level of appeal in the Medicare program is: | show 🗑
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| show | Three.
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| What should be done to inform a new patient of office fees and payment policies? | show 🗑
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| show | Before any services are provided.
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| The reason for a fee reduction must be documented in the patient's: | show 🗑
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| Professional courtesy means: | show 🗑
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| When collecting fees, your goal should always be to: | show 🗑
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| show | 30, 60, 90, and 120 days.
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| show | Dun messages.
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| A significant contribution to HMO development was the: | show 🗑
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| show | Prepaid health plan.
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| show | Salary paid by independent group.
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| show | Not employees and are not paid salaries.
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| An organization that gives members freedom of choice among physicians and hospital provides a higher level of benefits if the providers listed on the plan are used is called a/an: | show 🗑
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| show | Churning.
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| Referral of a patient recommended by one specialist to another specialist is known as: | show 🗑
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| show | Collect the copayment when the patient arrives for the office visit.
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| show | Capitation.
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| show | Quality improvement organization.
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| Medicare part A is run by: | show 🗑
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| Medicare is a: | show 🗑
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| show | Once a year.
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| show | Every other year.
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| show | Eyeglasses and prescription drugs.
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| show | Identifies claims to review for medical necessity, and monitors the number of times given procedures can be billed during a specific time frame.
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| show | May act on the Medicare beneficiary's behalf as a client representative.
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| When a remittance advice (RA) is received from Medicare, the insurance billing specialist should: | show 🗑
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| show | Deposit the check and then write to Medicare to notify them of the overpayment.
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| The letter "D" following the identification number on the patient's Medicare card indicates a: | show 🗑
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| show | Set up the public assistance programs.
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| show | Medical expenses of the needy unemployed.
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| show | Require help in meeting costs of medical care.
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| The federal aspects of Medicaid are the responsibilty of the: | show 🗑
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| Medicaid is administered by the: | show 🗑
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| show | Operate with federal grant support under the Title V of the Social Security Act.
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| Medicaid is available to needy and low-income people such as: | show 🗑
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| show | The medicaid-allowed amount.
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| show | Managed care programs.
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| TRICARE, formerly known as CHAMPUS, is funded through: | show 🗑
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| show | Tricare PRIME.
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