MEDICAL CODING AND BILLING

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1. 

WHAT IS THE PROGRAM MANDATED BY FEDERAL AND STATE GOVERNMENT THAT REQUIRES EMPLOYERS TO COVER MEDICAL EXPENSES AND LOSS OF WAGES FOR WORKERS WHO ARE INJURED ON THE JOB?

-WAGNER NATIONAL HEALTH ACT

-WORKER COMPENSATION

-HILL BURTON ACT

-BLUE CROSS BLUE SHIELD

 
WORKERS COMPENSATION
 
2. 

ACCORDING TO THE US CENSUS BUREAU DATA FROM 2005 WHAT % OF PEOPLE IN THE UNITED STATES ARE COVERED BY GOVERNMENT PLANS(MEDICARE, MEDICAID)

-9%

-27%

-60%

-45%

 
27%
 
3. 

WHICH ACT MANDATES REGULATIONS THAT GOVERN PRIVACY, SECURITY AND ELECTRONIC TRANSACTIONS STANDARDS FOR HEALTH CARE INFORMATION.

-ADMINISTRATIVE COMPLIANCE ACT

-HIPPA

-BALANCED BUDGET ACT

TEFRA

 
HIPPA
 
4. 

THE FIRST BLUE SHIELD PLAN WAS FOUNDED IN?

-MICHIGAN

-CALIFORNIA

-CONNECTICUT

-OHIO

 
CALIFORNIA
 
5. 

A SUCCESSFUL HEALTH INSURANCE SPECIALIST SHOULD HAVE WHICH OF THE FOLLOWING CHARACTERISTICS?

-WORK INDEPENDANTLY

-ATTENTION TO DETAILS

-ETHICS

-ALL OF THE ABOVE

 
ALL OF THE ABOVE
 
6. 

REIMBURSEMENT FOR INCOME LOST AS A RESULT OF TEMPORARY/PERMANENT ILLNESS OR INJURY IS:

-LIABILITY INSURANCE

-RELIABILITY INSURANCE

-DISABILITY INSURANCE

--NONE OF THE ABOVE

 
DISABILITY INSURANCE
 
7. 

WHAT DOES CPT STAND FOR?

-CODES POSTED VIA TELEPHONE

-CLINICAL PROCEDURE TESTS

-CURRENT PROCEDURAL TERMINOLOGY

-NONE OF THE ABOVE

 
CURRENT PROCEDURAL TERMINOLOGY
 
8. 

DISABILITY INSURANCE PROVIDES THE DISABLED PERSON WTIH FINANCIAL ASSISTANCE BUT DOESNT GENERALLY PAY FOR

-MEDICAL SERVICES-

-UNEMPLOYMENT INSURANCE BENEFITS

- BOTH

-NEITHER

 
BOTH MEDICAL SERVICES AND UNEMPLOYMENT INSURANCE BENEFITS
 
9. 

WHICH OF THE FOLLOWING IS NOT A PROFESSIONAL ASSOCIATION FOR HEALTH INSURANCE SPECIALIST

-AMERICAN ACADEMY OF CODERS

-AMERICAN MEDICAL ASSOCIATION

-AMERICAN HEALTH MANAGEMENT

 
AMERICAN MEDICAL ASSOCIATION
 
10. 

ICD-9CM STANDS FOR

 
INTERNATIONAL CLASSIFICATION OF DISEASES-9TH REVISION , CLINICAL MODIFICATION
 
11. 

IF THE INSURANCE PLAN HAS A HOLD HARMLESS CLAUSE; IT MEANS

 
PATIENT IS NOT RESPONSIBLE FOR PAYING WHAT THE INSURANCE PLAN DENIES
 
12. 
HEALTH CARE COVERAGE AVAILABLE THROUGH EMPLOYERS AND OTHER ORGANIZTIONS IN WHICH EMPLOYERS USUALLY PAY PART OR ALL OF THE PREMIUM COST IS CALLED?
 
GROUP HEALTH INSURANCE
 
13. 

THIS TYPE OF INSURANCE PROVIDES COVERAGE FOR CATASTROPHIC OR PROLONGED ILLNESS AND INJURIES

-MAJOR MEDICAL INSURANCE

-LIFETIME INSURANCE

-LIABILITY INSURANCE

-NONE OF THE ABOVE

 
MAJOR MEDICAL INSURANCE
 
14. 

ANOTHER NAME FOR HEALTH INSURANCE SPECIALIST IS

-MEDICAL RECORDS CLERK

-BILLER

-REIMBURSEMENT SPECIALIST

-NONE OF THE ABOVE

 
REIMBURSEMENT SPECIALIST
 
15. 

WHO REQUIRES PHYSICIAN OFFICES TO SUBMIT ICD-9SM CODES ON CMS1500 CLAIM FORMS?

-HEDIS

-MEDICARE

-NATIONAL HEALTH INSURANCE COMMITTEE

-MEDICAID

 
MEDICARE
 
16. 

EACH NEW PROVIDER MANAGED CARE CONTRACT INCREASES THE

-PRACTICE'S PATIENT DATA BASE

- # OF CLAIMS REQUIRMENTS/REIMBURSMNTS

-TIME THE OFFICE STAFF MUST DEVOTE TO FULFILLING CONTRACT REQUIRMENTS

-ALL OF THE ABOVE

 
ALL OF THE ABOVE
 
17. 

THE CPT MANUAL IS PUBLISHED BY THE:

-AMERICAN BOARD OF PHYSICIANS

-AMERICAN MEDICAL ASSOCIATION

-AMERICAN BILLING ASSOCIATION

 
AMERICAN MEDICAL ASSOCIATION
 
18. 

IF PREAUTHORIZATION FOR TREATMENT BY SPECIALISTS AND POST TREATMENT REPORTS WERE NOT FILED THE CLAIM WOULD BE:

-DENIED

-BILLED ONLY TO PATIENT

-RESUBMITTED

 
DENIED
 
19. 

TRICARE INCLUDES 3 PLAN OPTIONS WHICH OF THE FOLLOWING IS NOT ONE OF THOSE OPTIONS?

-TRICARE STANDARD

-TRICARE PRIME

-TRICARE SELECT

-TRICARE EXTRA

 
TRICARE SELECT
 
20. 

LIABILITY INSURANCE CLAIMS ARE MADE TO:

-COVER COST OF MEDICAL CARE FOR TRAUMATIC INJURY OR LOST WAGES

-COVER THE COST OF PHYSICIANS OVERHEAD

-COVER COST OF MEDICAL CARE TO NEEDY

 
COVER THE COST OF MEDICAL CARE FOR TRAUMATIC INJURIES OR LOST WAGES
 
21. 

WHAT INVOLVES LINKING EVERY PROCEDURE OR SERVICE CODE REPORTED ON THE CLAIM TO A CONDITION CODE THAT JUSTIFIES THE NECESSITY OF PERFORMING THAT PROCEDURE OR SERVICE?

-DISGNOSIS CODING

-PROCEDURE CODING

-MEDICAL NECESSITY

(2 ANSWERS)

 
DIAGNOSIS CODING AND MEDICAL NECESSITY
 
22. 

US CENSUS BUREAU DATA FROM 2005 ESTIMATES THAT WHAT % OF PEOPLE IN THE US ARE COVERED BY SOME FORM OF HEALTH INSURANCE

-60%

-95%

-84%

 
84%
 
23. 

PREVENTATIVE SERVICES:

-MAY RESULT IN EARLY DETECTION OF HEALTH PROBLEMS

-REQUIRED BY MOST INSURANCE COMPANIES

-ALLOW TREATMENT OPTIONS THAT ARE LESS DRAMATIC AND LESS EXPENSIVE

(CHOOSE 2)

 
THE FRST AND 3RD CHOICE
 
24. 

THE PROCESS OF REPORTING DIAGNOSES, PROCEDURES AND SERVICES AS NUMBERIC AND ALPHANUMERIC CHARACTERS ON THE INSURANCE CLAIM IS CALLED:

-WORK

-HEALTH INFORMATION

-CODING

-DATA ENTRY

 

CODING

 
25. 
t or f? to reduce coding & billing errors health insurance specialists need to ecplain complex insurance concepts and regulations to patients effectivly
 
true
 
26. 
t or f? insurance specialists who are employed by insurance companies review claims for completeness and accuract before authorizing the appropriate payment?
 
true
 
27. 
t or f? liability insurance is a policy that covers losses to a 3rd party caused by the insured?
 
true
 
28. 
t or f? OSHA was designed to protect all employers against injuries from occupational hazards in the workplace?
 
false
 
29. 
t or f? medical malpractice insurance is a type of liability insurance that covers physicians and other health care professionals for liability as to claims arising from patient treatment?
 
true
 
30. 
t or f? the mutual exchange of data between the provider and insurance company is called electronic claims processing?
 
false
 
31. 
t or f? the AAPC, AHMA and AMBA offer exams leading to professional credentials?
 
true
 
32. 
t or f? disablility insurance always pays for health care services and provides the disabled person with financial assistance?
 
false
 
33. 
t or f? health insurance specialists review health related claims to determine the medical necessity for procedures or services performed before reimbursment is made to the provider?
 
true
 
34. 
t or? medical care includes the identification of disease and te provision of care and treatment such as that provided my members of the health care team to persons who are sick injured status?
 
true
 
35. 
t or f? the patient receives a remittance advice which is a report that details the reults of processing a claim?
 
false
 
36. 
t or f? a health care facility that employs health insurance specialists is legally responsible for employees actions performed within the context of their employment is called respondeat superior?
 
true
 
37. 
t or f? group health insurance is coverage available through employers and other organizations where employers usually part part or all of premium costs?
 
true
 
38. 
t or f? title XVIII of the social security act provides health care services to americans over the age of 65 and is known as medicare?
 
true
 
39. 
t or f? third party administrators (TPAs) administer health care plans and process claims thus serving as a system of checks and balances for labor and managment?
 
true
 
40. 
t or f? in patient is person admitted to a hospital for treatment with expecation patient will remmain in hospital for period of 24hrs or more?
 
true
 
41. 
t or f? the first listed diagnoses and the primary disagnosis are the same thing?
 
false
 
42. 
t or f? codes that desribe signs and symptoms as opposed to definitive diagnoses are never acceptable for reporting purposes when the physician has not documented an established or confirmed diagnosis
 
false
 
43. 
t or f? v codes are located in the index and are assigned for patient encounters when a circumstance other than a disease or injury is present?
 
false
 
44. 
t or f? e codes are located in the tabular list of diseases and describe external causes of injury poisoning or other adverse reactions affecting a patients health?
 
true
 
45. 
t or f? nonessential modifiers are qualifying words that dont have to be inclded in the diagnostic statement fo the code # listed at the end of the parenthetical statements to apply
 
true
 
46. 
t or f? coding conventions are rules that apply to the assignment of icd9-cm codes and are always found in the guidelines
 
false
 
47. 
t or f? a lesion is a neoplasm defined as any discontinuity of tissue that is not malignant?
 
false
 
48. 
t or f? an adverse effect or reaction is the appearance of a pathologic condition cause by ingestion or exposre to a chemical substance properly administered or taken?
 
true
 
49. 
t or f? a late effect is a residual effect or sequelae of a previous acute illness injury or surgery?
 
true
 
50. 
t or f? the health insurance specialist employed in a physicians office assigns icd9-cm codes to procedures documented by the health care provider?
 
false
 
51. 
t or f? the icd9-cm is organized into 3 volumes?
 
true
 
52. 

the health insurance specialist employed in a physician's office assigns icd9-sm codes to:

-diagnoses signs symptoms documneted by nurse

-diagnoses signs symptoms documented by provider

 
by provider
 
53. 

what volume of the icd9sm contains the index to disease?

-voolume 3

-volume 2

-volume 1

 
volume 2
 
54. 

the medicare catastrophic coverage act mandated the reporting of icd9 diagnosis codes on what type of claims?

-outpatient

-inpatient

-medicare and medicaid claims

-medicare claims

 
all medicare claims
 
55. 

an outpatient is a person treated in which of the following settings?

-hospital observation unit

-ambulatory surgery center

-physician office

-all the above

 
all above
 
56. 

codes that describe signs and symtoms as opposed to deginitive diagnosis are acceptable to report when

-dr uses terminology rule out or probale

-coder cnt find appropriate code for diagnosis

-dr hsnt documented cnfrmd diagnosis

-sign n symptoms are never coded

 
the dr hasnt documented a confirmed diagnosis
 
57. 

__codes are located in the tabular list of diseases and are assigned for patient encounters whn a circumstance other than a disese or injury is present

-e code

-v code

-m code

 
v code
 
58. 

removal of a cast applied by another physician personal history of breast cancer and exposure to TB are all examples of what types of codes?

-e code

-v code

-m code

 
v code
 
59. 

what type of code describes external causes of injury poisining or other adverse reactions affecting a persons health?

-m code

-v code

-icd 9 cm code

-e code

 
e codes
 
60. 

the classification of industrial accidents accoding to agency is found in what appendix of the icd9cm?

Appendix: A B C or D?

 
D
 
61. 

the list of 3 digit categories is found in what appendix of the icd9cm?

Appendix E D C or B?

 
E
 
62. 

____identifies codes to be assigned when info needed to assign a more specific code cnt be located in the icd9cm coding manual?

-codes in slanted brackets

-nonessential modifiers

-NEC

-essential modifiers

 
NEC
 
63. 

A ___is a procedure performed for definitive treatment rather than diagnostic purposes

-principal procedure

-secondary procedure

-primary procedure

-first listed procedure

 
principle procedure
 
64. 

it is always necessary that these codes be coded directly from the pathology report

-codes of AIDS

-codes for hypertension

-codes for neoplasm

-codes for diabetes

 
codes for neoplasms
 
65. 

requiring diagnosis codes to be reported on submitted claims?

-e codes

-v codes

-medical necessity

-principal diagnosis

 

medical necessity

 
66. 

acknowledges patient responsbility for payment if medicare denies the claim?

-complication

-advanced benfit notice

-sequelae

 
advanced benfit notice
 
67. 

automates the coding process using computerized or web based software?

-encoder

-codes

-cpt

 
encoder
 
68. 

condition that develops after outpatient care?

-volume 3

-complications

-burns

 
complications
 
69. 

working diagnosis that isnt yet proven or established?

-qualified diagnoses

-primary diagnosis

-secondary diagnosis

 
qualified diagnosis
 
70. 

tabular list of diseases?

-volume 2

-volume 1

-volume 3

 
volume 1
 
71. 

index to disease?

-volume 3

-volume 2

volume 1

 
volume 2
 
72. 

late effects of an injury or illness?

-iatrogenic

-burns

-seqauelae

 
seqauelae
 
73. 

result of medical intervention?

-iatrogenic

-seqeuelae

-complcation

 
iatrogenic
 
74. 
what constitutes as a qualified diagnoses?
 
wokring diagnosis that hasnt been proven or established.
 
75. 

errors and omissions insurance?

-professional liability insurance

-hold harmless clause

-medical malpractice insurance

 
professional liability insurance
 
76. 

certified professional coder?

-cpt

-aapc

-eob

 
aapc
 
77. 

national codes

-hcpcs level 1 codes

-" " level 2 codes

-" "level 3 codes

 
level 2
 
78. 

exchange of data between provider and insurance company

-remittance advice

-coding

-electronic data interchange

 
electronic data interchange
 
79. 

diagnostic codes?

-j codes

-icd 9cm

-cpt codes

 
icd9cm
 
80. 

patient not responsible for paying what the plan denies

-eob

-remittance adivce

-hold harmless clause

 
hold harmless clause
 
81. 

results of processing a claim sent to patient

-eob

-mmp

-cpt

 
eob
 
82. 

hcpcs level 1 codes

-national

-icd 9

-cpt

 
cpt
 
83. 

which of the following is not an example of a managed care plan?

-integrated delivery system

-concumer directed health plan

-exclusive provider organization

-tripled option plan

 
consumer directed health plan
 
84. 

method of utlilizing health costs and quality of care by reviewing the appropriatness and necessity of care provided to patients prior to the administration of care is:

-surgical managment

-utillization management

-physician managemnt

 
utilization managment
 
85. 

managed care plan enrollees received most of their care from:

-any nonparticipating provider

-their primary care provider

-the physician of their choice

 
the primary care provider
 
86. 

network of physicians and hospitals that have joined together to contract with insurance companies to provide health care to subscribers for a discounted fee

-preferred provider organization

-integrated provider organization

-exclusive provider organization

 
preferred provider organization
 
87. 

what organization is owed by hospitals and phsyician groups that obatin managed care plan contracts?

-intergarated delivery organziation

-physician hospital organization

-inetgrated hospital/physician organizations

 
physician hospital organziation
 
88. 

this is created when a number of people are grouped for insurance purposes and the cost of health care coverage is determined by employees health status age sex and occupation

-internet data base

-risk pool

-risk databse

 
risk pool
 
89. 

plan offered by single insurance plan or as joint venture by 2 or more insurance carriers and which provides subc=scribers or employees with a coice of HMO PPO or traditional health plan is a :

-triple option plan

-flexible beneft plan

-cafteria plan

 
triple option plan
 
90. 

prior to scheduling elective surgery managed care plans often require

-preauthorization

-second surgical opinion

-preadmission

 
secon surgical opinion
 
91. 

the health care plan that reimburses providers for individual health care services provided is:

-managed care plan

-quality assurance plan

-fee for service plan

 
fee for service plan
 
92. 

what organization is responsible for the health of a group of enrollee and can be a health plan hospital physician group or health system?

-managed care organization

-quality assurance organization

-external review organziation

 
managed care organization
 
93. 

which of the following would be considered an example of a managed care plan?

-exclusive povider organization

-triple option plan

-point of service plan

-all the above

 
all the above
 
94. 

nonprofit organzation that contracts with and acquires the clinical and business assets of physician practices

-mso

-medical foundation

-network foundation

 
medical foundation
 
95. 

primary care provider

-gatekeeper

-enrolles

-capitation

 
gatekeeper
 
96. 

heatlh care accreditation organization

-joint comision

-case managment

-gate keeper

 
joint comission
 
97. 

physicians and hospitals joined together to contract with insurance companies for a discounted fee

-hmo

-ppo

-mso

 
ppo
 
98. 

provides health care to enrolled members on a prepaid basis

-hmo

-ppo

-mso

 
hmo
 
99. 

provides practice management services to individual physician practices

-mso

-hmo

-ppo

 
mso
 
100. 

development of patient care plans

-enrollees

-case managment

-joint comission

 
case management
 
101. 

patients may use hhmo providers or self refer to non hmo providers

-network provider

-point of service plan

-gate keeper

 
point pf service plan
 
102. 
t or f? hmos dont provide preventative care services to promote wellness or good health
 
false
 
103. 
t or f? a health maitenance organization(hmo) is an alternative to traditional group health insurance coverage and provides comprehensive health care services to voluntarily enrolled members on a pay monthly basis
 
false
 
104. 
t or f? case managment involves the development of patient care plans for the coordination and provision of care for complicated cases in a cost effective manner
 
true
 
105. 
t or f? the inspector general established the quality improvment system for managed care to ensure the accountability of managed care plans in terms of objective measurable standards
 
false
 
106. 
t or f? accredtation is a voluntary process that a health care facility or organization undergoes to demonstrate tht it has met stndrs beynd thse required by law
 
true
 
107. 
t or f? in managed health care plan enrollees receive care frm a primary care prvider who is a physician tht serves as a gatekeeper by providing essential health care services at the lowest possible cost.
 
true
 
108. 
t or f?a netwrk provider is a physician or health care facility under contract to the managed care plan.?
 
true
 
109. 
t or f?a risk pool is created when a number of people are grouped for insurance purposes
 
true
 
110. 
t or f? the national committee for quality assurance is a private for profit organization that asseses the quality of managed care plans in the united states
 
false
 
111. 
t or f? a preferred provider organization is a network of physicians and hospitals that have joined together to contract with insurance companies employers or other organizations to provide health care to subscribers for a substantial fee?
 
false
 
112. 
t or f? the intent of managed health care was to replace conventional fee for service plans with more affordable quality care to health care consumers
 
true
 
113. 
t or f? when a second physician is asked to evaluate the necessity of surgery and recommend the most economic appropriate facility it is considered coordination of care?
 
false
 
114. 

areas of the law that are not classified as criminal

-civil law

-criminal law

-case law

 
civil law
 
115. 

information communicated by a patient to a health care provider

-privacy

-privelaged communication

-fraud

 
privealged communication
 
116. 

intentional deception or misrepresentation

-abuse

-fraud

-case law

 
fraud
 
117. 
the practice of reporting multiple codes for a service when a single code should be assigned
 
unbundling
 
118. 

actions inconsistent with accepted practices

-fraud

-abuse

-miscommunication

 
abuse
 
119. 

document containing list of question that must be answered in writing

 
interrogatory
 
120. 

law based on court decisions that establish a precedent

-civil law

-criminal law

-case law

 
case law
 
121. 

public law that defines crimes and their prosecution

-criminal law

-civil law

-case law

 
criminal law
 
122. 
explain the difference between assignemtne of benefits and accept assignment
 

assisngment of benefits: regarding benefits

accept assignemnt: provider accepts the assignment

 
123. 
t or f? protected health information is information that is identifiable to an individual sch as name address etc
 
true
 
124. 
t or f?the HIPPA security rule adopts standards and safe gaurds to protect health information that is collected maintained and trasmitted electronically
 
true
 
125. 
t or f?a dated signed special release form is generally considered valid for as long as the patient sees the physician
 
false
 
126. 
t or f? the patient account record is a permanent record of all financial transactions between the patient and the practice
 
true
 
127. 
t or f?workers compensation insurance is always considered to be the primary insurance plan
 
true
 
128. 
t or f? the encounter form is the financial record source document used by health care providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter
 
true
 
129. 
t or f? a claims attachment is a set of supporting documentation or information that is associated with a health care claim or patient encounter
 
true
 
130. 
t or f? the privacy rule establishes standards for how PHI should be controlled by indicating authorized uses and disclosures and patients rights with respect to their health information
 
true
 
131. 
t or f?an appeal is documented as a letter signed by the provider explaining why a claim should be reconsidered for payment
 
true
 
132. 
t or f? an insurance company that is prohibited from reviewing patient records will probably refuse to reimburse the provider for a submitted claim
 
true
 
133. 
t or f? the national correct coding initiative was developed to reduce medicare program expenditures by detecting inappropriate codes submitted on claims and denying payment
 
true
 
134. 
t or f? record retention is the storage of documentation for an established period of time usually mandated by federal and or state law
 
true
 
135. 
t or f? the birthday rule state that the parent whose birth year is the the earliest holds the primary policy for dependent children
 
false
 
136. 
t or f? a clean claim is one that contains all required data elements needed to process and pay the claim
 
true
 
137. 
t or f? when submitting claims "signature on file" can be submitted for the patients signature as long as the patients signature is on file in the office
 
true
 
138. 
t or f? it is not necessary to submit a claims attachemnt when using an unlisted cpt code
 
false
 
139. 
t or f? hippa requires all health plans health care clearing houses and health care providers that conduct electronic financial or administrative transactions to comply with national patient privacy standards
 
true
 
140. 
t or f? a voluntary compliance program can help physicians avoid generating erroneous and fraudulent claims by ensuring that submitted claims are true and accurate.
 
true
 
141. 
t or f? third party payers use medical necessity measurements to make a decidion about whether to pay a claim
 
true
 
142. 

the___mandates the retention of patient records and health insurance claims for a minimum of 6 years

-hippa

-ama

-patient safety and quality improvement act

 
hippa
 
143. 

the most common form of medicare fraud is:

-soliciting offering or receiving kickbacks

-misrepresenting the diagnosis to justify payment

-billing for services not provided

-all

 
all
 
144. 

participants maintain at their own expense and at the same rate health care plan coverage tat would have been lost due to a triggering event

-health care financing administration

-prinvacy act

-consolidated omnibus budget reconciliation act

 
consolidation omnibus budget reconciliation act
 
145. 

medical necessity is the measure of whether a health care procedure or service is appropriate for

-diagnosis and treatment of condition

-3rd party allowed amont

-tests tht were ordered

 
diagnosis and treatment of condition
 
146. 

the cms 1500 claim form is used to report

-professional services

-inpatient expenses

-technical services

(choose 2)

 
professional services and technical services
 
147. 

__is the storage of documentation for an established period of time usually mandated by federal and or state law

-patient file review

-record retention

-physician storage act

 
record retention
 
148. 

which of the following is not an example of abuse

-falsifyin certificates of medical necessity plans

-violations of participating provider agreements

-excessive charges for services equipment or supplies

 
frst one
 
149. 

before scheduling an appointment w/a specialist a manage care patent must obtain a:

-referral from pcp

-preauthorization

-copy of medical records

(choose 2)

 
the frst 2
 
150. 

the patient ledger is also known as the

-patient account record

-superbill

-encounter form

 
patient account record
 
151. 

the chick in process for a patient who is__is more extensive than for a____patient

-established/new

-new/returning

-referred/new

 
new/returning
 
152. 

which of the following is NOT a criteria used to determin medical necessity?

-reimbursement

-value

-scope

-purpose

 
reimbursment
 
153. 

the cms1500 claim form requires responses to standard questions pertaining to whether the patients condition is related to:

-auto accident

-secondary insurance

-employment

-all

 
all
 
154. 

the__are the financial record source documents used by health care providers to record serices and diagnoses rendered duing the visit

-check out form

-superbill

-encounter form

(choose 2)

 
super bill and encounter form
 
155. 

in 1996 congress passed the ___because of concerns about fraud and abuse

-health insurance portability and accountability act

-center for medicare ad medicaid act

-group health plan requirement act

 
health insurance portability and accountability act
 
156. 

a ___contracts with a 3rd party payer and accepts whatever the plan pays for procedures or services performed

-nonparticipating provider

-network provider

-participating provider

-(choose 2)

 
network provider and participating provider
 
157. 

the health care industry is heavily regulated by___and_____legislation

-state/city

-city/local

-federal/state

 
federal and state
 
158. 

the___is the person responsible for paying the charges

-gaurantor

-patient

-beneficiary

 
garuantor
 
159. 

the development of an_____begins when the patient contacts a health care providers office and schedules an appointment

-superbill

-insurance claim

-patient claim

 
insurance claim