MEDICAL CODING AND BILLING

159 cards

flashcards fo r medica


 
  
Created May 3, 2009
by
kacosta21

 

 
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1

WHAT IS THE PROGRAM MANDATED BY FEDERAL AND STATE GOVERNMENT THAT REQUIRES EMPLOYERS TO...

 
WORKERS COMPENSATION
2

ACCORDING TO THE US CENSUS BUREAU DATA FROM 2005 WHAT % OF PEOPLE IN THE UNITED STATES ARE...

 
27%
3

WHICH ACT MANDATES REGULATIONS THAT GOVERN PRIVACY, SECURITY AND ELECTRONIC TRANSACTIONS...

 
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...

 
ALL OF THE ABOVE
6

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

-LIABILITY...

 
DISABILITY INSURANCE
7

WHAT DOES CPT STAND FOR?

-CODES POSTED VIA TELEPHONE

-CLINICAL PROCEDURE...

 
CURRENT PROCEDURAL TERMINOLOGY
8

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

 
BOTH MEDICAL SERVICES AND UNEMPLOYMENT INSURANCE BENEFITS
9

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

-AMERICAN...

 
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...
 
GROUP HEALTH INSURANCE
13

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

-MAJOR...

 
MAJOR MEDICAL INSURANCE
14

ANOTHER NAME FOR HEALTH INSURANCE SPECIALIST IS

-MEDICAL RECORDS CLERK

-BILLER

-REIMBURSEMENT...

 
REIMBURSEMENT SPECIALIST
15

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

-HEDIS

-MEDICARE

-NATIONAL...

 
MEDICARE
16

EACH NEW PROVIDER MANAGED CARE CONTRACT INCREASES THE

-PRACTICE'S PATIENT DATA BASE

-...

 
ALL OF THE ABOVE
17

THE CPT MANUAL IS PUBLISHED BY THE:

-AMERICAN BOARD OF PHYSICIANS

-AMERICAN...

 
AMERICAN MEDICAL ASSOCIATION
18

IF PREAUTHORIZATION FOR TREATMENT BY SPECIALISTS AND POST TREATMENT REPORTS WERE NOT FILED...

 
DENIED
19

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

-TRICARE...

 
TRICARE SELECT
20

LIABILITY INSURANCE CLAIMS ARE MADE TO:

-COVER COST OF MEDICAL CARE FOR TRAUMATIC...

 
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...

 
DIAGNOSIS CODING AND MEDICAL NECESSITY
22

US CENSUS BUREAU DATA FROM 2005 ESTIMATES THAT WHAT % OF PEOPLE IN THE US ARE COVERED BY...

 
84%
23

PREVENTATIVE SERVICES:

-MAY RESULT IN EARLY DETECTION OF HEALTH PROBLEMS

-REQUIRED...

 
THE FRST AND 3RD CHOICE
24

THE PROCESS OF REPORTING DIAGNOSES, PROCEDURES AND SERVICES AS NUMBERIC AND ALPHANUMERIC...

 

CODING

 

25
t or f? to reduce coding & billing errors health insurance specialists need to ecplain...
 
true
26
t or f? insurance specialists who are employed by insurance companies review claims for completeness...
 
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...
 
false
29
t or f? medical malpractice insurance is a type of liability insurance that covers physicians...
 
true
30
t or f? the mutual exchange of data between the provider and insurance company is called electronic...
 
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...
 
false
33
t or f? health insurance specialists review health related claims to determine the medical...
 
true
34
t or? medical care includes the identification of disease and te provision of care and treatment...
 
true
35
t or f? the patient receives a remittance advice which is a report that details the reults...
 
false
36
t or f? a health care facility that employs health insurance specialists is legally responsible...
 
true
37
t or f? group health insurance is coverage available through employers and other organizations...
 
true
38
t or f? title XVIII of the social security act provides health care services to americans over...
 
true
39
t or f? third party administrators (TPAs) administer health care plans and process claims thus...
 
true
40
t or f? in patient is person admitted to a hospital for treatment with expecation patient will...
 
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...
 
false
43
t or f? v codes are located in the index and are assigned for patient encounters when a circumstance...
 
false
44
t or f? e codes are located in the tabular list of diseases and describe external causes of...
 
true
45
t or f? nonessential modifiers are qualifying words that dont have to be inclded in the diagnostic...
 
true
46
t or f? coding conventions are rules that apply to the assignment of icd9-cm codes and are...
 
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...
 
true
49
t or f? a late effect is a residual effect or sequelae of a previous acute illness injury...
 
true
50
t or f? the health insurance specialist employed in a physicians office assigns icd9-cm codes...
 
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...

 
by provider
53

what volume of the icd9sm contains the index to disease?

-voolume 3

-volume...

 
volume 2
54

the medicare catastrophic coverage act mandated the reporting of icd9 diagnosis codes on...

 
all medicare claims
55

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

-hospital...

 
all above
56

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

 
the dr hasnt documented a confirmed diagnosis
57

__codes are located in the tabular list of diseases and are assigned for patient encounters...

 
v code
58

removal of a cast applied by another physician personal history of breast cancer and exposure...

 
v code
59

what type of code describes external causes of injury poisining or other adverse reactions...

 
e codes
60

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

 
D
61

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

Appendix...

 
E
62

____identifies codes to be assigned when info needed to assign a more specific code cnt...

 
NEC
63

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

-principal...

 
principle procedure
64

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

-codes...

 
codes for neoplasms
65

requiring diagnosis codes to be reported on submitted claims?

-e codes

-v...

 

medical necessity

 

66

acknowledges patient responsbility for payment if medicare denies the claim?

-complication

-advanced...

 
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...

 
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...

 
professional liability insurance
76

certified professional coder?

-cpt

-aapc

-eob

 
aapc
77

national codes

-hcpcs level 1 codes

-"        ...

 
level 2
78

exchange of data between provider and insurance company

-remittance advice

-coding

-electronic...

 
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...

 
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...

 
consumer directed health plan
84

method of utlilizing health costs and quality of care by reviewing the appropriatness and...

 
utilization managment
85

managed care plan enrollees received most of their care from:

-any nonparticipating...

 
the primary care provider
86

network of physicians and hospitals that have joined together to contract with insurance...

 
preferred provider organization
87

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

 
physician hospital organziation
88

this is created when a number of people are grouped for insurance purposes and the cost...

 
risk pool
89

plan offered by single insurance plan or as joint venture by 2 or more insurance carriers...

 
triple option plan
90

prior to scheduling elective surgery managed care plans often require

-preauthorization

-second...

 
secon surgical opinion
91

the health care plan that reimburses providers for individual health care services provided...

 
fee for service plan
92

what organization is responsible for the health of a group of enrollee and can be a...

 
managed care organization
93

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

-exclusive...

 
all the above
94

nonprofit organzation that contracts with and acquires the clinical and business assets...

 
medical foundation
95

primary care provider

-gatekeeper

-enrolles

-capitation

 
gatekeeper
96

heatlh care accreditation organization

-joint comision

-case managment

-gate...

 
joint comission
97

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

 
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...

 
case management
101

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

-network provider

-point...

 
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...
 
false
104
t or f? case managment involves the development of patient care plans for the coordination...
 
true
105
t or f? the inspector general established the quality improvment system for managed care to...
 
false
106
t or f? accredtation is a voluntary process that a health care facility or organization undergoes...
 
true
107
t or f? in managed health care plan enrollees receive care frm a primary care prvider who...
 
true
108
t or f?a netwrk provider is a physician or health care facility under contract to the managed...
 
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...
 
false
111
t or f? a preferred provider organization is a network of physicians and hospitals that have...
 
false
112
t or f? the intent of managed health care was to replace conventional fee for service plans...
 
true
113
t or f? when a second physician is asked to evaluate the necessity of surgery and recommend...
 
false
114

areas of the law that are not classified as criminal

-civil law

-criminal...

 
civil law
115

information communicated by a patient to a health care provider

-privacy

-privelaged...

 
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...

 
case law
121

public law that defines crimes and their prosecution

-criminal law

-civil...

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

assisngment of benefits: regarding benefits

accept assignemnt: provider accepts...

123
t or f? protected health information is information that is identifiable to an individual sch...
 
true
124
t or f?the HIPPA security rule adopts standards and safe gaurds to protect health information...
 
true
125
t or f?a dated signed special release form is generally considered valid for as long as the...
 
false
126
t or f? the patient account record is a permanent record of all financial transactions between...
 
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...
 
true
129
t or f? a claims attachment is a set of supporting documentation or information that is associated...
 
true
130
t or f? the privacy rule establishes standards for how PHI should be controlled by indicating...
 
true
131
t or f?an appeal is documented as a letter signed by the provider explaining why a claim should...
 
true
132
t or f? an insurance company that is prohibited from reviewing patient records will probably...
 
true
133
t or f? the national correct coding initiative was developed to reduce medicare program expenditures...
 
true
134
t or f? record retention is the storage of documentation for an established period of time...
 
true
135
t or f? the birthday rule state that the parent whose birth year is the the earliest holds...
 
false
136
t or f? a clean claim is one that contains all required data elements needed to process and...
 
true
137
t or f? when submitting claims "signature on file" can be submitted for the patients signature...
 
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...
 
true
140
t or f? a voluntary compliance program can help physicians avoid generating erroneous and fraudulent...
 
true
141
t or f? third party payers use medical necessity measurements to make a decidion about whether...
 
true
142

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

 
hippa
143

the most common form of medicare fraud is:

-soliciting offering or receiving kickbacks

-misrepresenting...

 
all
144

participants maintain at their own expense and at the same rate health care plan coverage...

 
consolidation omnibus budget reconciliation act
145

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

 
diagnosis and treatment of condition
146

the cms 1500 claim form is used to report

-professional services

-inpatient...

 
professional services and technical services
147

__is the storage of documentation for an established period of time usually mandated by...

 
record retention
148

which of the following is not an  example of abuse

-falsifyin certificates...

 
frst one
149

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

-referral...

 
the frst 2
150

the patient ledger is also known as the

-patient account record

-superbill

-encounter...

 
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...

 
all
154

the__are the financial record source documents used by health care providers to record serices...

 
super bill and encounter form
155

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

-health...

 
health insurance portability and accountability act
156

a ___contracts with a 3rd party payer and accepts whatever the plan pays for procedures...

 
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...

 
insurance claim

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