MEDICAL CODING AND BILLING

159 cards

Flashcards Fo R Medica


 
  
Created May 3, 2009
by
kacosta21

 

 
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  Side A   Side B
1
WHAT IS THE PROGRAM MANDATED BY FEDERAL AND STATE GOVERNMENT THAT REQUIRES EMPLOYERS TO COVER...
 
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 STANDARDS...
 
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 TESTS -CURRENT...
 
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 - # OF...
 
ALL OF THE ABOVE
17
THE CPT MANUAL IS PUBLISHED BY THE: -AMERICAN BOARD OF PHYSICIANS -AMERICAN MEDICAL ASSOCIATION -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 INJURY OR...
 
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 SOME...
 
84%
23
PREVENTATIVE SERVICES: -MAY RESULT IN EARLY DETECTION OF HEALTH PROBLEMS -REQUIRED BY MOST...
 
THE FRST AND 3RD CHOICE
24
THE PROCESS OF REPORTING DIAGNOSES, PROCEDURES AND SERVICES AS NUMBERIC AND ALPHANUMERIC CHARACTERS...
 
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 2 -volume 1  
 
volume 2
54
the medicare catastrophic coverage act mandated the reporting of icd9 diagnosis codes on what...
 
all medicare claims
55
an outpatient is a person treated in which of the following settings? -hospital observation...
 
all above
56
codes that describe signs and symtoms as opposed to deginitive diagnosis are acceptable to...
 
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 of...
 
D
61
the list of 3 digit categories is found in what appendix of the icd9cm? Appendix E D C or...
 
E
62
____identifies codes to be assigned when info needed to assign a more specific code cnt be...
 
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 codes -medical...
 
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 diagnosis -secondary...
 
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...
 
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 adivce -hold harmless...
 
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...
 
consumer directed health plan
84
method of utlilizing health costs and quality of care by reviewing the appropriatness and necessity...
 
utilization managment
85
managed care plan enrollees received most of their care from: -any nonparticipating provider -their...
 
the primary care provider
86
network of physicians and hospitals that have joined together to contract with insurance companies...
 
preferred provider organization
87
what organization is owed by hospitals and phsyician groups that obatin managed care plan contracts? -intergarated...
 
physician hospital organziation
88
this is created when a number of people are grouped for insurance purposes and the cost of...
 
risk pool
89
plan offered by single insurance plan or as joint venture by 2 or more insurance carriers and...
 
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 health...
 
managed care organization
93
which of the following would be considered an example of a managed care plan? -exclusive povider...
 
all the above
94
nonprofit organzation that contracts with and acquires the clinical and business assets of...
 
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...
 
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...
 
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 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...
 
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 of...
 
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 tat...
 
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 expenses -technical...
 
professional services and technical services
147
__is the storage of documentation for an established period of time usually mandated by federal...
 
record retention
148
which of the following is not an  example of abuse -falsifyin certificates of medical...
 
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 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...
 
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 insurance...
 
health insurance portability and accountability act
156
a ___contracts with a 3rd party payer and accepts whatever the plan pays for procedures or...
 
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...
 
insurance claim


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