MEDICAL CODING AND BILLING

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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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