Medical Billing and Coding Final study guide
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| 8544895637 | What is a rule of conduct established and enforced by an authority or governing body,such as the federal government | Law | 0 | |
| 8544895638 | Another name for terminating care of a patient is | D) withdrawing from a case | 1 | |
| 8544895639 | A health-care professional who stops care without providing an equally qualified substitute can be charged with | D) abandonment | 2 | |
| 8544895640 | The appropriate way for a physician to terminate the care of a patient is to | Send the patient a certified letter | 3 | |
| 8544895641 | What is the document called in which a patient names someone to make decisions regarding medical care in the event he or she is unable to do so? | durable power of attorney | 4 | |
| 8544895642 | A written court order addressed to a specific person, requiring that person's presence in court at a specific time is | subpoena | 5 | |
| 8544895643 | A process in which the opposing sides choose a person outside the court system with special knowledge in the field, to hear and decide a dispute is a(n) | arbitration | 6 | |
| 8544895644 | At the end of a labor and delivery nurse's shift, a nurse leaves a woman in labor before the nurse's replacement arrives. What kind of negligence does this constitute? | abandonment | 7 | |
| 8544895645 | A surgical incision is reopened after a patient starts to show signs of internal bleeding. It is discovered that the surgeon did not complete closure of all severed capillaries at the operative site. This is an example of | malpractice | 8 | |
| 8544895646 | A legal document addressed to the patient's family and physicians stating what type of treatment the patient wishes or does not wish when terminally ill is an(n) | living will | 9 | |
| 8544895647 | A physician reports a case of acquired immunodeficiency syndrome(AIDS) to the state. This is | the physician's public duty | 10 | |
| 8544895648 | Which of the following is the appropriate way for the medical assistant working in a physician's office to leave a message for patients at their place of employment? | leave a message that the patient's doctor's office is calling | 11 | |
| 8544895649 | is considered a standard of behavior and a concept of right and wrong, beyond the legal consideration. | Ethics | 12 | |
| 8544895650 | Which of the following created federal laws to protect health-care workers from health hazards on the job | OSHA | 13 | |
| 8544895651 | are formed through the influence of the family, culture and society, and serve as a basis for ethical conduct. | Moral values | 14 | |
| 8544895652 | For two parties to enter into an agreement, or contract, it is essential that both are capable of understanding the terms and conditions. This is referred to as | contractual capacity | 15 | |
| 8544895653 | Speaking in such a way as to negatively influence others against an individual is an example of | defamation of character | 16 | |
| 8544895654 | The promise of "miracle cures" is an example of | fraud | 17 | |
| 8544895655 | An advantage of computers in that they | process information with great speed | 18 | |
| 8544895656 | A guideline for releasing medical information is to | have the patient give a verbal consent | 19 | |
| 8544895657 | Internal audits are done | on random records by medical staff | 20 | |
| 8544895658 | One of the most important duties of a medical assistant is to | fill out and maintain accurate and thorough patient records | 21 | |
| 8544895659 | Important information about a patient's medical history and present condition is found in the | patient's chart | 22 | |
| 8544895660 | Patient records are used for | patient education, evaluating the quality of treatment, and medical research. | 23 | |
| 8544895661 | WHich of the following organizations reviews patient charts to monitor whether the care provided and fee charged met accepted standards? | Joint Commission on Accreditation of Healthcare Organizations | 24 | |
| 8544895662 | The appropriate way to speak to a patient who has a hearing impairment is to | speak slowly | 25 | |
| 8544895663 | The appropriate way to address a patient is | Mrs. Jones | 26 | |
| 8544895664 | A physician tries unsuccessfully to call a patient. The medical assistant should | record and date the call in the patient record | 27 | |
| 8544895665 | The best place to interview a patient is | in a private room | 28 | |
| 8544895666 | The type of documentation that provides an orderly series of steps for dealing with any medical case is | SOAP | 29 | |
| 8544895667 | Of the federal programs providing health care, the largest is, which provides health insurance for citizens aged 65 and other | Medicare | 30 | |
| 8544895668 | The person whose name the insurance is carried under is called the | Subscriber | 31 | |
| 8544895669 | In most cases, the insurer pays an annual cost or___ for health -care insurance. | premium | 32 | |
| 8544895670 | A fixed dollar amount the subscriber must pay or "meet" each year before the insurer begins to cover expenses is the | deductible | 33 | |
| 8544895671 | Some medical practices may require the subscriber to pay a small fee at the time of service. | copayment | 34 | |
| 8544895672 | In a typical medical practice, insurance claims are filed | a few business days after the date of service | 35 | |
| 8544895673 | The most likely outcome of an insurance claim submitted with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be | denied as a billing error because the treatment was not medically necessary based on the diagnosis | 36 | |
| 8544895674 | An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the | review for allowable benefits | 37 | |
| 8544895675 | Which of the following is what the patient owes after the insurance company has paid? | subscriber liability | 38 | |
| 8544895676 | Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property? | liability | 39 | |
| 8544895677 | Under Medicare Part B, patients are not permitted to | enroll, because coverage is automatic | 40 | |
| 8544895678 | A patient who has been hospitalized up to 90 days for each benefit period is covered under | Medicare Part A | 41 | |
| 8544895679 | A benefit period for Medicare begins the day a patient goes into the hospital and ends when that patient has not been hospitalized for ___ days | 60 | 42 | |
| 8544895680 | Which of the following is a characteristic of Medicaid? | it is a health cost assistance program | 43 | |
| 8544895681 | Patients under the age of 65 who are blind or widowed or who have serious long-term disabilities, such as chronic joint pain or _____, many also be entitled to Medicare. | kidney failure | 44 | |
| 8544895682 | Which of the following is included in Medicare benefits for respite care | The terminally ill patient is moved to a care facility for the respite | 45 | |
| 8544895683 | An organizations that provides pain relief to terminally ill patients and supports these patients and their families is a | hospice | 46 | |
| 8544895684 | The amount Medicare pays the physician or health-care provider after the $100 annual deductible is met is | 80% | 47 | |
| 8544895685 | Which of the following is included under Workers' Compensation insurance? | Rehabilitation costs are covered to return an employee to work | 48 | |
| 8544895686 | Medicare encourages all practices to file claims electronically because | the process saves time | 49 | |
| 8544895687 | A characteristic of health maintenance organizations(HMO) is | physicians with HMO contracts are often paid a capitated rate | 50 | |
| 8544895688 | HMO copayments are often | $10-$20 | 51 | |
| 8544895689 | A husband and wife are both employed and have work-sponsored insurance plans that cover each other and their three children. Which insurance plan is the primary payer? | the insurance plan of the person whose birthday comes first in the calendar year | 52 | |
| 8544895690 | Electronic media claims (EMC) include | data elements that are transmitted in a computer file | 53 | |
| 8544895691 | An appropriate approach to maintaining patient confidentiality on the computer is to | change your password every 90 days | 54 | |
| 8544895692 | Under a contracted or fixed prepayment called____, physicians are paid a fixed amount of money to provide needed care. | capitation | 55 | |
| 8544895693 | TRICARE and CHAMPVA cover | families of all military personnel. | 56 | |
| 8544895694 | When entering data in medical billing programs, always | enter information using capital letters | 57 | |
| 8544895695 | The determination of the amount of money paid by a third-party papyer for a procedure is | pre-certification | 58 | |
| 8544895696 | What is the approval for payment from a third-party requested prior to a procedure? | pre-authorization | 59 | |
| 8544895697 | When a physician agrees to accept assignment, this means the physician | will accept the amount of money that Medicaid will pay as payment in full for the Medicaid covered service | 60 | |
| 8544895698 | Eligibility for Medicaid is | based on the patient's reported income from the previous month | 61 | |
| 8544895699 | Which of the following is part of the process for verifying workers' compensation coverage? | obtaining the employer's approval to provide treatment | 62 | |
| 8544895700 | What is the term for the 10-digit number identifying the physician's medical specialty? | taxonomy code | 63 | |
| 8544895701 | What are usual fees that are listed on the office's fee schedule | fee charged to most of their patients most of the time under typical conditions | 64 | |
| 8544895702 | Which of the following must be verbally discussed with the beneficiary to enable the beneficiary to consider options and make informed choices? | ABN | 65 | |
| 8544895703 | If providers submit a claim for a simple procedure when in fact a more complicated procedure was documented in the medical record,______may occur | underpayment | 66 | |
| 8544895704 | Which of the following may occur when providers submit claims that do not meet Medicare's coding or medical neccessity policies? | denial of claim | 67 | |
| 8544895705 | The use of ICD-9 codes is mandated by | HIPAA | 68 | |
| 8544895706 | A patient's diagnosis as established by the physician | describes the primary condition for which the patient is receiving treatment | 69 | |
| 8544895707 | ICD-9 codes are updated | yearly | 70 | |
| 8544895708 | The Alphabetic Index is organized by | the condition | 71 | |
| 8544895709 | When you encounter the word see in the Alphabetic Index, you know that | you must look in another category | 72 | |
| 8544895710 | The Tabular List is organized by | the part of the body involved | 73 | |
| 8544895711 | In order to ensure reimbursement at the highest allowed level,CPT codes must | include numbers and modifiers that reflect the services performed | 74 | |
| 8544895712 | ___The____ codes are the most important of the CPT codes | E/M | 75 | |
| 8544895713 | ___For reporting purposes, CPT considers a patient "new" if the patient has not received professional services within the past ___year(s) | three | 76 | |
| 8544895714 | When unbundling is done intentionally to receive more payment than is correct, the claim is likely to be considered | fraudulent | 77 | |
| 8544895715 | The Health Care Common Procedure Coding System(HCPCS) was developed for use in coding services for | Medicare patients | 78 | |
| 8544895716 | Analysis of the connection between the diagnostic and the procedural information on a claim is called | code linkage | 79 | |
| 8544895717 | An act of deception used to take advantage of another person or entity is called | fraud | 80 | |
| 8544895718 | A health-care provider who practices under false qualifications/credentials is guilty of | fraud | 81 | |
| 8544895719 | To avoid the risk of fraud by discovering and correcting compliance problems, medical offices usually have a(n) | compliance plan | 82 | |
| 8544895720 | Which of the following ICD-9-CM conventions is used around synonyms, alternative workings, or explanations? | | | | 83 | |
| 8544895721 | Which of the following ICD-9-CM conventions indicates that the entries following it refine the content of a preceding entry? | includes | 84 | |
| 8544895722 | Which ICD-9-CM convention indicates that an entry is not classified as part of the preceding code | excludes | 85 | |
| 8544895723 | The ICD-9-CM convention code first underlying disease means | the code may not be used as the first code | 86 | |
| 8544895724 | What does the ICD-9-CM convention NEC indicate | not elsewhere classifiable | 87 | |
| 8544895725 | When analyzing diagnoses and locating the correct ICD code, in which step of the five-step process do you record the diagnosis code on the insurance claim | step 5 | 88 | |
| 8544895726 | In which step of the five-step process of analyzing and locating the correct ICD code do you locate the statement of the diagnosis in the patient's medical record? | step 1 | 89 | |
| 8544895727 | In step 3 of the five-step process of analyzing and locating the correct ICD code, you will | locate the code from the Alphabetic index in the ICD's Tabular index | 90 | |
| 8544895728 | Step 4 of the five-step process of analyzing and locating the correct ICD involves | finding the code that corresponds to the patient's specifie disease or condition | 91 | |
| 8544895729 | Finding the code in the ICD's Alphabetic Index is which step of analyzing and locating the correct ICD? | step 2 | 92 | |
| 8544895730 | If a lab bills for a general health panel but fails to perform one of the tests, it is guilty of which of these fraudulent coding and billing practices | reporting services that were not performed | 93 | |
| 8544895731 | When a patient has no symptoms of a disease and the provider performs the tests for that disease at the patient's request, the provider has committed which of these fraudulent coding and billing practices? | performing billing for procedures that are not related to the patient's condition | 94 | |
| 8544895732 | Billing for an Evaluation and Management service when the only service provided was a simple injection is an example of | reporting services at a higher level than was carried out | 95 | |
| 8544895733 | There is a question concerning a claim for a procedure submitted last year. Where will you look to double-check codes in question? | last year's CPT | 96 | |
| 8544895734 | A plus sign (+) is used to indicate | add-on codes | 97 | |
| 8544895735 | Modifiers to CPT indicate | that some special circumstance applies to the service | 98 | |
| 8544895736 | National codes issued by CMS that cover many supplies and durable medical equipment are | HCPCS Level II codes | 99 | |
| 8544895737 | Inaccuracy of linking diagnostic codes and procedural codes will result in all of the following except | timely processing of claims | 100 | |
| 8544895738 | Which of these structures or substances in the skin helps prevent UV radiation from damaging deep structures of the skin? | melanin | 101 | |
| 8544895739 | An easy way to remember when an E code is required is | if the diagnosis makes you ask "How did that happen?" | 102 | |
| 8544895740 | The skin plays a role in regulating body temperature by | dilating or constricting blood vessels in the skin | 103 | |
| 8544895741 | Which of the following is mostly adipose tissue? | subcutaneous layer | 104 | |
| 8544895742 | Sweat glands are found in the | dermis | 105 | |
| 8544895743 | When the supply of oxygen in the blood is low, the skin looks rather pale or | bluish | 106 | |
| 8544895744 | The most deadly skin cancer is | melonoma | 107 | |
| 8544895745 | The most common skin cancer is | basal cell carcinoma | 108 | |
| 8544895746 | The first thing you should do when answering the telephone is | identify the medical office and yourself | 109 | |
| 8544895747 | The appropriate way to deal with a caller who refuse to identify himself is to | suggest that he write a letter to the physician and mark it "Personal" | 110 | |
| 8544895748 | The recommended procedure for handling billing inquiries is to | pull the patient's chart and billing information | 111 | |
| 8544895749 | If a patient was overcharged for services, the appropriate procedure is to | ask the patient to wait for a corrected statement before sending payment | 112 | |
| 8544895750 | If patient calls with a billing problem but, in fact the proper fee was charged, the best approach is to | speak to the physician before responding to the patient | 113 | |
| 8544895751 | If a patient remains dissatisfied after discussing a bill, | document all comments and relay the information to the physician | 114 | |
| 8544895752 | A guideline for dealing with an angry caller is to | assure the patient that you will do your best to correct the problem | 115 | |
| 8544895753 | A guideline to follow when an attorney calls the office is to | release information only when the physician has authorized you to do so | 116 | |
| 8544895754 | One of the most important telephone skills is saying words correctly, which is called | pronunciation | 117 | |
| 8544895755 | Speaking clearly and distinctly to help the person you are speaking to understand you is called | enunciation | 118 | |
| 8544895756 | The appropriate way to address a patient with a last name that is different to pronounce is to | ask the patient how to pronounce her name | 119 | |
| 8544895757 | If you do not recognize the name of the patient calling the most appropriate response is | "Have you been to this practice before?" | 120 | |
| 8544895758 | If you put a caller on hold and determine it will be a long wait, | offer to call back | 121 | |
| 8544895759 | When a call with a patient is long or complicated | summarize the details of the call to ensure understanding by both you and the patient | 122 | |
| 8544895760 | When dealing with a caller who is nervous, upset, or angry, | show empathy and an understanding of the caller's feelings | 123 | |
| 8544895761 | Before placing an outgoing telephone call to a patient you should | verify the correct phone number | 124 | |
| 8544895762 | Fax machines in a medical office | should be placed in a secure location | 125 |
