Medical Billing and Coding Laws Flashcards

Medical Billing and Coding Final study guide

3944444313	What is a rule of conduct established and enforced by an authority or governing body,such as the federal government	Law	0
3944444314	Another name for terminating care of a patient is	D) withdrawing from a case	1
3944444315	A health-care professional who stops care without providing an equally qualified substitute can be charged with	D) abandonment	2
3944444316	The appropriate way for a physician to terminate the care of a patient is to	Send the patient a certified letter	3
3944444317	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
3944444318	A written court order addressed to a specific person, requiring that person's presence in court at a specific time is	subpoena	5
3944444319	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
3944444320	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
3944444321	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
3944444322	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
3944444323	A physician reports a case of acquired immunodeficiency syndrome(AIDS) to the state. This is	the physician's public duty	10
3944444324	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
3944444325	is considered a standard of behavior and a concept of right and wrong, beyond the legal consideration.	Ethics	12
3944444326	Which of the following created federal laws to protect health-care workers from health hazards on the job	OSHA	13
3944444327	are formed through the influence of the family, culture and society, and serve as a basis for ethical conduct.	Moral values	14
3944444328	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
3944444329	Speaking in such a way as to negatively influence others against an individual is an example of	defamation of character	16
3944444330	The promise of "miracle cures" is an example of	fraud	17
3944444331	An advantage of computers in that they	process information with great speed	18
3944444332	A guideline for releasing medical information is to	have the patient give a verbal consent	19
3944444333	Internal audits are done	on random records by medical staff	20
3944444334	One of the most important duties of a medical assistant is to	fill out and maintain accurate and thorough patient records	21
3944444335	Important information about a patient's medical history and present condition is found in the	patient's chart	22
3944444336	Patient records are used for	patient education, evaluating the quality of treatment, and medical research.	23
3944444337	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
3944444338	The appropriate way to speak to a patient who has a hearing impairment is to	speak slowly	25
3944444339	The appropriate way to address a patient is	Mrs. Jones	26
3944444340	A physician tries unsuccessfully to call a patient. The medical assistant should	record and date the call in the patient record	27
3944444341	The best place to interview a patient is	in a private room	28
3944444342	The type of documentation that provides an orderly series of steps for dealing with any medical case is	SOAP	29
3944444343	Of the federal programs providing health care, the largest is, which provides health insurance for citizens aged 65 and other	Medicare	30
3944444344	The person whose name the insurance is carried under is called the	Subscriber	31
3944444345	In most cases, the insurer pays an annual cost or___ for health -care insurance.	premium	32
3944444346	A fixed dollar amount the subscriber must pay or "meet" each year before the insurer begins to cover expenses is the	deductible	33
3944444347	Some medical practices may require the subscriber to pay a small fee at the time of service.	copayment	34
3944444348	In a typical medical practice, insurance claims are filed	a few business days after the date of service	35
3944444349	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
3944444350	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
3944444351	Which of the following is what the patient owes after the insurance company has paid?	subscriber liability	38
3944444352	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
3944444353	Under Medicare Part B, patients are not permitted to	enroll, because coverage is automatic	40
3944444354	A patient who has been hospitalized up to 90 days for each benefit period is covered under	Medicare Part A	41
3944444355	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
3944444356	Which of the following is a characteristic of Medicaid?	it is a health cost assistance program	43
3944444357	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
3944444358	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
3944444359	An organizations that provides pain relief to terminally ill patients and supports these patients and their families is a	hospice	46
3944444360	The amount Medicare pays the physician or health-care provider after the $100 annual deductible is met is	80%	47
3944444361	Which of the following is included under Workers' Compensation insurance?	Rehabilitation costs are covered to return an employee to work	48
3944444362	Medicare encourages all practices to file claims electronically because	the process saves time	49
3944444363	A characteristic of health maintenance organizations(HMO) is	physicians with HMO contracts are often paid a capitated rate	50
3944444364	HMO copayments are often	$10-$20	51
3944444365	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
3944444366	Electronic media claims (EMC) include	data elements that are transmitted in a computer file	53
3944444367	An appropriate approach to maintaining patient confidentiality on the computer is to	change your password every 90 days	54
3944444368	Under a contracted or fixed prepayment called____, physicians are paid a fixed amount of money to provide needed care.	capitation	55
3944444369	TRICARE and CHAMPVA cover	families of all military personnel.	56
3944444370	When entering data in medical billing programs, always	enter information using capital letters	57
3944444371	The determination of the amount of money paid by a third-party papyer for a procedure is	pre-certification	58
3944444372	What is the approval for payment from a third-party requested prior to a procedure?	pre-authorization	59
3944444373	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
3944444374	Eligibility for Medicaid is	based on the patient's reported income from the previous month	61
3944444375	Which of the following is part of the process for verifying workers' compensation coverage?	obtaining the employer's approval to provide treatment	62
3944444376	What is the term for the 10-digit number identifying the physician's medical specialty?	taxonomy code	63
3944444377	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
3944444378	Which of the following must be verbally discussed with the beneficiary to enable the beneficiary to consider options and make informed choices?	ABN	65
3944444379	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
3944444380	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
3944444381	The use of ICD-9 codes is mandated by	HIPAA	68
3944444382	A patient's diagnosis as established by the physician	describes the primary condition for which the patient is receiving treatment	69
3944444383	ICD-9 codes are updated	yearly	70
3944444384	The Alphabetic Index is organized by	the condition	71
3944444385	When you encounter the word see in the Alphabetic Index, you know that	you must look in another category	72
3944444386	The Tabular List is organized by	the part of the body involved	73
3944444387	In order to ensure reimbursement at the highest allowed level,CPT codes must	include numbers and modifiers that reflect the services performed	74
3944444388	___The____ codes are the most important of the CPT codes	E/M	75
3944444389	___For reporting purposes, CPT considers a patient "new" if the patient has not received professional services within the past ___year(s)	three	76
3944444390	When unbundling is done intentionally to receive more payment than is correct, the claim is likely to be considered	fraudulent	77
3944444391	The Health Care Common Procedure Coding System(HCPCS) was developed for use in coding services for	Medicare patients	78
3944444392	Analysis of the connection between the diagnostic and the procedural information on a claim is called	code linkage	79
3944444393	An act of deception used to take advantage of another person or entity is called	fraud	80
3944444394	A health-care provider who practices under false qualifications/credentials is guilty of	fraud	81
3944444395	To avoid the risk of fraud by discovering and correcting compliance problems, medical offices usually have a(n)	compliance plan	82
3944444396	Which of the following ICD-9-CM conventions is used around synonyms, alternative workings, or explanations?	\| \|	83
3944444397	Which of the following ICD-9-CM conventions indicates that the entries following it refine the content of a preceding entry?	includes	84
3944444398	Which ICD-9-CM convention indicates that an entry is not classified as part of the preceding code	excludes	85
3944444399	The ICD-9-CM convention code first underlying disease means	the code may not be used as the first code	86
3944444400	What does the ICD-9-CM convention NEC indicate	not elsewhere classifiable	87
3944444401	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
3944444402	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
3944444403	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
3944444404	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
3944444405	Finding the code in the ICD's Alphabetic Index is which step of analyzing and locating the correct ICD?	step 2	92
3944444406	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
3944444407	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
3944444408	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
3944444409	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
3944444410	A plus sign (+) is used to indicate	add-on codes	97
3944444411	Modifiers to CPT indicate	that some special circumstance applies to the service	98
3944444412	National codes issued by CMS that cover many supplies and durable medical equipment are	HCPCS Level II codes	99
3944444413	Inaccuracy of linking diagnostic codes and procedural codes will result in all of the following except	timely processing of claims	100
3944444414	Which of these structures or substances in the skin helps prevent UV radiation from damaging deep structures of the skin?	melanin	101
3944444415	An easy way to remember when an E code is required is	if the diagnosis makes you ask "How did that happen?"	102
3944444416	The skin plays a role in regulating body temperature by	dilating or constricting blood vessels in the skin	103
3944444417	Which of the following is mostly adipose tissue?	subcutaneous layer	104
3944444418	Sweat glands are found in the	dermis	105
3944444419	When the supply of oxygen in the blood is low, the skin looks rather pale or	bluish	106
3944444420	The most deadly skin cancer is	melonoma	107
3944444421	The most common skin cancer is	basal cell carcinoma	108
3944444422	The first thing you should do when answering the telephone is	identify the medical office and yourself	109
3944444423	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
3944444424	The recommended procedure for handling billing inquiries is to	pull the patient's chart and billing information	111
3944444425	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
3944444426	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
3944444427	If a patient remains dissatisfied after discussing a bill,	document all comments and relay the information to the physician	114
3944444428	A guideline for dealing with an angry caller is to	assure the patient that you will do your best to correct the problem	115
3944444429	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
3944444430	One of the most important telephone skills is saying words correctly, which is called	pronunciation	117
3944444431	Speaking clearly and distinctly to help the person you are speaking to understand you is called	enunciation	118
3944444432	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
3944444433	If you do not recognize the name of the patient calling the most appropriate response is	"Have you been to this practice before?"	120
3944444434	If you put a caller on hold and determine it will be a long wait,	offer to call back	121
3944444435	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
3944444436	When dealing with a caller who is nervous, upset, or angry,	show empathy and an understanding of the caller's feelings	123
3944444437	Before placing an outgoing telephone call to a patient you should	verify the correct phone number	124
3944444438	Fax machines in a medical office	should be placed in a secure location	125