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Medical |! Billing |! and |! Coding |!
Certificate |! exam |! with |! verified |!
answers
Chief |! Complaint |! (element |! 1 |! of |! history) |! - |! Correct |! answer |! ✔History |! of |! present |! illness, |! Review |! symptom, |! Past, |! Family, |! and |! Social |! history History |! Levels |! (Element |! 2 |! of |! history) |! and |! Examination |! Levels |! (Element |! 3 |! of |! History) |! - |! Correct |! answer |! ✔Problem |! focused, |! expanded |! problem |! focused, |! detailed, |! Comprehensive Medical |! Decision |! Making |! Complexity |! Levels |! (element |! 4 |! of |! history) |! - |! Correct |! answer |! ✔Straightforward, |! Low, |! Moderate, |! High
straightforward |! - |! Correct |! answer |! ✔Minimal |! diagnosis Minimal |! risk Minimal |! complexity |! of |! data Low |! - |! Correct |! answer |! ✔Limited |! diagnosis Limited/low |! risk |! to |! patient Limited |! data Moderate |! - |! Correct |! answer |! ✔Multiple |! diagnosis Moderate |! risk |! to |! patient Moderate |! amount |! and |! complexity |! of |! data high |! - |! Correct |! answer |! ✔Extensive |! diagnosis high |! risk |! to |! patient extensive |! amount |! and |! complexity |! of |! data truncated |! coding |! (error |! in |! coding) |! - |! Correct |! answer |! ✔using |! diagnosis |! codes |! that |! are |! not |! as |! specific |! as |! possible assumption |! coding |! (fraudulent |! coding) |! - |! Correct |! answer |! ✔reporting |! items |! of |! services |! that |! are |! not |! actually |! documented errors |! of |! the |! coding |! process |! - |! Correct |! answer |! ✔-altering |! documentation |! after |! services |! are |! reported
Internal |! Audits Retrospective |! audits |! - |! Correct |! answer |! ✔Types |! of |! Audits |! done |! to |! avoid |! billing |! and |! coding |! errors External |! Audits |! - |! Correct |! answer |! ✔a |! private |! payer |! or |! government |! investigator's |! review |! of |! selected |! records |! of |! a |! practice |! for |! compliance Internal |! Audits |! - |! Correct |! answer |! ✔self-audit |! conducted |! by |! a |! staff |! member |! or |! consultant Retrospective |! Audits |! - |! Correct |! answer |! ✔conducted |! after |! the |! claim |! has |! been |! send |! the |! remittance |! advice |! has |! been |! received Adjustments |! - |! Correct |! answer |! ✔amounts |! added |! to |! or |! taken |! away |! from |! the |! balance |! of |! an |! account Two |! methods |! to |! determine |! rates |! to |! be |! paid |! to |! providers |! - |! Correct |! answer |! ✔Charge; |! Resource Charge |! - |! Correct |! answer |! ✔based |! fees |! are |! established |! using |! the |! fees |! of |! providers |! providing |! similar |! services resource |! - |! Correct |! answer |! ✔-how |! difficult |! is |! it |! for |! the |! provider |! to |! do |! the |! procedure -how |! much |! office |! overhead |! is |! involved
-the |! relative |! risk |! the |! procedure |! presents |! to |! the |! patient |! and |! the |! provider Clearing |! Houses |! - |! Correct |! answer |! ✔Edits |! and |! transmits |! batches |! of |! claims |! to |! insurance |! companies Fee |! schedule |! - |! Correct |! answer |! ✔Payment |! is |! predetermined |! according |! to |! a |! table |! of |! diagnoses |! and |! their |! eligible |! fees usual |! - |! Correct |! answer |! ✔fee |! normally |! charged |! for |! a |! given |! service Customary |! fee |! - |! Correct |! answer |! ✔fee |! in |! the |! range |! of |! usual |! fees |! charged |! by |! physicians |! of |! similar |! training |! experience |! for |! the |! same |! service |! within |! the |! same |! specific |! and |! limited |! socioeconomic |! are resonable |! fee |! - |! Correct |! answer |! ✔fee |! that |! meets |! both |! usual |! or |! customary |! fees |! or |! is |! considered |! justifiable |! by |! responsible |! medical |! opinion |! considering |! special |! circumstances |! of |! the |! particular |! case |! in |! question relative |! value |! studies |! (rvs) |! - |! Correct |! answer |! ✔a |! list |! of |! 5 |! digit |! procedure |! codes |! for |! services |! with |! unit |! values |! that |! indicate |! the |! value |! for |! each |! procedure Capitation |! - |! Correct |! answer |! ✔physician |! has |! a |! contract |! with |! an |! insurance |! company |! to |! be |! paid |! whether |! he |! sees |! the |! patient |! of |! not
self-referral |! - |! Correct |! answer |! ✔A |! patient |! who |! refers |! himself |! to |! a |! specialist. Medicaid |! - |! Correct |! answer |! ✔Federal |! program |! that |! provides |! medical |! benefits |! for |! low-income |! persons. Medicare |! - |! Correct |! answer |! ✔A |! federal |! program |! of |! health |! insurance |! for |! persons |! 65 |! years |! of |! age |! and |! older Medicare |! Part |! A(Inpatient) |! - |! Correct |! answer |! ✔Hospital |! insurance |! for |! the |! aged |! and |! disabled. |! Covers |! institutional |! providers |! for |! inpatient, |! hospice, |! home |! health |! services |! and |! services |! within |! hospital. Medicare |! Part |! B |! - |! Correct |! answer |! ✔Referred |! to |! as |! supplementary |! Medical |! insurance. |! Supplement |! of |! part |! A |! that |! covers |! outpatient, |! services |! by |! physicians, |! durable |! medical |! equipment, |! clinical |! lab |! services |! and |! ambulatory |! services. Medicare |! Part |! C |! (Medicare |! Advantage |! Plans) |! - |! Correct |! answer |! ✔Health |! coverage |! option |! includes |! part |! A |! & |! part |! b |! & |! operated |! by |! private |! insurance |! companies |! that |! are |! approved |! by |! & |! under |! contract |! w |! medicare Medicare |! part |! D |! - |! Correct |! answer |! ✔Prescription |! drug |! coverage participating |! physician |! - |! Correct |! answer |! ✔Accepts |! assignment payment |! sent |! to |! physician
nonparticipating |! physician |! - |! Correct |! answer |! ✔Does |! not |! accept |! assignment payment |! sent |! to |! patient patient |! pays |! physician Temporary |! disability |! (TD) |! - |! Correct |! answer |! ✔patient |! cannot |! perform |! all |! functions |! of |! his |! or |! her |! job |! for |! a |! limited |! period |! of |! time weekly |! benefits |! are |! based |! on |! employees |! earnings Permanent |! Disability |! - |! Correct |! answer |! ✔Injured |! worker |! is |! left |! with |! a |! residual |! disability Sometimes |! patient |! can |! be |! rehabilitated |! in |! another |! line |! of |! work When |! a |! patient |! case |! becomes |! permanent |! and |! stationary |! and |! no |! further |! improvement |! is |! expected, |! the |! case |! is |! rated |! to |! the |! percentage |! of |! permanent |! disability |! and |! adjudicated |! so |! a |! monetary |! settlement |! can |! be |! made. Workers |! Compensation |! - |! Correct |! answer |! ✔A |! form |! of |! insurance |! paid |! by |! the |! employer |! providing |! cash |! benefits |! to |! workers |! injured |! or |! disabled |! in |! the |! course |! of |! employment. Allowed |! amount |! - |! Correct |! answer |! ✔the |! amount |! insurance |! companies |! consider |! to |! be |! an |! appropriate |! fee |! for |! a |! given |! service Co-insurance |! - |! Correct |! answer |! ✔the |! percentage |! of |! the |! bill |! for |! services |! that |! the |! policy |! holder |! must |! pay
Sliding |! Fee |! Scale |! - |! Correct |! answer |! ✔When |! offices |! charge |! fees |! based |! on |! a |! patient's |! financial |! ability |! to |! pay. fee |! schedule |! - |! Correct |! answer |! ✔A |! list |! of |! charges |! or |! established |! allowances |! for |! specific |! medical |! services |! and |! procedures Preferred |! Provider |! Organization |! (PPO) |! - |! Correct |! answer |! ✔group |! of |! healthcare |! providers |! that |! provide |! services |! to |! a |! specific |! group, |! often |! at |! a |! reduced |! rate Health |! Maintenance |! Organization |! (HMO) |! - |! Correct |! answer |! ✔insurance |! method |! that |! focuses |! on |! prevention |! of |! disease, |! must |! see |! providers |! from |! an |! approved |! list Treatment, |! payment, |! and |! healthcare |! operations |! (TPO) |! - |! Correct |! answer |! ✔Under |! HIPAA |! privacy |! rule, |! providers |! do |! not |! need |! specific |! authorization |! in |! order |! to |! release |! a |! patient's |! private |! health |! information |! for |! treatment, |! payment |! and |! operations. point |! of |! service |! plan |! - |! Correct |! answer |! ✔Hybrid |! of |! HMO |! & |! PPO |! w/ |! greater |! flexibility |! on |! choosing |! specialists |! outside |! network |! w/ |! benefits |! still |! provided |! but |! @ |! higher |! co-pay. consumer-driven |! health |! plan |! (CDHP) |! - |! Correct |! answer |! ✔medical |! insurance |! that |! combines |! a |! high-deductible |! health |! plan |! with |! a |! medical |! savings |! plan
Healthcare |! Reimbursement |! Account |! (HRA) |! - |! Correct |! answer |! ✔An |! employer-funded |! plan |! that |! reimburses |! employees |! for |! incurred |! medical |! expenses |! that |! are |! not |! covered |! by |! the |! company's |! standard |! insurance |! plan. Health |! Savings |! Account |! (HSA) |! - |! Correct |! answer |! ✔a |! tax-free |! savings |! account—funded |! by |! employees, |! employer, |! or |! both—to |! spend |! on |! routine |! medical |! costs. |! Usually |! combined |! with |! a |! high-deductible |! policy |! to |! pay |! for |! catastrophic |! care Flexible |! Savings |! Account |! (FSA) |! - |! Correct |! answer |! ✔consumer |! driven |! health |! plan |! funding |! options |! that |! has |! employer |! and |! employee |! contributions PM |! PM |! - |! Correct |! answer |! ✔per |! member |! per |! month schedule |! of |! benefits |! - |! Correct |! answer |! ✔list |! of |! medical |! expenses |! covered |! by |! a |! health |! plan COBRA |! - |! Correct |! answer |! ✔Consolidated |! Omnibus |! Budget |! Reconciliation |! Act; |! law |! to |! provide |! terminated |! employees |! or |! those |! who |! lose |! insurance |! coverage |! because |! of |! reduced |! work |! to |! be |! able |! to |! buy |! group |! insurance |! for |! themselves |! and |! their |! families |! for |! a |! limited |! amount |! of |! time. Assignment |! of |! benefits |! - |! Correct |! answer |! ✔reimbursement |! is |! sent |! directly |! from |! payer |! to |! provider
heart |! - |! Correct |! answer |! ✔cardi/o cancerous |! - |! Correct |! answer |! ✔carcin/o head |! - |! Correct |! answer |! ✔cephal/o Cerebrum |! - |! Correct |! answer |! ✔cerebr/o Cell |! - |! Correct |! answer |! ✔cyt/o teeth |! - |! Correct |! answer |! ✔dent/o skin |! - |! Correct |! answer |! ✔derm/o electrical |! activity |! - |! Correct |! answer |! ✔electr/o intestines |! - |! Correct |! answer |! ✔enter/o fetus |! - |! Correct |! answer |! ✔fet/o stomach |! - |! Correct |! answer |! ✔gastr/o
Uterus |! - |! Correct |! answer |! ✔hyster/o nose |! - |! Correct |! answer |! ✔rhin/o flesh |! - |! Correct |! answer |! ✔sarc/o clotting |! - |! Correct |! answer |! ✔thromb/o urinary |! tract |! - |! Correct |! answer |! ✔ur/o pertaining |! to |! - |! Correct |! answer |! ✔-al -algia |! - |! Correct |! answer |! ✔pain -dynia |! - |! Correct |! answer |! ✔pain -ectomy |! - |! Correct |! answer |! ✔excision, |! removal -emia |! - |! Correct |! answer |! ✔blood |! condition -genic |! - |! Correct |! answer |! ✔produced |! by
end, |! endo |! - |! Correct |! answer |! ✔within epi- |! - |! Correct |! answer |! ✔above, |! upon hyper- |! - |! Correct |! answer |! ✔excessive hypo- |! - |! Correct |! answer |! ✔deficient, |! below, |! under, |! less |! than |! normal peri- |! - |! Correct |! answer |! ✔surrounding, |! around sub- |! - |! Correct |! answer |! ✔under, |! below -ectomy |! - |! Correct |! answer |! ✔excision, |! removal -graphy |! - |! Correct |! answer |! ✔process |! of |! recording -metry |! - |! Correct |! answer |! ✔process |! of |! measuring -scopy |! - |! Correct |! answer |! ✔visual |! examination -stomy |! - |! Correct |! answer |! ✔new |! opening
-tomy |! - |! Correct |! answer |! ✔incision -tripsy |! - |! Correct |! answer |! ✔crushing Anterior |! - |! Correct |! answer |! ✔front |! of |! the |! body Posterior |! - |! Correct |! answer |! ✔back |! of |! body deep |! - |! Correct |! answer |! ✔away |! from |! the |! surface proximal |! - |! Correct |! answer |! ✔Nearer |! to |! the |! trunk |! of |! the |! body Distal |! - |! Correct |! answer |! ✔farther |! from |! the |! origin |! of |! a |! body |! part |! or |! the |! point |! of |! attachment |! of |! a |! limb |! to |! the |! body |! trunk inferior |! - |! Correct |! answer |! ✔below |! another |! structure Superior |! - |! Correct |! answer |! ✔Higher |! on |! the |! body, |! nearer |! to |! the |! head Medial |! - |! Correct |! answer |! ✔Toward |! the |! midline |! of |! the |! body Lateral |! - |! Correct |! answer |! ✔side
expressed |! consent |! - |! Correct |! answer |! ✔consent |! given |! by |! adults |! who |! are |! of |! legal |! age |! and |! mentally |! competent |! to |! make |! a |! rational |! decision |! in |! regard |! to |! their |! medical |! well-being Implied |! consent |! - |! Correct |! answer |! ✔Type |! of |! consent |! in |! which |! a |! patient |! who |! is |! unable |! to |! give |! consent |! is |! given |! treatment |! under |! the |! legal |! assumption |! that |! he |! or |! she |! would |! want |! treatment. Respondeat |! Superior |! - |! Correct |! answer |! ✔let |! the |! master |! answer HIPAA |! - |! Correct |! answer |! ✔Health |! Insurance |! Portability |! and |! Accountability |! Act |! of |! 1996 empathy |! - |! Correct |! answer |! ✔having |! an |! understanding |! and |! compassion |! for |! what |! they |! may |! be |! experiencing Establised |! patient |! - |! Correct |! answer |! ✔patient |! who |! has |! been |! seen |! multiple |! times |! by |! this |! facility New |! Patient |! - |! Correct |! answer |! ✔Individual |! who |! has |! not |! received |! any |! professional |! services |! from |! the |! physician |! or |! another |! physician |! of |! the |! same |! specialty |! who |! belongs |! to |! the |! same |! group |! practice |! within |! the |! past |! 3 |! years. advantages |! of |! electronic |! health |! records |! - |! Correct |! answer |! ✔*Safety |! *Quality |! of |! Care |! *Efficiency |! *Cost |! Reduction
HIPAA |! Security |! Rule |! - |! Correct |! answer |! ✔regulations |! outlining |! the |! minimum |! administrative, |! technical, |! and |! physical |! safeguards |! required |! to |! prevent |! unauthorized |! access |! to |! protected |! health |! care |! information HIPAA |! National |! Identifiers |! - |! Correct |! answer |! ✔Employers Healthcare |! providers Health |! plans Patients Patient |! Encounter |! - |! Correct |! answer |! ✔any |! personal |! contact |! between |! a |! patient |! and |! a |! physician |! or |! other |! person |! authorized |! to |! furnish |! healthcare |! services |! for |! the |! diagnosis |! or |! treatment |! of |! the |! patient day |! sheet |! - |! Correct |! answer |! ✔a |! report |! that |! provides |! information |! on |! practice |! activities |! for |! a |! twenty-four-hour |! period 3 |! steps |! to |! establish |! financial |! responsibility |! - |! Correct |! answer |! ✔Verify |! the |! patient's |! eligibility |! for |! insurance |! benefits. Determine |! pre |! authorization |! and |! referral |! requirements. Determine |! the |! primary |! payer |! if |! more |! than |! one |! insurance |! plan |! is |! in |! effect Patient |! is |! covered |! under |! two |! group |! plans |! - |! Correct |! answer |! ✔Plan |! that |! has |! been |! effect |! for |! the |! longest |! period |! of |! time |! is |! the |! primary, |! unless |! that |! employee |! has |! been |! laid |! -off |! or |! retired, |! the |! original |! plan |! in |! existence |! is |! then |! the |! primary.
