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Billing |! and |! Coding |! Final |! Exam |!
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solutions
A |! claims |! assistance |! professional |! (CAP) |! acts |! as |! an |! informal |! representative |! of |! patients |! and |! helps |! patients |! interpret |! insurance |! contracts. |! - |! Correct |! answer |! ✔False Which |! level |! of |! education |! is |! generally |! required |! for |! one |! who |! seeks |! employment |! as |! an |! insurance |! coder? |! - |! Correct |! answer |! ✔c) |! Completion |! of |! an |! accredited |! program |! for |! coding |! certification The |! amount |! of |! money |! an |! insurance |! billing |! specialist |! earns |! is |! dependent |! on |! which |! factors? |! - |! Correct |! answer |! ✔d) |! All |! of |! the |! above: |! knowledge, |! experience, |! size |! of |! employing |! institution Medical |! etiquette |! refers |! to... |! - |! Correct |! answer |! ✔a) |! consideration |! for |! others A |! billing |! specialist |! is |! entrusted |! with.... |! - |! Correct |! answer |! ✔d) |! All |! of |! the |! above: |! holding |! patients' |! medical |! information |! in |! confidence, |! collecting |! monies, |! being |! a |! reliable |! resource |! for |! coworkers
Standards |! of |! conduct |! by |! which |! an |! insurance |! billing |! specialist |! determines |! the |! propriety |! of |! his |! or |! her |! behavior |! in |! a |! relationship |! are |! know |! as |! medical |! _____. |! - |! Correct |! answer |! ✔ethics It |! is |! _____ |! to |! report |! incorrect |! information |! to |! private |! insurance |! carriers |! because |! this |! can |! possible |! damage |! the |! individual |! and |! the |! integrity |! of |! the |! database. |! - |! Correct |! answer |! ✔unethical The |! Office |! of |! Civil |! Right |! enforces... |! - |! Correct |! answer |! ✔privacy |! and |! security |! rules. Privileged |! information |! is |! related |! to |! the |! treatment |! and |! progress |! of |! patients. |!
- |! Correct |! answer |! ✔True The |! focus |! on |! the |! health |! care |! practice |! setting |! and |! reducing |! administrative |! costs |! and |! burdens |! are |! the |! goals |! of... |! - |! Correct |! answer |! ✔HIPAA |! Title |! II |! Administrative |! Simplification Which |! 3 |! measures |! should |! be |! taken |! by |! a |! coder |! who |! has |! knowledge |! of |! fraud |! or |! abuse? |! - |! Correct |! answer |! ✔Notify |! the |! provider |! verbally |! and |! in |! writing; |! document |! the |! false |! statement |! or |! representation; |! don't |! discuss |! the |! problem |! with |! anyone |! who |! is |! not |! involved The |! contract |! is |! a |! worker's |! comp |! case |! exists |! between |! the... |! - |! Correct |! answer |! ✔physician |! and |! insurance |! company
The |! official |! American |! Hospital |! Association |! policy |! states |! that |! abbreviations |! should |! be |! totally |! eliminated |! from |! the |! more |! vital |! section |! of |! the |! record, |! such |! as |! the... |! - |! Correct |! answer |! ✔d) |! all |! of |! the |! above: |! final |! dx, |! operative |! notes, |! discharge |! summaries A |! new |! patient |! is |! one |! who |! - |! Correct |! answer |! ✔b) |! has |! not |! received |! any |! professional |! services |! from |! a |! physician |! or |! another |! physican |! of |! the |! same |! specialty |! who |! belongs |! to |! the |! group |! practice |! within |! the |! past |! 3 |! yrs. An |! established |! patient |! is |! one |! who |! - |! Correct |! answer |! ✔has |! previously |! received |! professional |! services |! from |! a |! physician |! or |! another |! physician |! of |! the |! same |! specialty |! who |! belongs |! to |! the |! group |! practice |! within |! the |! past |! 3 |! yrs. It |! is |! possible |! for |! the |! primary |! diagnosis |! and |! principal |! diagnosis |! to |! be |! the |! same. |! - |! Correct |! answer |! ✔True An |! E |! code |! may |! never |! be |! sequenced |! in |! the |! first |! position. |! - |! Correct |! answer |! ✔True Fractures |! are |! coded |! as |! open |! if |! there |! is |! no |! indication |! of |! wheter |! the |! fracture |! is |! open |! or |! closed. |! - |! Correct |! answer |! ✔False Never |! code |! using |! just |! one |! volume |! of |! the |! diagnostic |! code |! books. |! - |! Correct |! answer |! ✔True
Diagnoses |! that |! relate |! to |! a |! patient's |! previous |! medical |! problem |! and |! that |! have |! no |! bearing |! on |! the |! patients' |! present |! condition |! should |! be |! __________ |! when |! coding. |! - |! Correct |! answer |! ✔excluded Why |! is |! the |! correct |! sequence |! of |! codes |! on |! an |! insurance |! claim |! important? |! - |! Correct |! answer |! ✔To |! make |! chronology |! of |! patient |! care |! events |! understood |! and |! to |! make |! the |! severity |! of |! disease |! understood The |! Healthcare |! Common |! Procedure |! System |! (HCPCS)consists |! of |! 2 |! levels |! of |! codes. |! - |! Correct |! answer |! ✔True The |! key |! components |! that |! determine |! an |! evaluation |! and |! management |! code |! are |! documented |! by a. |! the |! medical |! assistant b. |! the |! physician c. |! the |! insurance |! billing |! specialist d. |! none |! of |! the |! above |! - |! Correct |! answer |! ✔b. |! the |! physician The |! surgical |! package |! for |! non-Medicare |! cases |! includes |! the a. |! b. |! preoperative |! visit, |! operation, |! local |! infiltration, |! digital |! block |! or |! topical |! anesthesia, |! and |! normal |! uncomplicated |! postoperative |! care. c. d. |! - |! Correct |! answer |! ✔b. |! preoperative |! visit, |! operation, |! local |! infiltration, |! digital |! block |! or |! topical |! anesthesia, |! and |! normal |! uncomplicated |! postoperative |! care.
If |! a |! payment |! problem |! develops |! with |! an |! insurance |! company |! and |! the |! company |! ignores |! claims |! and |! exceeds |! time |! limits |! to |! pay |! a |! claim, |! it |! is |! prudent |! to |! contact |! the... |! - |! Correct |! answer |! ✔state |! insurance |! commissioner A |! follow-up |! effort |! made |! to |! an |! insurance |! company |! to |! locate |! the |! status |! of |! an |! insurance |! claim |! is |! called |! a/an... |! - |! Correct |! answer |! ✔inquiry What |! should |! you |! do |! if |! an |! insurance |! carrier |! requests |! information |! about |! another |! insurance |! carrier? |! - |! Correct |! answer |! ✔provide |! the |! information An |! insurance |! claim |! for |! which |! prior |! approval |! was |! not |! obtained |! would |! be... |! - |! Correct |! answer |! ✔rejected |! (denied) What |! should |! be |! done |! if |! an |! insurance |! claim |! denial |! is |! received |! b/c |! a |! billed |! service |! was |! not |! a |! program |! benefit? |! - |! Correct |! answer |! ✔Send |! a |! statement |! to |! the |! patient |! with |! a |! notation |! of |! the |! response |! from |! the |! insurance |! company When |! downcoding |! occurs, |! payment |! will... |! - |! Correct |! answer |! ✔be |! less Information |! provided |! on |! the |! pt |! registration |! form |! will |! prove |! critical |! to |! any |! billing |! and |! collection |! efforts. |! - |! Correct |! answer |! ✔True When |! no |! business |! or |! home |! telephone |! number |! is |! listed |! on |! the |! pt |! registration |! form, |! this |! may |! be |! an |! indication |! of |! a |! future |! nonpaying |! patient. |!
- |! Correct |! answer |! ✔True
A |! collection |! rate |! of |! 80 |! to |! 85% |! should |! be |! a |! goal |! for |! the |! practice |! administrator |! in |! charge |! of |! collections |! in |! the |! physician's |! office. |! - |! Correct |! answer |! ✔False |! (100%) It |! is |! legal |! to |! offer |! patients |! a |! cash |! discount |! when |! the |! entire |! fee |! is |! paid |! at |! the |! time |! of |! service. |! - |! Correct |! answer |! ✔True In |! most |! situations, |! both |! private |! insurers |! and |! the |! federal |! government |! ban |! waiving |! the |! copayment |! portion |! of |! the |! pt's |! fee. |! - |! Correct |! answer |! ✔True You |! should |! not |! give |! pts |! the |! option |! of |! asking |! if |! they |! would |! like |! to |! pay |! now |! or |! have |! a |! bill |! sent. |! - |! Correct |! answer |! ✔True A |! medical |! practice |! cannot |! refuse |! to |! let |! an |! established |! pt |! see |! the |! doctor |! because |! of |! a |! debt. |! - |! Correct |! answer |! ✔True If |! a |! pt |! writes |! "paid |! in |! full" |! on |! a |! check |! against |! an |! account |! that |! will |! not |! be |! paid |! in |! full |! with |! the |! check, |! the |! acceptance |! of |! the |! check |! indicates |! an |! acceptance |! of |! the |! "paid |! in |! full" |! remark. |! - |! Correct |! answer |! ✔False According |! to |! the |! FDCPA, |! debtors |! can |! never |! be |! contacted |! at |! work. |! - |! Correct |! answer |! ✔False Medicare |! accounts |! may |! not |! be |! written |! off |! until |! sequential |! statements |! have |! been |! sent |! with |! an |! increasing |! intensity |! in |! the |! collection |! message |! and |! a |! genuine |! collection |! effort |! has |! been |! made. |! - |! Correct |! answer |! ✔True
Managed |! care |! plans |! never |! require |! a |! CMS-1500 |! claim |! form |! to |! be |! completed |! and |! submitted. |! - |! Correct |! answer |! ✔False A |! copayment |! in |! a |! managed |! care |! plan |! is |! usually |! a |! fixed |! dollar |! amount |! (predetermined |! fee). |! - |! Correct |! answer |! ✔True When |! an |! HMO |! is |! paid |! a |! fixed |! amount |! for |! each |! patient |! served |! without |! considering |! the |! actual |! number |! or |! nature |! of |! services |! provided |! to |! each |! person, |! this |! is |! known |! as... |! - |! Correct |! answer |! ✔b) |! capitation An |! organization |! that |! gives |! members |! freedom |! of |! choice |! among |! physicians |! and |! hospitals |! and |! provides |! a |! higher |! level |! of |! benefits |! if |! the |! providers |! listed |! on |! the |! plan |! are |! used |! is |! call |! a/an |! - |! Correct |! answer |! ✔c) |! preferred |! provider |! organization |! (PPO) Medicare |! provides |! insurance |! for |! disabled |! workers |! of |! any |! age. |! - |! Correct |! answer |! ✔True Employee |! and |! employer |! contributions |! help |! pay |! for |! Medicare |! Part |! A |! health |! services. |! True |! or |! False? |! - |! Correct |! answer |! ✔True A |! program |! that |! offers |! a |! combination |! of |! HMO-style |! cost |! management |! and |! PPO-style |! freedom |! of |! choice |! is |! a/an... |! - |! Correct |! answer |! ✔a) |! point |! of |! service |! (POS) |! plan
The |! pt |! is |! likely |! to |! be |! the |! most |! cooperative |! in |! furnishing |! details |! necessary |! for |! a |! complete |! registration |! process... |! - |! Correct |! answer |! ✔before |! any |! services |! are |! provided. A |! partnership |! program |! permits |! Tricare-eligible |! people |! to |! receive |! inpatient |! treatment |! from |! civilian |! providers |! of |! care |! in |! a |! military |! hospital. |! t |! or |! f |! - |! Correct |! answer |! ✔true Tricare |! is |! subject |! to |! state |! regulatory |! agencies |! that |! control |! insurance |! policies. |! t |! or |! f |! - |! Correct |! answer |! ✔false For |! a |! Champva |! beneficiary, |! if |! the |! physician |! is |! nonparticipating |! and |! does |! not |! accept |! assignment, |! the |! pt |! completes |! the |! top |! portion |! of |! the |! CMS-1500... |! t |! or |! f |! - |! Correct |! answer |! ✔true Tricare/Champva |! is |! usually |! the |! 2nd |! payer |! when |! the |! beneficiary |! is |! enrolled |! in |! other |! health |! ins |! plans. |! t |! or |! f |! - |! Correct |! answer |! ✔true Tricare |! is |! funded |! through... |! - |! Correct |! answer |! ✔a. |! the |! US |! Congress People |! not |! entitiled |! to |! benefits |! under |! Tricare |! are... |! - |! Correct |! answer |! ✔a. |! Champva |! beneficiaries What |! is |! the |! system |! called |! that |! Tricare |! claims |! processors |! use |! to |! verify |! beneficiary |! eligibility? |! - |! Correct |! answer |! ✔d. |! DEERS
Vidoetapes |! made |! of |! the |! pt |! w/out |! his |! knowledge |! to |! document |! injury |! are |! called... |! - |! Correct |! answer |! ✔d. |! sub-rosa |! films The |! fed |! govt |! financially |! supports |! the |! minimum |! assistance |! level |! of |! the |! medicaly |! needy |! aged, |! and |! the |! states |! must |! wholly |! support |! any |! part |! of |! the |! program |! that |! goes |! beyond |! the |! federal |! minimum. |! True |! or |! False? |! - |! Correct |! answer |! ✔True The |! fed |! govt |! designs |! the |! Medicaid |! program |! for |! each |! state |! of |! the |! basis |! of |! the |! needs |! of |! the |! state. |! True |! or |! False? |! - |! Correct |! answer |! ✔False The |! fed |! govt |! determines |! the |! payment |! for |! medical |! services |! in |! the |! Medicaid |! program. |! True |! or |! False? |! - |! Correct |! answer |! ✔False Emergency |! care |! and |! pregnancy |! services |! are |! exempt |! by |! law |! from |! copayment |! requirements. |! True |! or |! False? |! - |! Correct |! answer |! ✔True It |! is |! possible |! for |! a |! Medicaid |! patient |! to |! be |! on |! Medicaid |! 1 |! month |! and |! off |! Medicaid |! the |! following |! month. |! True |! or |! False? |! - |! Correct |! answer |! ✔True A |! physician |! may |! accept |! or |! refuse |! Medicaid |! pts |! on |! the |! basis |! of |! the |! individual |! pt |! and |! his |! or |! her |! circumstances. |! True |! or |! False? |! - |! Correct |! answer |! ✔False
In |! the |! Medicaid |! program, |! Congress |! authorized |! vendor |! payments |! for |! medical |! care, |! which |! are |! payments |! from |! the |! ... |! - |! Correct |! answer |! ✔welfare |! agency |! directly |! to |! the |! physician. |! 1950 The |! federal |! aspects |! of |! Medicaid |! are |! the |! responsibility |! of |! the |! ... |! - |! Correct |! answer |! ✔CMS Medicaid |! is |! availble |! to |! needy |! and |! low-income |! people |! such |! as |! ... |! - |! Correct |! answer |! ✔blind, |! disabled, |! aged |! 65+ |! ***(All |! of |! the |! above) The |! number |! of |! Medicare |! benefit |! periods |! a |! patient |! can |! have |! for |! hospital |! is |! limited. |! True |! or |! False? |! - |! Correct |! answer |! ✔False Funds |! for |! Medicare |! Part |! B |! come |! equally |! from |! those |! who |! sign |! up |! for |! it |! and |! the |! federal |! government. |! True |! or |! False? |! - |! Correct |! answer |! ✔True Once |! a |! patient |! changes |! from |! Medicare |! to |! a |! senior |! HMO, |! the |! patient |! must |! stay |! with |! that |! HMO |! for |! the |! reaminder |! of |! the |! calendar |! year. |! True |! or |! False? |! - |! Correct |! answer |! ✔False A |! nonparticipating |! physician |! who |! is |! not |! accepting |! assignment |! may |! bill |! any |! fee |! he |! or |! shw |! wants. |! - |! Correct |! answer |! ✔False Medicare |! Part |! A |! is |! run |! by... |! - |! Correct |! answer |! ✔c. |! the |! Centers |! for |! Medicare |! and |! Medicaid |! Services.
Day |! sheet |! - |! Correct |! answer |! ✔Daily |! record |! of |! activities, |! patients |! treated, |! fees |! charged, |! and |! payments |! received. Encounter |! form |! - |! Correct |! answer |! ✔Record |! of |! one |! patient's |! visit |! showing |! procedures |! performed, |! charges, |! and |! diagnosis. |! In |! a |! manual |! system, |! this |! document |! may |! also |! be |! referred |! to |! as |! a |! fee |! slip, |! routing |! slip, |! or |! superbill. Guarantor |! - |! Correct |! answer |! ✔The |! person |! or |! third |! party |! responsible |! for |! payment |! of |! a |! patient's |! medical |! bills. HIPAA |! Security |! Rule |! - |! Correct |! answer |! ✔Legislation |! that |! outlines |! the |! required |! administrative, |! technical, |! and |! physical |! safeguards |! to |! prevent |! unauthorized |! access |! to |! protected |! health |! care |! information. What |! is |! the |! time |! limit |! for |! a |! veteran |! to |! file |! a |! claim |! to |! receive |! outpatient |! treatment |! at |! VA |! expense |! for |! a |! service-connected |! disability? |! - |! Correct |! answer |! ✔w/in |! one |! year ICD-9-CM |! - |! Correct |! answer |! ✔Listing |! of |! codes |! for |! medical |! diagnoses. Patient |! ledger |! - |! Correct |! answer |! ✔Record |! of |! all |! activity |! (charges, |! payments, |! and |! adjustments) |! in |! an |! individual |! patient's |! account. Procedure |! - |! Correct |! answer |! ✔A |! service |! performed |! by |! a |! physician |! or |! other |! provider.
Transactions |! - |! Correct |! answer |! ✔Charges, |! payments, |! and |! adjustments |! for |! services |! provided |! to |! patients. List |! 5 |! important |! financial |! records |! that |! are |! kept |! by |! a |! medical |! office. |! - |! Correct |! answer |! ✔... The |! pt |! registration |! form |! should |! be |! updated |! at |! least |! every... |! - |! Correct |! answer |! ✔ 6 |! months |! or |! every |! time |! the |! pt |! is |! seen It |! is |! believed |! that |! the |! longer |! the |! injured |! person |! remains |! out |! of |! work, |! the |! better |! the |! chance |! of |! recovery |! and |! return |! to |! workplace. |! t |! or |! f |! - |! Correct |! answer |! ✔false Authorization |! to |! treat |! a |! pt |! with |! an |! industrial |! injury |! may |! be |! obtained |! by |! phone |! or |! by |! form |! called |! Medical |! Service |! Order. |! t |! or |! f |! - |! Correct |! answer |! ✔true A |! narrative |! industrial |! report |! should |! include |! only |! objective |! findings |! and |! not |! subjective |! factors. |! - |! Correct |! answer |! ✔false Disability |! income |! insurance |! is |! available |! from... |! - |! Correct |! answer |! ✔d. |! all |! of |! the |! above |! (a. |! private |! ins |! co, |! b. |! employer-sponsored |! plans, |! c. |! govt-funded |! programs) In |! 1956, |! US |! Congress |! established |! a |! program |! under |! Title |! II |! of |! the |! SS |! Act |! for |! long-term |! disability |! known |! as |! ... |! - |! Correct |! answer |! ✔SSDI
