Download Medical Coding exam with precise detailed answers and more Exams Medicine in PDF only on Docsity!
Medical |! Coding |! exam |! with |! precise |!
detailed |! answers
HIPAA |! (part |! 1) |! - |! Correct |! answer |! ✔Health |! Insurance |! Portability |! and |! Accountability |! Act ICD |! - |! Correct |! answer |! ✔International |! Classification |! of |! Diseases |! required |! by |! Medicaid |! and |! Medicare CPT |! - |! Correct |! answer |! ✔Current |! Procedural |! Terminology |! ( CDM |! - |! Correct |! answer |! ✔Charge |! Description |! Manager Has |! all |! the |! info |! about |! health |! care |! services |! that |! patients |! have |! received |! and |! financial |! transactions |! that |! have |! taken |! place |! Makes |! sure |! that |! the |! provider |! accurately |! charges |! the |! patient |! for |! routine |! services |! and |! supplies Claim |! - |! Correct |! answer |! ✔A |! claim |! is |! a |! complete |! record |! of |! all |! the |! services |! provided |! to |! a |! patient forms |! of |! info |! needed |! for |! a |! claim |! - |! Correct |! answer |! ✔full |! name |! and |! demographic |! information.
account |! number |! - |! Correct |! answer |! ✔Number |! on |! an |! invoice |! that |! identifies |! specific |! episode |! of |! care, |! date |! of |! service |! or |! patient Medicare |! summary |! notice |! (MSN) |! - |! Correct |! answer |! ✔document |! that |! outlines |! the |! amounts |! billed |! by |! the |! provider |! and |! what |! the |! patient |! must |! pay |! the |! provider what |! does |! HIPAA |! mean? |! (part |! 2) |! - |! Correct |! answer |! ✔Fed |! Act |! to |! ensure |! the |! privacy |! of |! Protected |! Health |! Information |! (PHI) defines |! the |! permitted |! uses |! and |! disclosures |! of |! PHI Enforces |! rules |! and |! regs |! set |! forth |! in |! this |! Act |! by |! civil |! and |! criminal |! penalties What |! is |! Protected |! Health |! Information? |! - |! Correct |! answer |! ✔PHI |! is |! all |! individually |! identifiable |! healthcare |! information |! in |! all |! forms: |! (VOWE) -Visual -Oral -Written -Electronic Individually |! Identifiable |! Information |! - |! Correct |! answer |! ✔Info |! is |! individually |! identifiable |! if: -It |! id's |! the |! individual |! or |! offers |! a |! reasonable |! basis |! for |! id -It |! is |! created |! or |! received |! by |! a |! covered |! entity |! or |! an |! employer -Relates |! to |! the |! past, |! present |! or |! future |! physical |! or |! mental |! health |! or |! condition, |! the |! provision |! of |! health |! care, |! or |! the |! payment |! for |! heath |! care
Incidental |! Uses |! and |! Disclosures |! - |! Correct |! answer |! ✔HIPAA |! explicitly |! permits |! certain |! incidental |! uses |! and |! disclosures |! that |! occur |! as |! a |! by-product |! of |! a |! us |! or |! disclosure |! otherwise |! permitted |! by |! HIPAA Examples |! of |! incidental |! uses |! and |! disclosures |! - |! Correct |! answer |! ✔-calling |! out |! name |! of |! patient |! names |! is |! waiting |! area -discussing |! a |! patient |! at |! a |! nursing |! station |! where |! visitors |! my |! overhear -discussing |! treatment |! in |! a |! room |! shared |! by |! more |! that |! one |! patient REASONABLE |! SAFEGUARDS |! TO |! BE |! USED |! TO |! PROTECT |! PHI |! - |! Correct |! answer |! ✔-speak |! quietly |! when |! discussing |! a |! pts |! condition |! where |! it |! may |! be |! overheard -avoid |! using |! a |! pts |! name |! in |! public |! or |! hallways |! or |! elevators -posting |! signs |! to |! remind |! employees |! to |! protect |! pt |! confidentiality -Isolating |! or |! locking |! file |! cabinets |! or |! record |! rooms -providing |! security |! such |! as |! passwords, |! screen |! savers, |! automatic |! log-off's, |! etc |! on |! computers |! where |! personal |! information |! is |! maintained 7 |! PRIVACY |! RIGHTS |! (relate |! to |! pts) |! - |! Correct |! answer |! ✔-The |! right |! to |! Notice |! of |! Privacy |! Practices -The |! right |! to |! request |! Restrictions |! in |! PHI -The |! Right |! to |! Confidential |! Communications -The |! Right |! to |! inspect |! and |! get |! copies |! of |! PHI
- |! The |! Right |! to |! Request |! Amendments |! to |! the |! PHI
- |! The |! Right |! to |! an |! Accounting |! of |! Disclosures |! of |! th |! ePHI |! (Who |! else |! saw |! the |! medical |! records)
- |! The |! Right |! to |! Complain HCPCS |! CODES |! BACKGROUND |! - |! Correct |! answer |! ✔have |! 3 |! levels -cpt |! codes -hcpcs |! level |! ii |! codes |! (separate |! book, |! ambulance |! transport, |! drugs -category |! iii |! codes |! - |! tracking |! ends |! in |! "T" |! for |! temporary HCPCS |! means |! - |! Correct |! answer |! ✔Healthcare |! Financing |! Administration Common Procedure Coding |! System Created |! by |! Medicare |! in |! 1983. |! Used |! by |! Medicaid |! system |! also CPT |! - |! Correct |! answer |! ✔Current |! Procedural |! Terminology -5-digit |! numeric |! codes -Physician |! services |! (E&M |! codes) |! Evaluation |! and |! Management |! -Procedures, |! Diagnostic |! and |! Therapeutic -2 |! digit |! modifiers -modifiers |! faciliate |! alteration |! of |! a |! service/procedure |! due |! to |! specific |! circumstances FIRST |! PUBLISHED |! IN |! 1966
World |! Health |! Organization |! - |! Correct |! answer |! ✔Made |! ICD LEVEL |! I |! CPT |! - |! Correct |! answer |! ✔ 5 |! digig |! numeric |! codes |! which |! describe |! physicians |! services |! for |! both |! therapeutic |! and |! diagnostic |! services 2 |! digit |! modifyers |! are |! available |! for |! use |! only |! in |! physician |! office |! coding, |! when |! appropriate. |! Modifiers |! are |! used |! to |! report |! that |! a |! precedure |! has |! been |! altered |! by |! a |! specific |! circumstance. LEVEL |! II |! CPT |! - |! Correct |! answer |! ✔Medicare |! ONLY |! Codes! |! HCPCS |! Level |! II |! is |! a |! standardized |! code |! system |! that |! describes |! classifications |! of |! like |! products |! that |! are |! medical |! in |! nature |! by |! category |! for |! the |! purpose |! of |! efficient |! claims |! processing. |! These |! codes |! are |! used |! primarily |! for |! billing |! purposes! |! They |! range |! from |! A |! codes: |! Transport |! services, |! medical/surgical |! supplies |! - |! to |! V |! codes: |! Vision |! Services What |! is |! documentation? |! - |! Correct |! answer |! ✔the |! record |! of |! clinical |! observations |! and |! care |! a |! patient |! recieves |! at |! a |! health |! care |! facility. |! It |! is |! used |! to |! communicate |! relevant |! patient |! information |! among |! health |! care |! professionals. |! It |! also |! serves |! as |! the |! basis |! of |! info |! conveyed |! to |! third |! party |! (insurance |! medicare |! and |! medicaid) |! payers |! who |! are |! responsible |! for |! reimbersing |! providers. Disclosure |! refers |! to |! the |! way |! health |! information |! is |! - |! Correct |! answer |! ✔disseminated |! from |! a |! covered |! entity |! or |! its |! Business |! associate |! BA |! to |! an |! outside |! person |! or |! organization.
Stark |! Law |! - |! Correct |! answer |! ✔states |! that |! physicians |! are |! not |! allowed |! to |! refer |! patients |! to |! a |! practioner |! with |! whom |! they |! have |! a |! financial |! relationship. |! Also |! prohibitsthe |! referred |! practitioner |! from |! presenting |! claims |! to |! Medicare. |! The |! Center |! for |! Medicare |! and |! Medicaid |! SErvices |! (CMS) |! has |! oversight |! responsibilities |! of |! this |! law. |! (BOX |! 17 |! Referring |! Doctor) Office |! of |! Inspector |! General |! (OIG) |! - |! Correct |! answer |! ✔Federal. |! Protects |! Medicare |! and |! other |! HHS |! programs |! from |! FRAUD |! and |! abuse |! by |! conducting |! audits Medicare |! - |! Correct |! answer |! ✔Federally |! funded |! health |! insurance |! for |! age |! 65 |! or |! older, |! people |! under |! 65 |! who |! have |! disabilities |! and |! all |! ages |! with |! end-stage |! kidney |! disease Medicaid |! - |! Correct |! answer |! ✔Government |! based |! health |! insurance |! that |! pays |! for |! medical |! assistance |! for |! those |! who |! have |! low |! incomes |! and |! limited |! financial |! resources DRGs |! - |! Correct |! answer |! ✔Diagnosis |! Related |! Groups used |! as |! a |! payment |! system |! for |! inpatient |! Medicare |! patients Claim |! - |! Correct |! answer |! ✔a |! complete |! record |! of |! the |! services |! provided |! by |! the |! health |! care |! professional |! along |! with |! appropriate |! insurance |! information Electronic |! Data |! Interchange |! - |! Correct |! answer |! ✔The |! transfer |! of |! electronic |! information |! in |! a |! standard |! format
2 |! pieces |! of |! information |! that |! need |! to |! be |! collected |! from |! patients |! - |! Correct |! answer |! ✔FULL |! NAME |! AND |! DATE |! OF |! BIRTH |! SOCIAL |! SECURITY |! # VErify |! Insurance! |! - |! Correct |! answer |! ✔Before |! submitting |! a |! claim |! it |! is |! important |! to |! make |! sure |! that |! the |! insurance |! is |! valid |! and |! the |! services |! are |! a |! covered |! benefit Birthday |! Rule |! - |! Correct |! answer |! ✔Applies |! to |! parents |! who |! both |! have |! health |! insurance |! and |! list |! children |! as |! dependents. |! The |! health |! plan |! of |! the |! parent |! whos |! birthday |! comes |! first |! in |! the |! current |! year |! is |! the |! primary |! and |! will |! be |! billed |! first |! for |! insurance |! claims. 3 |! KINDS |! OF |! INSURANCE |! INFORMATION |! needed |! to |! be |! collected |! from |! Patient |! - |! Correct |! answer |! ✔-Correct |! Policy |! number -Group |! Number -Policy |! effective |! date -type |! of |! policy Insurance |! Premium |! - |! Correct |! answer |! ✔a |! weekly, |! monthly |! or |! annual |! cost |! for |! the |! plan |! or |! insurance |! coverage. COINSURANCE |! PERCENTAGE |! - |! Correct |! answer |! ✔Amount |! provider |! is |! allowed |! for |! service |! and |! the |! amount |! he |! was |! paid. |! a |! common |! % |! split |! is |! 80% |! for |! insurance |! carrier |! and |! 20% |! for |! patient. 3 |! Major |! kinds |! of |! government |! insurance |! plans |! - |! Correct |! answer |! ✔Medicare
Medicaid State |! children's |! Health |! insurance |! Program |! (SCHIP) Private |! Health |! Insurance |! vs |! Employer |! Self-insured |! plans |! - |! Correct |! answer |! ✔Private |! health |! insurance |! is |! paid |! by |! individuals |! int |! he |! form |! of |! premiums |! to |! the |! insurance |! company. |! Employer |! Self-insured |! plans |! are |! purchased |! in |! mass |! by |! the |! employer |! and |! can |! be |! more |! cost |! effective. |! Employers |! fund |! the |! health |! insurance |! plans REFERRAL |! - |! Correct |! answer |! ✔Written |! recommendation |! to |! a |! specialist Precertification |! - |! Correct |! answer |! ✔A |! review |! that |! looks |! at |! whether |! the |! procedure |! could |! be |! performed |! safely |! but |! less |! expensively |! in |! an |! outpatient |! setting Predetermination |! - |! Correct |! answer |! ✔A |! written |! request |! for |! a |! verification |! of |! benefits GATEKEEPER |! - |! Correct |! answer |! ✔Usually |! the |! Primary |! care |! physician. |! Determines |! if |! referrals |! to |! specialists, |! services |! or |! facitities |! are |! needed |! and |! then |! selects |! the |! provider |! the |! patient |! should |! go |! to. Preauthorization |! - |! Correct |! answer |! ✔Approval |! from |! the |! health |! plan |! for |! an |! impatient |! hospital |! stay |! or |! surgery. |! Before |! giving |! approval |! the |! health |! plan |! will |! assess |! whether |! the |! procedure |! is |! medically |! necessary |! an |! how |! long |! the |! hospital |! stay |! should |! be.
Remittance |! Advice |! (RA) |! - |! Correct |! answer |! ✔a |! report |! sent |! from |! the |! 3rd |! party |! payer |! to |! the |! provider Reconciliation |! - |! Correct |! answer |! ✔the |! process |! the |! billing |! office |! goes |! thru |! to |! determine |! what |! payments |! h |! ave |! come |! in |! from |! the |! third |! party |! payer |! and |! what |! the |! patient |! owes |! the |! provider. |! The |! billing |! office |! uses |! the |! RA |! EO |! and |! MSN |! to |! make |! these |! determinations. Reason |! for |! ICD9 |! - |! Correct |! answer |! ✔Standard |! for |! reporting |! diagnosis |! in |! all |! us |! healthcare |! settings. |! Serves |! as |! a |! way |! for |! health |! care |! professionals |! to |! let |! third |! party |! payers |! know |! what |! services |! were |! provided. |! Helps |! ensure |! the |! health |! care |! professionals |! and |! facilities |! are |! reimbursed |! in |! a |! timely |! manner structure |! of |! icd9 |! cm |! - |! Correct |! answer |! ✔Volume |! 1 |! Tabular |! list |! of |! Diseases |! and |! Injuries Volume2: |! The |! Alphabetic |! Index |! to |! Diseases |! and |! Injuries Volume |! 3: |! The |! Classification |! for |! Procedures |! for |! Reporting |! Hospital |! Procedures ICD |! 10 |! Sections: |! - |! Correct |! answer |! ✔1=Section |! of |! the |! ID010-PCS |! System |! where |! the |! code |! is |! indexed 2=The |! body |! system 3=Root |! operation, |! such |! as |! excision |! or |! incision 4=Specific |! body |! part 5=Approach |! used 6=DEvice |! used |! to |! perform |! the |! procedure
7=Qualifier |! to |! provide |! addtional |! information |! about |! the |! procedure |! (diagnostic |! vs. |! therapeutic) V |! codes |! - |! Correct |! answer |! ✔Used |! to |! classify |! visits |! when |! circumstances |! other |! than |! disease |! or |! injury |! are |! the |! reason |! for |! the |! appt |! (ICD9-CM) E |! Codes |! - |! Correct |! answer |! ✔Used |! to |! classify |! environmental |! events, |! circumstances |! and |! conditions |! such |! as |! cause |! of |! injury, |! poisoning, |! and |! other |! adverse |! events Medical |! and |! Surgical |! CHARACTERS |! (0) |! ICD |! 10-PCS |! - |! Correct |! answer |! ✔CHARACTERS 1- |! Section 2-Body |! System 3-Root |! Operation 4-Body |! Part 5-Approach 6-Device 7-Qualifyer SBRBADQ Informed |! consent |! - |! Correct |! answer |! ✔providers |! explain |! medical |! or |! diagnostic |! procedures, |! surgical |! interventions |! and |! the |! benefits |! and |! risks |! involved, |! giving |! patients |! an |! opportunity |! to |! ask |! questions |! before |! medical |! intervention |! is |! provided
Medicare |! Part |! A |! - |! Correct |! answer |! ✔Provides |! hospitilizations |! to |! eligible |! individuals Medicare |! Part |! B |! - |! Correct |! answer |! ✔Voluntary |! supplemental |! medical |! insurance |! to |! help |! pay |! for |! physicians |! and |! other |! medical |! professionals |! services, |! medical |! services |! and |! medical |! surgical |! supplies |! not |! covered |! by |! Medicare |! Part |! A third |! party |! payer |! - |! Correct |! answer |! ✔organization |! other |! than |! a |! patient |! who |! pays |! for |! services |! such |! as |! insurance |! companies |! medicare |! and |! medicaid timely |! filing |! requirement |! - |! Correct |! answer |! ✔whithin |! 1 |! calendar |! year |! of |! a |! claim |! date |! of |! service electronic |! data |! interchange |! EDI |! - |! Correct |! answer |! ✔the |! transfer |! of |! electronic |! information |! in |! a |! standard |! format coordination |! of |! benefit |! rules |! - |! Correct |! answer |! ✔determines |! which |! insurance |! plan |! is |! primanry |! and |! which |! is |! secondary Conditional |! payment |! - |! Correct |! answer |! ✔medicare |! payment |! that |! is |! recovered |! after |! primary |! insurance |! pays Crossover |! claim |! - |! Correct |! answer |! ✔claim |! submitted |! by |! primary |! and |! secondary |! insurance |! plan
claim |! transmission |! errors |! - |! Correct |! answer |! ✔missing |! or |! invalid |! patient |! id |! number |! and |! lack |! of |! authorization |! or |! referral |! number Medicare |! Administrative |! Contractor |! (MAC) |! - |! Correct |! answer |! ✔processes |! Medcare |! parts |! A |! and |! B |! claims |! from |! hospitals, |! physicians |! and |! other |! providers Conditional |! Payment |! - |! Correct |! answer |! ✔medicare |! payment |! that |! is |! recovered |! after |! primary |! insurance |! pays
