Medical Technology and Medical Billing & Coding

An organization that processes claims and provides administrative services for another organization is:

third-party administrator

The health insurance model that offers the most flexibility for patients is:

traditional health insurance.

Electronic data interchange is:

transferring data back and forth between two or more entities.

Adult immunizations are different from immunizations given to children.

true

Electronic claims are submitted via the internet.

true

Insurance information should be collected on the first visit.

true

Multiple providers can access the patient's EHR simultaneously.

true

The semicolon indicates that modifying terms and descriptions follow.

true

A document sent by the insurance company to the provider and the patient explaining the allowed charge, the amount reimbursed for services, and the patient's financial responsibilities is:

explanation of benefits.

Claims that are done by direct billing first go to a clearinghouse.

false

Dirty claims cannot be resubmitted.

false

Only physicians can be providers of medical services.

false

The National Provider Identifier is assigned by the AMA.

false

The more parts of a medical record that are coded, the less useful the data becomes.

false

There is a national implant registry.

false

When the birthday rule is used to determine which policy is primary and which is secondary, it is the policy of the person who is the oldest that is considered primary.

false

In some managed care plans referrals to a specialist must be approved by the:

gatekeeper.

A policy that covers a number of people under a single contract issued to the employer:

group policy.

The health insurance mode that offers the least flexibility for patients is:

health maintenance organizations.

A ________ line is used between two or more positions that report to the same manager above.

horizontal

The medical assistant should never code a patient as having __________ unless it is clearly documented as confirmed in the medical record.

human immunodeficiency virus

In the Alphabetic Index main terms appear:

in bold.

Someone who is poor, needy, or impoverished is considered:

indigent.

The term nonclinical refers to healthcare occupations that do NOT:

involve medical or diagnostic patient services.

All of the following statements are true of an alphabetic filing system EXCEPT:

it is a difficult system to learn.

The BEST way to ensure that preventative services are delivered appropriately is to:

make evidence-based information readily available at the time of the patient visit.

The signs and symptoms of a disease are its __________.

manifestations

If the ICD-10-CM codes and the CPT/HCPCS codes do not match the claim will not show __________.

medical necessity

Services and/or supplies used to treat the patients diagnosis meet the accepted standard of medical practice is the definition of:

medical necessity.

Services that are needed to improve the patient's current health are considered:

medically necessary.

The provider who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

participating

The first step in an inpatient admission and discharge is:

patient demographic and insurance information is collected.

According to the Privacy Rule, a person authorized to act on behalf of an individual to make healthcare related decisions is a(n):

personal representative.

All of the following are functional benefits of the EHR EXCEPT:

physician identification.

Licensed practical nurses may only work under the supervision of registered nurses and:

physicians.

The medical assistant should always follow office __________ for claim review and signatures.

policies

A written agreement between two parties, where one party agrees to pay another party if certain specified circumstances occur is a:

policy.

The insured's address in block 7 refers to the __________ address.

policyholder's

A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services is:

preauthorization.

The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that procedure is the definition of:

precertification.

The amount of money paid to keep an insurance policy in force is the:

premium.

Health maintenance systems are also known as:

preventative care systems.

An order from a primary care provider for the patient to see a specialist is a(n):

referral.

All of the following are examples of secondary health records EXCEPT:

reports from other providers

The allowed amount for Medicare charges is determined using:

resource-based relative value scale.

Organizations that fund their own insurance programs offer their employees:

self-funded plans.

Burns are coded by:

site and degree and the body surface involved.

The state of the patient as either new or established is called the patient __________.

status

At times, the medical assistant must code a(n) __________ if the physician is not yet sure of the diagnosis.

symptoms

Communication technology used to deliver medical care to a patient in another location is called:

telemedicine.

ALOS

Average Length of Stay

Which of the following is a method of closed treatment of fractures?

Both A and B: a. Without manipulation and/or traction b. With manipulation and/or traction

Medical record filing methods are:

Both A and B: alphabetic and numeric.

Inpatient stays longer than 48 hours require a(n):

Both A and C, a. history and physical. c. discharge summary.

Veterans of the U.S. armed forces may be covered by:

CHAMPVA.

The abbreviation for Centers for Medicare and Medicaid Services is:

CMS.

Which of the following methods can be used to determine a patients eligibility for insurance?

Calling the provider services number on the back of the health insurance ID and using the provider web portal sponsored by the patients health insurance company

Which of the following best describes the responsibility of diagnostic technicians?

Capture radiographic images

CPR

Cardiopulmonary Resuscitation

Codes with a plus sign are additional codes that must be used with which of the following?

Category I codes

Which of the following codes can be used to help measure performance and outcomes?

Category II codes

A new or experimental procedure or service code is a category code.

Category code 3

CDC

Centers for Disease Control and Prevention

CMS

Centers for Medicare and Medicaid Services (formerly known as Health Care Financing Administration)

Healthy Heart Hospital needs to hire a professional to validate data and perform clinical research reports. Which of the following should they hire?

Clinical Data Specialist

abstract

Collecting important information from the health record.

CAP

College of American Pathologists

The ________ accredits medical laboratories.

College of American Pathologists

CARF

Commission on Accreditation of Rehabilitation Facilities

CT

Computed Tomography (also CAT, Computerized Axial Tomography)

COP

Conditions of Participation (Medicare)

COB

Coordination of Benefits

CPT-4®

Current Procedural Terminology, Fourth Edition

DEEDS

Data Elements for Emergency Department Systems

Which of the following positions is responsible for ensuring that an organization's data is secure?

Data resource administrator

The patient billing record includes which of the following information?

Demographic information

diagnosis

Determining the cause of a condition, illness, disease, injury, or congenital defect.

chronic

Developing slowly and lasting for a long time, generally 3 or more months.

Determining the cause of a condition, illness, disease, injury, or congenital defect describes which of the following terms?

Diagnosis

DNR

Do Not Resuscitate

DEA

Drug Enforcement Agency

Nomenclatures are:

EHR coding systems.

EKG

Electrocardiogram (also ECG)

ECG

Electrocardiogram (also EKG)

EEG

Electroencephalogram

EDI

Electronic Data Interchange

EHR

Electronic Health Record

HIPAA established the ________ Identifier to identify employer sponsored health insurance.

Employer

EIN

Employer Identification Number

The branch of medicine dealing with the incidence, distribution, and control of disease in a population and prevalence of disease in large populations and with detection of the source and cause of epidemics of infectious disease describes which of the following terms?

Epidemiological

__________ are indented under the main term and must be included in the diagnostic statement.

Essential modifiers

Which of the following levels of history includes a review of the systems that relate to the chief complaint?

Expanded problem-focused history

Clinical analysts and clinical applications coordinators have the same responsibilities.

False

Medicare and Medicaid are both governed by the American Medical Association

False

Most medical assistants work in inpatient care settings.

False

Surgery centers are usually owned by insurance companies.

False

The HIPAA Privacy Rule replaces any federal, state, or other laws that might grant individuals greater privacy.

False

The a code first notation can usually be ignored.

False

The coder should always refer to the Tabular Index first.

False

Which of the following is an explanation for the decline in the number of acute care hospitals?

Improvements have been made in surgical techniques.

Patient care approached from a holistic approach defines:

Patient-centered medical home

Which of the following is typically documented in the explanation of benefits (EOB)?

Patients deductible and co-insurance

Which of the following is NOT an advantage of the PHR?

Patients enter the information themselves.

After the deductible has been met the policyholder is responsible for a certain percentage of the bill is the definition of:

co-insurance

A certain percentage of the allowed amount that the policyholder is responsible for is:

co-insurance.

When a code is stored in the EHR, the record is considered:

codified.

A set dollar amount that the patient must pay for each office visit is the definition of:

copayment.

A set dollar amount that the policyholder must pay for each office visit is:

copayment.

The medical assistant should __________ the front and back of the patients insurance card.

copy

Healthcare providers, insurance companies, and clearinghouses are referred to by HIPAA documents as:

covered entities.

The ability of EHR systems to store or quickly locate materials relevant to the findings of the current case is referred to as:

decision support.

A set dollar amount that the policyholder must pay before the insurance company starts to pay for services is the definition of:

deductible.

The amount of money the policyholder pays per claim before the insurance company will pay on the claim is known as the:

deductible.

All of the following EXCEPT ________ departments are commonly found in larger acute care facilities.

dental

An integration architect is responsible for:

developing and managing the HL7 interfaces.

Clinical health professionals that evaluate a patient's nutritional needs are called:

dietitians.

Errors in a paper health records should be corrected by FIRST:

drawing one line in ink through the error.

The Health Insurance Portability and Accountability Act (HIPAA):

e. All of the above: a. requires security policies for patient information stored electronically. b. mandates protection for the privacy of patient records. c. establishes specific standards for data codes and data sets.

PRO

Peer Review Organization (now Quality Improvement Organization)

PHR

Personal Health Record

PIN

Personal Identification Number

histologic

Pertaining to the study of body tissues.

Which of the following expenses would be paid by Medicare Part B?

Physician's office visits

Most of today's health insurance policies cover which of the following?

Preventive care and procedures deemed medically necessary

cataract

Progressive loss of transparency of the lens of the eye.

________ always express the relationship between two counts of the same thing.

Proportions

PPS

Prospective Payment System

PHI

Protected Health Information

EPHI

Protected Health Information in Electronic Form

QIO

Quality Improvement Organization (formerly Peer Review Organization)

Which of the following sections uses the code range between 70000 and 79999?

Radiology section

RHIO

Regional Health Information Organization

To make repayment to for expense or loss incurred describes which of the following terms?

Reimbursement

RAI

Resident Assessment Instrument

A patient admitted with a pulmonary condition would most likely need the services of which of the following allied health professionals?

Respiratory therapist

Which type of referral is usually processed immediately?

STAT

UCDS

Uniform Clinical Data Set

UHDDS

Uniform Hospital Discharge Data Set

UM

Utilization Management

Which of the following steps to medical billing should be performed prior to rendering medical services?

Verify the patients eligibility for insurance coverage and collect patient insurance information.

WAN

Wide-Area Network

The International Classification of Diseases was established by:

World Health Organization.

Patients who have a condition requiring an overnight stay for one or more days would typically be treated in a(n):

acute care facility.

A(n) ________ is NOT considered an ambulatory care setting.

acute care hospital

To settle or determine judicially is the definition of:

adjudicate.

All of the following documentation guidelines have been developed by AHIMA EXCEPT:

all entries in the health record should not be permanent.

To examine claims for accuracy and completeness before they are submitted is to _________ the claims.

audit

A(n) ________ requires the patient's permission to disclose PHI.

authorization

The HITECH Act:

authorizes Medicare incentive payments to doctors and hospitals using a certified her.

A designated person who receives funds from an insurance policy is:

beneficiary.

A payment method in which providers are paid for each individual enrolled in a plan, regardless of whether the person sees the provider that month, is called a ______ plan.

capitation

A formal request for payment from an insurance company for services provided is:

claim.

If Mr. Jones insurance has a $500 deductible and then pays 80% of the charges, how much will his policy pay on his bill of $4,359?

$3087.20

A detailed history takes the shortest amount of time.

'False'.

medically necessary

Accepted healthcare services that are appropriate for the evaluation and treatment of a disease, condition, illness or injury and are consistent with the applicable standard of care.

Which of the following is NOT a measure that can be taken to maintain the security of patient records?

Access to files by all employees at all times

myxedema

Advanced hypothyroidism in adulthood.

The ________ was given $50 million by Congress to support efforts to reduce medical errors.

Agency for Healthcare Research and Quality

DRG

Diagnosis-Related Group

The study of the causes or origin of diseases describes which of the following terms?

Etiology

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

HMOs

The federal- and state-sponsored health insurance program for the medically indigent is called:

Medicaid.

This professional organization strives to improve the performance of medical group practice professionals.

Medical Group Management Association

The name given to the initiative that integrates performance and outcome measures into the accreditation process is:

ORYX.

The CPT coding manual is updated annually on

October 1

OCR

Office of Civil Rights

When searching the alphabetic index, "humerus" is an example of which of the following?

Organ or anatomic site

OASIS

Outcome and Assessment Information Set

Which part of Medicare covers inpatient hospital charges?

Part A

PACS OR PAC SYSTEM

Picture Archiving and Communication System

PET

Positron Emission Tomography

The Health Information Technology for Economic and Clinical Health Act was signed into law by:

President Barack Obama.

PSRO

Professional Standards Review Organization

To find the most accurate code, coders use the following progression

Sections, subsections, categories, subcategories

An abnormal condition resulting from a previous disease describes which of the following terms?

Sequela

epidemiology

The branch of medicine dealing with the incidence, distribution, and control of disease in a population. It also involves the prevalence of disease in large populations, in addition to detection of the source and cause of epidemics of infectious disease.

specificity

The quality or state of being specific.

The provider is paid a set amount for each enrolled person assigned to them, per period of time, whether or not that person has received services is the definition of:

capitation.

When coding neoplasms __________ is defined as the absence of invasion of surrounding tissues.

carcinoma in situ

Reports derived from HEDIS data can be used by employers to:

choose the best plan for their employees.

Meeting the stipulated requirements to participate in the healthcare plan is the definition of:

eligibility.

An enterprise application specialist is responsible for:

ensuring that data stored in different systems is available throughout the organization.

The cause of a disorder is its __________.

etiology

A PAR provider can bill the patient for the difference between their fee and insurance companies allowed amount.

false

A list of the fixed fees for services is a:

fee schedule.

A ________ is used to display a desired group of findings in a presentation that allows for quick entry of information.

form

Diagnostic coding was originally developed to study causes of:

mortality.

The first step in filing a claim with a third-party is:

obtain accurate billing information from the patient.

Professionals who use work and play therapy to increase a patient's independence are called:

occupational therapists.

The date in block 14 is the date:

of the onset of the illness.

The responsibility of the DRG Coordinator is to:

optimize reimbursement through correct billing and documentation.

A(n) ________ chart best illustrates managerial relationships between various positions in a facility.

organizational

Service provided to stop certain conditions from occurring or to lead to an early diagnosis are considered:

preventive

An approved list of physicians, hospitals, and other providers is a(n):

provider network.

Ethical obligations of the HIM professional do NOT include:

quantity of information.

Ambulatory care facilities are usually owned by:

the providers that work in them.

Most inpatient hospital admissions begin in:

the registration department.

When performing diagnostic coding you should start in looking in the:

Alphabetic Index.

ACS

American College of Surgeons

When do social workers use the term client?

In settings other than hospitals

reimbursement

To make repayment for an expense or a loss incurred.

contraindicate

To specify that an agent or procedure should not be used.

All of the following are factors concerning the quality of data EXCEPT:

accessibility.

A review of individual cases by a committee to make sure that services are medically necessary is called a(n):

utilization review.

In a clinical trial, patients:

volunteer to participate.

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called:

worker's compensation.

Downcoding can increase reimbursements.

'False'.

It is acceptable to code from the Alphabetic Index.

'False'.

Revised codes are not highlighted in the CPT manual.

'False'.

The place of service never changes for physician billing.

'False'.

Anesthesia coding is based on a billing formula.

'True'.

Downcoding and upcoding are illegal practices, and medical assistants can be prosecuted for either practice.

'True'.

Subcategories are the lowest level of code description and specificity.

'True'.

Ratios are usually mathematically reduced until either the numerator or denominator is:

1

The physician's office place-of-service code is:

11

A secondary health plan is noted in which block?

11d

How many diagnoses can be reported on the CMS-1500?

12

The assignment of benefits is located in block:

13

One time unit in anesthesia coding typically equals which of the following?

15 minutes

The physician's signature is located in block:

31

The billing provider's NPI number is placed in block:

33a

The insured's name is found in block

4

If a patient is admitted on August 12 and discharged on August 17, what is the LOS?

5 days

ICD-10-CM uses up to ___ characters to identify a disease or injury.

7

encounter form

A document used to capture the services/procedures and diagnoses for a patient visit. The fees for the services/procedures are usually included on the encounter form.

dementia

A mental disorder in which the individual experiences a progressive loss of memory, personality alterations, confusion, loss of touch with reality, and stupor (seeming unawareness of, and disconnection with, one's surroundings).

impending

A term used in the diagnosis of a condition that can be imminently threatening. For example, a patient showing signs of prediabetes may in the near future develop diabetes; therefore, in this case, diabetes is an impending condition.

Collecting important information from the health record describes which of the following terms?

Abstract

Which of the following is a message or a reminder that is automatically generated by the EHR system?

Alert

Which of the following plans require healthcare providers to become participating providers?

All government-sponsored health plans and most privately sponsored health plans

Which of the following is NOT a function performed by a DUR program?

All of the above are performed by a DUR program: The patient's diagnosis history is checked. The drug being prescribed is checked with the patient's current medications. The patient's allergy records are checked. Ingredients of a drug are checked against the ingredients of a drug already being taken.

Health plans, clearinghouses, and healthcare provider entities are covered by which part of HIPAA law?

All of the above, a. Privacy Rule b. Security Rule c. Administrative Simplification Subsection

The Documentation standard includes which of the following implementation specifications?

All of the above, a. Time limit b. Availability c. Updates

Which of the following is a component of the Administrative Simplification Subsection?

All of the above, a. Uniform identifiers b. Privacy c. Transactions and code sets d. Security

Information from health records is often used to track:

All of the above, a. child abuse. b. births. c. exposure to hazardous materials. d. communicable diseases.

State laws regulate:

All of the above, a. medical staff requirements. b. patient records. c. facility operation. d. nursing staff requirements.

Benefits of accreditation by the Joint Commission include:

All of the above, a. strengthening of community confidence in the healthcare organization. b. enhanced staff development and recruitment. c. improved risk management. d. competitive edge in the marketplace.

Indexes are used to:

All of the above: analyze date for quality improvement. automatically identify records to be abstracted for internal registries. identify and sort records for external use.

Medical records used for procedural coding can include which of the following?

All of the above: a. Encounter form b. Progress notes c. Pathology report d. Radiology report

The AHIMA Code of Ethics serves which of the following purposes?

All of the above: a. It helps HIM professionals identify relevant considerations when professional obligations conflict or ethical uncertainties arise. b. It provides ethical principles by which the public can hold HIM professionals responsible. c. It socializes new practitioners to the field to HIM's mission, values, and ethical principles. d. It provides core values on which the HIM mission was based.

Which of the following statements is true about outpatient facilities?

All of the above: a. Patient registration occurs only at the first visit. b. Outpatient facilities usually have a simpler management structure. c. Medical information is usually accessed less frequently and by fewer individuals than in inpatient facilities. d. Patients usually do not stay overnight in outpatient facilities.

The American Health Information Management Association offers which of the following credentials by a certification exam?

All of the above: a. Registered Health Information Administrator b. Certified Coding Specialist c. Registered Health Information Technician

The length of time that records are kept depends on:

All of the above: a. contract obligations. b. state law. c. policies of the facility. d. age of the patient.

An example of a "loose sheet" or a document that may need to be added to a chart at a later time is a:

All of the above: discharge summary, lab report, letter from another clinic, and consultation report.

Standardized codes or terms are also often referred to as:

All of the above: nomenclatures, vocabularies, and clinical terminologies.

An eponym will be used in which of the following CPT divisions?

Alphabetic index

The term outpatient care is synonymous with which of the following terms?

Ambulatory care

The Association for Healthcare Documentation Integrity was formally known as the:

American Association for Medical Transcription.

What organization sought to improve surgical results by requiring that hospitals keep records in addition to other minimum standards?

American College of Surgeons

Which of the following organizations governs the accreditation of medical schools and residency programs?

American Medical Association

Students interested in a career in biomedical and health informatics would benefit from a student membership in which of the following organizations?

American Medical Informatics Association (AMIA)

sequela

An abnormal condition resulting from a previous disease.

FBI

Federal Bureau of Investigation

Which of the following are not reviewed by a utilization review committee?

Fees for services provided

The format of HCPCS is

First character alpha, then numeric

FDA

Food and Drug Administration

In which acute care ownership situation are profits paid to investors?

For-profit organizations

HIPAA

Health Insurance Portability and Accountability Act

HEDIS

Health Plan Employer Data and Information System

HCPCS

Healthcare Common Procedure Coding System

An organization composed of healthcare experts and information professionals who create standards for exchange, management, and integration of electronic health information is called:

Healthcare Level Seven.

HPI

History of Present Illness

In the early days of HIM, hospitals began hiring medical record clerks to ensure that medical records were complete and stored appropriately due to which of the following programs?

Hospital Standardization

diagnostic statement

Information about a patient's diagnosis or diagnoses that has been taken from the medical documentation.

______________ are notes included in the Tabular Index to provide additional guidance for selected diagnosis codes.

Instructional notations

IDN

Integrated Delivery Network

ICD-9-CM

International Classification of Diseases, Ninth Revision, Clinical

Which of the following statements is NOT true of a standard nomenclature?

It cannot be used for point-of-care data entry.

JCAHO

Joint Commission on Accreditation of Healthcare Organizations (now referred to simply as the Joint Commission)

LOS

Length of Stay

MRI

Magnetic Resonance Imaging

MPI

Master Patient Index

Which of the following is the sum of the values divided by the frequency?

Mean

Accepted healthcare services appropriate for the evaluation and treatment of a disease, condition, illness, or injury and consistent with the applicable standard of care describes which of the following terms?

Medically necessary

MOU

Memorandum of Understanding (between Government Entities)

MDS

Minimum Data Set

The relative frequency of deaths in a specific population describes which of the following terms?

Mortality

The abbreviation that is the equivalent of a unspecified is __________.

NOS (not otherwise specified)

NCDB

National Cancer Data Base

HEDIS was created by the:

National Committee for Quality Assurance. (NCQA)

NCVHS

National Committee on Vital Health Statistics

NHIN

National Health Information Network

NPI

National Provider Identifier

Patients belonging to a MCO usually are required to get a referral from their ____ before seeing a specialist.

PCP

Under which of the following Medicare plans for primary care and specialists services is the patient required to pay a monthly premium?

Part B

Which part of Medicare covers prescription drug services?

Part D

Qualitative and quantitative codes for drug testing are found in which of the following CPT sections?

Pathology

All of the following are implementation specifications in the Security Management Process EXCEPT:

Patient Information Review.

Physical status modifier P4 is assigned to which of the following?

Patient with severe systemic disease that is a constant threat to life

When completing the CMS-1500 form, which section contains information about the patient and the insured?

Section 2

Which of the following is a numbering system in which a new number is assigned for each admission or ED visit?

Serial numbering

SNF

Skilled Nursing Facility

The Federal Tax ID number (Box 25) for the provider filing the claim can be presented as:

Social Security Number (SSN) and Employer Identification Number (EIN)

encoder

Software that will apply diagnostic or procedure codes to medical conditions or procedures.

Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?

TRICARE

Health insurance designed for military dependents and retired military personnel is called:

TRICARE.

A(n) __________ claim has been completed accurately and completely.

clean

The code for HIV indicates which of the following?

The HIV virus is present

mortality

The relative frequency of deaths in a specific population.

etiology

The study of the causes or origin of diseases.

Which of the following statements is NOT true about physician assistants (PAs)?

They can see patients when a physician is not present.

A good understanding of workflow can be beneficial for all professionals working with health information and information technology.

True

A neoplasm or new growth is coded by the site or location of the neoplasm and its behavior.

True

DRG is an acronym for diagnosis-related groups.

True

Etiology refers to the underlying cause or origin of a disease.

True

Main terms appear in bold type.

True

Politics can influence decisions regarding healthcare facility licensing.

True

Professional values require an individual to put aside personal values.

True

Radiology departments store images such as CT scans, PET scans, and MRIs on a Picture Archiving and Communication System

True

The exchange of health information across medical practices and facilities owned by different entities for better patient well-being is encouraged by regional health information organizations.

True

Which of the following letters in the ICD-10-CM is reserved by the World Health Organization to assign new diseases with uncertain etiology?

U

HHS

U.S. Department of Health and Human Services

UACDS

Uniform Ambulatory Care Data Set

UAMCMDS

Uniform Ambulatory Medical Care Minimum Data Set