Billing and coding exam style questions

HIPAA stands for which of the following? Health Insurance Portability and Accountability Act Health Insurance Practices and Agreements Health Insurance Privacy Assessment and Agreement Health Insurance Privacy and Agreements

Health Insurance Portability and Accountability Act

Which CPT modifier should the billing and coding specialist attach to a consultation code when the service performed is required by a third party payer or government regulatory body? -22 (Unusual Procedural Services) -26 (Professional Component) -32 (Mandated Services) -59 ( Distinct Procedural Services)

-32(mandated services)

Bad debt is defined as: money you're never going to see, uncollectable -Patient refunds -Uncollectible A/R -Collectible A/R -Payment refunds

-Uncollectible A/R

Identify the first section character that would be assigned to the following procedures: Cesarean Section 1 - Obstetrics F - Mental health B - Other procedure 4 - Measurement and Monitoring

1 - Obstetrics

A new patient is one who has not received services from the physician or any other physician in that group for 1 year 3 year 90 days 2 years

3 year

An established patient presents to the clinic complaining of a sore throat, cough, and a stuffy nose. This is patient with known diabetes and hypertension. The physician documents diabetes, hypertension and upper respiratory infection. Which of the following is the first listed diagnosis? Upper respiratory infection Hypertension Diabetes Sore throat

Upper respiratory infection

The term malignant refers to: Site to which is malignant tumor has spread Malignancy that is located within the original site of development Used to describe a cancerous tumor that grows worse over time Site of origin or where the tumor originated

Used to describe a cancerous tumor that grows worse over time

Coding to the highest level of specificity means Using a fourth, fifth, sixth, or seventh digit when required Coding all the conditions listed in the patient's chart Coding just the condition for which the patient is being seen The doctor must be as specific as possible in his diagnosis(this is right to)

Using a fourth, fifth, sixth, or seventh digit when required

What is meant by the term "Code to the Highest Level of Specificity"? -Code using inconclusive and rule out diagnoses -Using the code the doctor annotates, even if the physician notes do not coincide -Using the most specific code possible -Code using the four digit subcategory code even when a five digit code is available

Using the most specific code possible

The suffix -scopy means Insertion Exclusion Incision Visualize

Visualize

are used to report encounter for circumstances other than a disease or injury in ICD-10-CM A codes V codes E codes Z codes

Z codes

A patient was suspected of having a myocardial infarction. After staying in the hospital as an outpatient in observation, the doctor found nothing wrong and sent the patient home. What code would you use in this scenario? 121.9 Acute myocardial infarction, unspecified 120.0 Unstable angina Z03.5 Observation for other suspected cardiovascular diseases Z03.4 Observation for suspected myocardial infarction

Z03.4 Observation for suspected myocardial infarction

If a patient is treated for both an acute and chronic condition, each of which has a separate code, how should the codes be listed? Acute code V code V code, condition code Chronic code, acute code Acute code, chronic code

Acute code, chronic code

When working under a managed care plan, physicians agree to: Accept fees that are predetermined by the plan Base free on national trends Set fees within certain ranges provided by the plan Charge fees that are based on local community averages

Accepts fees that are predetermined by the plan

Most individuals receiving TANF payments are limited to a ________________ year benefits period. 7 5 1 10

5

An unintentional, harmful reaction to the correct dosage of a drug is called: An adverse effect A late effect A Co-existing condition A manifestation

A late effect

When coding HCPCS codes, which of the following symbols would mean that the code is an add-on code? A red dot A plus sign A bull's eye A triangle

A plus sign

Which of the following forms notifies a patient, in writing, that they will be required to cover the costs for services provided if the payment is denied by Medicare and deemed medically unnecessary? Assignment of Benefits Advance Beneficiary Notice (ABN) Release of information Arbitration agreement

Advance Beneficiary Notice (ABN)

The tertiary insurance pays After the first and second payer After the patient has paid the co-insurance After the first payer After the receipt of the claim

After the first and second payer

When a panel code from the Pathology and Laboratory section is reported: 90% of the listed tests must have been performed All the listed test must have been performed 50% of the listed test must have been performed All of the listed tests must have been performed on the same day

All the listed test must have been informed

The insurance carrier is allowed to use any method to determine the amount for a service, also known as the Fee schedule Allowed amount Insurance premium Deductible

Allowed amount

Physician usually submit claims for patients and receive payments directly from the payers. The policy holder authorized this by signing and dating a: Assignment of benefits Schedule of benefits Encounter form Accept assignment

Assignment of benefits

Identify the first section character that would be assigned to the following procedure: Computerized tomography, spine 9 - Chiropractic F - Mental health B - imaging C - Nuclear Medicine

B - imaging

A payer's initial processing of a claim screens for Basic errors in claim data or missing information Claim attachments Medical edits Utilization guidelines

Basic errors in claim data or missing information

Which of the following CPT conventions indicates the code description is revised? Blue triangle Plus sign Lightning bolt Red dot

Blue triangle

What box on the CMS 1500 is for Dx codes? Box 15 Box 36 Box 21 Box 4

Box 21

Which of the following is one of the section in the CPT Coding Manual Pathology and Laboratory Vaccinations Encounters Pharmacy

Pathology and Laboratory

Veterans with service related disabilities are eligible for care under which of the following programs: Medicare TRICARE CHAMPVA CHAMPUS

CHAMPVA

Identify the term for first-listed diagnosis in the following encounter or visit. Initial office visit for patient requiring management of COPD an CHF Pain management Initial visit Established patient COPD and CHF

COPD and CHE

Which of the following pieces of information would you find on the encounter form(superbill)? Chief complaint Lab result Radiology reports Patient demographics

Patient demographics

The common abbreviation for chest x-ray is: CRAY CXT CXRAY CXR

CXR

Which of the following terms refers to a cancerous neoplasm in its original location? Ca in situ (cancer in a fixed place) Malignant secondary Malignant primary Benign

Ca in situ (cancer in a fixed place)

In accordance to the Health Insurance Portability and Accountability act (HIPPA), which of the following organizations considers health plans, health care provider and clearinghouses as covered entities? American Medical Association (AMA) Utilization Reviews Accreditation Commission (URAC) American heart association (AHA) Center for Medicare and Medicaid Services (CMS)

Center for Medicare and Medicaid Services (CMS)

Payers should comply with the required Claim turnaround time Retention schedule Remittance advice Insurance aging report

Claim turnabout time

Multigravida is a term associated with Pregnancy Arthritis Glaucoma Bronchitis

Pregnancy

Information given by a patient to medical personnel that cannot be disclosed without consent constitutes Duty of Care Privileged communication Negligence Judgement

Privileged communication

In the following equation, identify the term for the first listed diagnosis in the following encounter or visit. Established patient present to clinic with exacerbation(irritation) of Crohn's disease. Patient's rheumatoid arthritis is stable. Rheumatoid arthritis Established patient Crohn's disease Arthritis

Crohn's disease

Identify the first section character that would be assigned to the following procedure: Gait Training 9 - Chiropractic 7 - Osteopathic 0 - Medical and Surgical E - Physical Rehabilitation

E - Physical Rehabilitation

What do the letter NOS (not elsewhere specified) indicate? Equals unspecified Encloses synonyms alternative words or explanatory phrases Appears under a code to further define or explain the content Indicates terms that are to be coded elsewhere

Equals unspecified

Who should be billed for the treatment of an emancipated minor? The parent who is financially responsible for the minor The minor The parent who came to the office with the minor The guardian

The minor

Which of the following is not a commonly used transmission method for HIPAA claims? Clearinghouse Direct transmission Direct data entry Fax

Fax

Medicare is funded by: Employers Federal funds State funds The patient

Federal funds

________ is usually sponsored and partially paid by an employer TRICARE Worker's Aide Group Health Insurance Private Insurance

Group Health Insurance

If a health plan member received medical services from a provider who does not participate in the plan, the cost for the member is typically: Negotiable Lower Higher The same

Higher

The three key factors in selecting E/M codes are Time, severity of presenting problem and history Past history, history of present illness and chief complaint History, examination and medical decision making History, examination and time

History, examination and medical decision making

The UB-04 is used for primary what type of patient visit? Hospital inpatient Urgent care Emergency room Clinic

Hospital inpatient

Medicare Part A covers: Prescription drugs MAC's Hospital services Physician services

Hospital services

A medical term that contains the root word meaning "uterus" Hysterectomy Colporrhaphy Oophorectomy Salpingectomy

Hysterectomy

Which of the following is not a correct format for ICD-10-CM? All letters are used in ICD-10-CM, except the letter U ICD-10 consists of three to five characters The first character used is always an alphabetic The second character is always a number character

ICD-10 consists of three to five characters

A lab report cannot be used for coding purposes because: Pathologist are not physicians They are not reviewed by a physician before inclusion in the record They are diagnostic tests They are not part of the health record

They are not reviewed by a physician before inclusion in the record

Assigning the proper ICD-10-CM code means following the proper order of selecting the code. Which step below should be the very first thing a coder does? Verify codes in the Tabular List Locate each main term in the Alphabetic Index Read any instructional terms in the Tabular List Identify all main terms included in clinical diagnostic statement

Identify all main terms included in clinical diagnostic statement

Claims that have errors or omissions that must be corrected and resubmitted to receive reimbursement are called Draft Corrected claim Clean Incomplete

Incomplete

What do the letters NEC (not elsewhere classified) indicate? -Appears under a code further define or explain the content -Indicates terms that are to be coded elsewhere -Encloses synonyms, alternative words or explanatory phrases -Indicates the use of code assignment for 'other' when a more specific code does not exist

Indicates the use of code assignment for 'other' when a more specific code does not exist

Why is a superbill/encounter form an important document in the office? It ensures the correct patient data information and procedure codes It is used when considering purchasing medical billing software It has information needed for vendors It ensures the correct spelling of the patient's name

It ensures the correct patient data information and procedure codes

A deviated septum due to a nasal fracture could be considered a Adverse effect Allergic effect Early effect Late effect

Late effect

During collections, most practices use Local police and state police Audit reports and tax returns Letters and calls email messages and faxes

Letters and calls

CPT is what level of Healthcare Common and Procedure coding system? Level IV Level III Level I Level II

Level I

If both parents cover dependents on their plan, the child's primary insurance is usually determined by the birthday rule. What is meant by the birthday rule? -The parent whose birthday is closes to the child's birthday is the primary -the mother is older than the father than she is primary =The parent whose birthday is earlier in the calendar year is the primary =The father is usually older than the mother so he is the primary

The parent whose birthday is earlier in the calendar year is the primary

In order to find a code using the ICD-10-CM manual, the first step is to look up the _____________ in the index? Main term Manifestation Sub term Nonessential modifier

Main term

The word used in medical terminology to mean "toward the midline of the body" is Medial Ventral Lateral Dorsal

Medial

at insurance company is the payer of last resort? Group insurance Workers compensation Medicaid Blue Cross and Blue Shield

Medicaid

A late effect may be indicated in documentation by the use of the expression(s): Malignant Missile, puncture, with foreign body Due to an old-due to a previous Primary or secondary

Missile, puncture, with the foreign body

What type of insurance allows treatment virtually anywhere with a high deductible that policy holder are willing to pay? EPO COBRA HMO PPO

PPO

Which Medicare Part do most patients have in order to cover vaccinations? Part C Part B Part D Part A

Part D

The abbreviation for PFSH is: Present, family and social history Past, family and/or social history Patient, family and/or system history Past, family and system history

Past, family and social history

The abbreviation PMPM stand for Premenstrual after midnight Per member per month Provider membership per management Provider management provider manual

Per member per month

Co-insurance is calculated based on: The numbers of policy holders in a plan A capitation rate A percentage of a charge A fired charge for each visit

Percentage of charge

There are three participants in the medical insurance relationship the first party, the second party and the third party. Who is referred to as the second party? Insurance company Secondary insurance Physician Patient

Physician

Identify the first section character that would be assigned to the following procedure: Insertion of radium into cervix (brachytherapy): Obstetrics F - Diagnostic imaging Radiation Oncology Nuclear medicine

Radiation Oncology

A certification number for a procedure is the result of which transaction and process? Referral and authorization Claim status Coordination of benefits Health care payments and remittance advice

Referral and authorization

Medical Necessity is defines as Coverage for any service Coverage for any illness a Acceptable treatment Service that are reasonable and necessary for the related diagnosis or treatment

Service that are reasonable and necessary for the related diagnosis or treatment

Which insurance is provided only for active duty and retired military members and their families? Medicaid CHAMPVA Medicare TRICARE

TRICARE

What is the Medicare Coverage Gap also known as the "donut hole"? It is the gap in coverage from month to month It is specific part of Medicare coverage that can be subscribed to It is out of pocket cost associated with a hospital stay The amount out of pocket cost after a certain amount of money has been spent from Medicare on prescription drugs

The amount out of pocket cost after a certain amount of money has been spent from Medicare on prescription drugs

The principal diagnosis when coding ICD-10-CM codes refers to which of the following? The condition or diagnosis that brought the patient into the facility The signs or symptoms An external cause code A "Z" code for a history or cancer

The condition or diagnosis that brought the patient into the facility

A claim may be down coded because The documentation does not justify the level of service The claim is for non-covered services The procedure code applies to a patient of the other gender The claim does not list a charge for every procedure code

The documentation does not justify the level of service

In reference to coding laterally and ICD-10-CM, which of the following statements is not true? Revision The last character in the code indicates that laterality Laterality include the right side, left side or bilateral A bilateral code is always provided

The last character in the code indicates that laterality

The day sheet produced by the practice management program shows The payments and charges that occurred on that date The overdue accounts on that date What each payer owes the practice as of that date What each patient owes the practice as of that date

The payments and charges that occurred on that date

Which of the following statements is true under the doctrine of respondent superior? The person who has been employed for the longest period of time is responsible for any errors made by the medical staff The physician is responsible for any errors made by the medical staff The billing and coding specialist is superior to other members of the medical staff The billing and coding specialist is responsible for any errors made by the medical staff

The physician is responsible for any errors made by the medical staff

Physicians establish a list of their usual fees for: Their Medicare patients The procedures and services they frequently perform The charges they have written off Worker's compensation patients

Their medicare patients

What is a capitated payment? -This is a regular payments received by the physician -This is when a physician can only charge a specific amount of money -This is when a physician has a contract with an insurance company to be paid whether he sees the patient or not -This is when a provider can only see specific patients with specific insurance

This is when a physician has a contract with an insurance company to be paid whether he sees the patient or not

Parentheses () are used in ICD-10-CM for which of the following purposes? To enclose supplementary words that may be present ( non-essential modifiers) To indicate something needs to be excluded To indicate code also To indicate essential modifiers

To enclose supplementary words that may be present ( non-essential modifiers)

The patient aging report is used to Enter write offs to a patient's account Track overdue claims from payers Collect overdue accounts from patients Enter payments into the patient billing system

Track overdue claims for payers

Coding is the Transformation of verbal description into numbers Assignment of appropriate codes on medical claim forms Number that is entered to open a lock box Why healthcare facilities receive reimbursement

Transformation of verbal description into numbers

Under the HIPAA Privacy Rule, providers do not need specific authorization in order to release a patient's PHI for TPO purposes. What does TPO stand for? Treatment, patient protection, operations Type of payment, patient and observation Type of insurance payment and health care operations Treatment, payment and health care operations

Treatment, payment and healthcare operations

The first three factors a coder must consider when coding are patient status, place of service and Type of co-pay Type of billing Type of service Type of insurance

Type of service

The process done before claims submission to examine claims for accuracy and completeness is to Audit Revise Reject Correct

audit

Verification of insurance benefits is usually done by Asking the patient the effective date Calling the patient's employer Requesting a letter of eligibility from the carrier Calling the insurance carrier

calling the insurance carrier

What is correctly completed claim submitted within the policy time limit? Incomplete Draft Dirty Clean

clean

Which of the following instructional notes suggests that a second code may be required includes See Code also See also

code also

Which of the following statements best describes unbundling? Coding a different CPT code for each procedure performed Coding a procedure with multiple codes when a single code should be used Coding a procedure with multiple codes and modifiers Coding all procedures and services with one single code

coding all procedures and services with one single code

A code that reports more than one diagnosis with one code is a _______________ code Compound Combination Complex Multiple

combination

he four types of examination in order of difficulty (from least difficult to most difficult) are problem focused, expanded problem focused, detailed and Comprehensive Serious Diagnostic Reactive

comprehensive

Which of the following facilities does not use CMS-1500 forms? Nursing home Dialysis clinic Asc (Ambulatory Surgery Center) acute care

dialysis clinic

The definition of fraud would be: Submitting a claim with incorrect patient information Unintentionally making a coding error Intentionally upcoding in order to increase payment Providing poor quality care to the patient

intentionally upcoding in order to increase payment

Schedule of benefits means: Managed care organization Medical service covered under the insured's policy HMO Coordination of benefits

medical service covered under the insured's policy

Block I of the CMS 1500 contains what information? Insured name Carrier address Patient's name Type of insurance coverage

patients name

To indicate that something lies neared the surface, use the term: Distal Proximal Deep Superficial

superficial