Capstone Final Review

Continuity of Care means

medical attention that continues smoothly from one provider to another so that the patient receives the most benefit

A legal instrument that authorizes a person to act as the agent of the grantor is called a

power of attorney

If Mr. Jone's insurance has a $500 deductible and a $50 surgery copay, how much will his insurance pay on his bill of $4,359?

$3,809

A secondary health plan is noted in which block of the CMS-1500 form?

11d

How many diagnoses can be reported on a CMs-1500 form?

12

The patients name is found in which block on the CMS-1500 form

2

Which of the following codes is assigned to an urgent care facility as the place of service?

20

Procedures performed on the patient are found in what block of the CMS-1500 form?

24d

The assignment of benefits is located in which block on the CMS-1500 form?

27

The physicians signature is located in which block of the CMS-1500 form?

31

Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent

32000

The insureds name is found in which block of the CMS-1500 form?

4

Liver Function study with hepatobiliary agents, with serial images

78220

Basis metabolic panel

80048

Triglycerides

84478

New Patient office visit, problem-focused history and examination, straightforward decision making

99201

New Patient office visit, comprehensive history and examination, and moderate-complexity decision making

99204

New Patient office visit, comprehensive history and examination, high-comlexity decision making

99205

Hospital discharge day management, 45 minutes

99239

Which of the following individuals would NOT normally be eligible for Medicare?

A 23 year-old recipient of AFDC

The Tricare option that is similar to a preferred provider network is Tricare

Extra

A detailed history takes the shortest amount of time.

False

All conditions that occur during or following medical care or surgery are classified as complications.

False

Health insurance typically covers services and procedures considered medically necessary. Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary.

False

It is acceptable to code from the Alphabetic Index.

False

PHI stands for "private health information".

False

The EMR relates to more than one healthcare organization.

False

The codes for pernicious anemia and a vitamin B12 deficiency are the same.

False

The formal action of a legislative body is called an appeal.

False

The patient owns the medical record.

False

The system is not capable of telling whether a certain procedure matches a specific diagnosis code

False

When wounds of more than one classification are repaired, list the less complicated repair as the primary procedure and the more complicated repair as the secondary procedure.

False

A policy that covers a number of people under a single master contract issued to the employer or to an association with which they are affiliated and that is not self-funded is usually called

Group policy

A person who represents a minor in legal situations is called

Guardian Ad Litem

A set of laws designed to standardize electronic data exchangeg and protect health information is

HIPAA

What is the HIPAA privacy rule requirement for the retention of health records?

HIPAA does not include requirements

Which section of the law, commonly known as the Economic Stimulus Package, pertains to healthcare?

HITECH Act

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

HMO's

Which of the following codes will be used for a patient with a history of myocardial infarction with no symptoms but diagnosed by means of an electrocardiogram?

I25.2

How are subterms treated in the alphabetic index to diseases and injury?

Indented two spaces under the level of the preceding line

Malfeasance

Intentionally doing something either legally or morally wrong

In most cases, does the electronic health record system require more or less storage space than a paper filing system?

Less

Respondeat superior is a Latin term meaning

Let the master answer

Which of the following insurance protects the healthcare facility if there is an accident in the facility that causes bodily injury or property damage?

Liability Insurance

The benefits of HIPAA include

Lower administrative costs

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

Medicaid

Which of the following is NOT a type of civil law?

Misdemeanor

Which of the following indirect filing systems is used by a majority of large clinics and hospitals?

Numeric filing

Local governments create and enact

Ordinances

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

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

The person bringing a case or legal action to court is the

Plaintiff

A strong, highly glazed composition paper or heavy card stock is called

Pressboard

Which of the following is NOT a method of organizing a medical record?

Progressively

Which of the following health information exchanges allows providers to find and/or request information on a patient from other providers?

Query-based exchange

Something that has significant and demonstrable bearing on the matter at hand is

Relevant

The "R" entry in the SOAPER charting method means

Response

Which type of referral is usually processed immediately?

STAT

Which of the following ICD-10-CM sections include guidelines for reporting additional diagnoses in non-outpatient settings?

Section III

Organizations that fund their own insurance programs offer their employees

Self-funded plans

Which of the following HMO models hires physicians and pays them a salary rather than contracting the physicians to create a network?

Staff Model

Information that is gained by questioning the patient or that is taken from a form is called

Subjective Information

The date in block 14 of the CMS-1500 form is the date of

The onset of the illness

Who ultimately decides whether a medical record can be released?

The patient

Which statement is NOT true regarding the reasons for keeping accurate medical records?

The patients family may want to examine the record and correct errors.

Entities that make payment on an obligation or debt but are not parties of the contract that created the debt are called

Third-party payers

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

Tricare

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

True

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

True

Information contained in an electronic health record usually can be accessed from several different physical places.

True

Medical records offer protection to the physician during legal proceedings if they are accurate and complete.

True

Nearly all of the physician's income is derived from the insurance payments received for services rendered.

True

Physicians can expect reductions in the amounts that they are paid from Medicare and Medicaid if they are not in compliance by 2015.

True

Something that is easily understood or recognized by the mind is a manifestation.

True

The "cafeteria-style" plan allows employers to choose the benefits they want for their respective employees.

True

The EHR allows access to patient information in an emergency.

True

The HITECH Act imposes data breach notification requirements for unauthorized uses and disclosures of "unsecured PHI"

True

The three basic filling methods are alphabetic, numeric, and alphanumeric.

True

There must be a cause-and-effect relationship between the care provided and the condition, and an indication in the documentation that it is a complication.

True

When multiple wounds are repaired, add together the lengths of those in the same classification.

True

Which of the following is NOT a disadvantage of managed care?

Authorized services usually are covered

Which of the following is typically documented in the EOB?

Co-Insurance AND Patients Deductible

All 50 states require reporting which of the following to the local health department?

Confirmed cases of acquired immunodeficiency syndrome

Which part of Medicare covers prescription drug services?

D

Which of the following is NOT objective information?

Family History

A major crime, such as rape, murder, or burglary, is classified as

Felony

Which of the following is NOT an advantage of a numeric filing system?

Filing activity is greatest when the system is initiated

How would you properly index the name "Jill Freeman, M.D." for filing if you had another patient with the same name but without the title?

Freeman, Jill M.D.

Which of the following include compensation for pain and suffering?

General Damages

What is one of the benefits of using a paper health record?

Good evidence of patient care

Advantages of the EHR system include

Ability of the physician to see more patients in a day

The medical assistant should always verify which of the following prior to the patients appointment?

All of the above *Benefits and exclusions *Effective date of insurance *Eligibility

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

All of the above *Radiology report *Progress notes *Pathology report *Encounter form

Disadvantages of the EHR system include

All of the above *training time *learning curve *cost

Which of the following civil laws most directly affect the medical profession?

All of the above *Administrative Law *Tort Law *Contract Law

Public medical facilities must allow individuals with disabilities to easily and safely

All of the above *enter and exit buildings *use drinking fountains *move from floor to floor

Which of the following is a pretrial disclosure of pertinent facts or documents by one or both parties to a legal action of proceeding?

Deposition AND Discovery tool

Claims that have errors or omissions that must be corrected and resubmitted to recieve reimbursement are called

Dirty Claims

A correction to a medical record can be made by

Drawing a line through the entry and writing the correct information

When coding for drug toxicity, which of the following refers to a condition when a patient takes less of a medication than is prescribed by his or her provider or by the manufacturers instructions?

Underdosing

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

With AND Without manipulation and/or traction

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

Workers compensation