Chapter 16 and 17 Knowledge Check

A. A. Down-coding is also referred to as code creep or overcoding. B. When attached documentation does not match the written description of the procedure, the reimbursement will always be the lowest paying code that fits the written description. C. Down-coding happens when the coding system used on the claim form does not match the coding system used by the insurance carrier. D. Denial of payment may occur due to a lack of documentation for medical necessity.

All of the following statements regarding down-coding are accurate EXCEPT:

D. A. The Patient Protection and Affordable Care Act (PPACA) requires all individuals who don't currently have health insurance to purchase health coverage. B.The main goal of health care insurance is that it should be available to all citizens of the United States. C.Some procedures are not covered by health insurance because they have not been sufficiently proved to be effective. D.The main goal of health care insurance is that it should be available only to those who can afford it.

All of the following statements regarding health insurance are true EXCEPT:

D. A. to decrease outbreaks of contagious diseases. B. to develop quality indicators, which provide information for public health and safety. C. to analyze and improve quality medical care. D. to confirm the patient's diagnosis and limit future health insurance coverage.

Coding information is used for all of the following purposes EXCEPT:

C. A. diagnosis of diseases B. care and treatment provided by the healthcare provider. C. billing the patient. D. diagnosis of disorders

Medical care consists of all of the following EXCEPT:

nomenclature

Medical codes come from complex __________________ systems comprised of a detailed organization of information based on body systems.

A. A. deductible B. capitation C. copayment D. exclusion

A(n) __________________ is an amount of money that the insured must pay out-of-pocket for medical services before the policy begins to pay.

C. A. Evaluation and Management B. Pathology and Laboratory C. Medicine D. Surgery

The ___________ section of the CPT manual codes for immunizations, injections, dialysis, allergen immunotherapy, and chemotherapy, as well as ophthalmologic, cardiovascular, pulmonary, and neurologic procedures.

C. A. Radiology B. Pathology and Laboratory C. Evaluation and Management D. Surgery

The ___________ section of the CPT manual takes every possible combination of visits into consideration and assigns each its own number.

benefactor

The ________________is the person covered under the terms of the policy.

Current Procedural Terminology (CPT)

The____________________ system was developed by the American Medical Association (AMA).

C. A. Use a combination of upper- and lower-case letters when completing the form. B. You must ensure correct use of punctuation. C. Any date entered on the form must be in eight-digit form. D. The form must always be completed in blue ink.

Which of the following statements is accurate with regard to completing the CMS-1500 claim form?

B. A. point-of-service B. medical tourism C. exclusive provider organization D. preferred provider

Which type of insurance consists of health-provider networks paying the insured client to go abroad for treatment at internationally accredited hospitals?

B. A. triple option B. traditional indemnity C. TRICARE D. CHAMPVA

Which type of insurance provides coverage on a fee-for-service basis?

D. A. Deductibles B. Capitations C. Copayments D. Exclusions

__________________ are noncovered services that are not a part of the insurance policy.

Blue Cross Blue Shield

is the largest payer group in the United States.