NCCT STUDY

The cervix must dilate to about ___ centimeters in diameter before the baby can be delivered

10

Approx. 11 million Americans have some loss of vision from ______ and 2 million + are living with an advanced from of the disease

Age-related macular degeneration

What is a chronic disorder characterized by swelling, inflammation, and constriction of the bronchi and bronchioles?

Asthma

Who is responsible for controlling health care costs?

DHHA (*U.S. Department of Health and Human Services*)

A___is a charge added to an existing balance

Debit

A_____Indicates that the amount paid is less than the total due

Debit balance

Shaft of a bone best describes the _______

Diaphysis

What is not used to diagnose HIV infection?

Biopsy

Which type of modifier is listed first?

CPT

Which of the following is not a symptom of gastroenteritis?

Constipation

_____ is a disease affecting the arteries surrounding the heart which carry oxygen and nutrients to the myocardium

Coronary artery disease

Indicates that the amount paid is greater than was due or that the account is being paid in advance of service provided

Credit balance

The fourth character of the neoplasm code for an eye identifies what?

Location

DMEPOS claims are submitted to DME __________.

Medicare administrative contractors

A cause of arrhythmia

Medications

Health Affairs (HA) refers to the Office of the Assistant Secretary of Defense for Health Affairs, which is responsible for

Military readiness and peacetime health care

What is not one of the three categories of connective tissue?

Myelinic connective tissue

As part of the administrative simplification provisions of HIPAA, which of the following unique identifiers is assigned to third party payers

National Health PlanID (PlanID)

The ________ lobe is associated with vision

Occipital

Bone-building cells are called

Osteoblasts

When following up on a denied claim, an insurance and coding specialist should have which of the following information available when speaking with the insurance company?

PT insurance ID #, date claim was denied, date of service

Which of the following information is necessary to post payments from the RA/EOB?

PT name, date of service, billed CPT codes

Suffix -dynia means

Pain

When using the EHR to schedule a patient visit, which of the following screens should be used to complete the scheduling process?

Patient Search

The federal government administers several health care programs, some of which require services to be reimbursed according to predetermined reimbursement methodologies, which are established as __________.

Payment system

What is simply a collection of medical records compiled and maintained by an individual?

Personal health records (PHR)

When coders have questions about documented diagnoses or procedures/services, they should use a __________ process to contact the responsible physician to request clarification about documentation and the code(s) to be assigned

Physician query

When is a referral from a provider required?

For workers compensation patients

Main muscle in the calf of the leg

Gastrocnemius

Most common underlying cause of nephrotic syndrome is

Glomerulonephritis

Which of the following is also known as clap and is one of the most common STDs in the United States?

Gonorrhea

Which is the special group that requires states to pay Medicare Part B premiums for individuals with incomes between 120 percent and 175 percent of the federal poverty level?

Qualifying individuals

The Federal Black Lung Program provides medical treatment and other benefits for __________ conditions related to former employment in the nation's coal mines.

Respiratory

Federal regulations require *Medicaid to establish and maintain a(n) __________ program, which safeguards against unnecessary or inappropriate use of Medicaid services or excess payments* and assesses the quality of those services.

Surveillance and utilization review

If a patient is covered by two different policies, the usual procedure for submitting a claim would be __________.

To submit to the primary payer first, followed by submitting to the secondary after primary payment is received

If a provider refuses to accept assignment, when must the patient pay for services?

Upon denial of insurance payment

Circumscribed elevation of skin containing fluid is a

Vesicle

Type of skin lesion with itchy, temporarily elevated areas with an irregular shape formed as a result of localized skin edema as seen with hives or insect bites

Wheal

A patient does not need to provide signed consent for the medical office to release information about:

a public health risk

Amenorrhea is a term that can be defined as _____.

abnormal absence of a menstrual period

Inflammation of the sebaceous glands and hair follicles of the skin is

acne vulgaris

When is it appropriate to file a patient's secondary insurance claim?

after the remittance advice is received by the medical practice

What is the most common type of vaginal infection that causes irritation symptoms?

candidiasis

When blood enters the vast network of capillaries, called a(n) _____________, it is so dispersed that the rate of flow is reduced to a slow trickle, permitting time for O2 and nutrients to enter the tissue cells in exchange for CO2 and waste products.

capillary bed

Encephalitis:

causes nerve cell destruction

Asymmetrical melanoma

may have shades of red, white, or blue

A claims examiner employed by a third-party payer reviews health-related claims to determine whether the charges are reasonable, in addition to

determining medical necessity of services/procedures.

Encounter forms should be audited to ensure the _____.

diagnosis is in proper ICD-10-CM format

Most financial accounting is based on the _____ method of bookkeeping

double-entry

Most common bursae are located at the

elbow, knee, and shoulder

HIPAA regulations require all payers to accept __________ attachments.

electronic

What does a second degree burn involve?

epidermis and part of the dermis layer of skin, partial subcutaneous tissue

When patients arrive at the office, the administrative medical assistant should:

explain all instructions thoroughly

Disability insurance typically provides what type of insurance to the injured person?

financial

When filing alphabetically:

hyphenated surnames and hyphenated firm names are indexed as one unit

The main disadvantage of single-booking is that:

if patients' problems are easily addressed, there may be *gaps in the schedule*

Which type of biopsy involves removing a portion of the tumor for testing?

incisional

Which type of HMO offers subscribers healthcare services by physicians who remain in their individual settings.

independent practice association

When posting an insurance payment via an EOB, the amount that is considered contractual is the _____.

insured allowed amount

With congestive heart failure (CHF), the myocardium of the ___ is most commonly affected.

left ventricle

BCBS fee-for-service __________ coverage includes additional benefits, such as office visits, physical and occupational therapy, and mental health encounters.

major medical

When a capitation account is applied to the ledger, it is also known as a _____.

monthly prepayment amount

When the same payer issues the primary, secondary, or supplemental policies, the correct procedure for submitting the claim would be to submit

one claim for all policies

The suffix -stomy means:

opening

Some BCBS contracts also include one or more riders, which are special clauses that stipulate additional coverage __________ the standard contract.

over and above

All of the following hormones are produced by the anterior pituitary except _____.

oxytocin

A narrative clinic note is written in a(n) __________ format.

paragraph

Hepatitis A is spread by:

the fecal-oral route

A Jones procedure is a fracture of what part of the body?

the fifth metatarsal of the foot

The _____ the vocal cords, the higher the pitch of one's voice.

tighter and longer

What are fracture codes based on?

treatment type

The smallest infectious organism is a:

virus

Primary cause of myopia associated with the _____ of the eye

Shape

The epididymis is

Shaped like a half-moon

The Occupational Safety and Health Act of 1970 created the Occupational Safety and Health Administration (OSHA) to protect employees against injuries from occupational hazards in the workplace. *OSHA and its state partners (of approximately 2,100 inspectors) establish protective __________, which are enforced.* OSHA also reaches out to employers and employees by providing technical assistance and consultation programs.

Standards

Quasi-public agency that provides workers compensation insurance coverage to private and public employees and acts as an agent in state workers compensation cases involving state employees?

State insurance fund

All of the checks received should be ________________ as soon as they are accepted.

Endorsed or signed

A third part payer made an error while adjudicating a claim. Which of the following should the insurance and coding specialist do?

Resubmit the claim with an attachment explaining the error

The physician believes a patient might have problems with her liver. Where would the doctor palpate to feel for the spleen?

Right side of the patient's abdomen beneath the diaphragm.

Which of the following patient information is needed to determine a Medicaid sliding fee scale?

Salary, poverty level, number of dependents

The directional reference that draws an imaginary line through the side of the body vertically from the top of the head to the feet is called the

coronal plane

The patient is sent a statement for an office visit. The total amount of the bill is $100.00 and this amount must be paid before the insurance company will pay on the claim. Which of the following is this called?

deductible

Which part of the brain is the reflex center for chewing, tasting, and secreting saliva?

pons

Which is a review for medical necessity of inpatient care prior to the patient's admission?

preadmission certification

Which is the special group that requires states to pay Medicare premiums, deductibles, and coinsurance amounts for individuals whose income is at or below 100 percent of the federal poverty level and whose resources are at or below twice the standard allowed under SSI?

qualified Medicare beneficiaries

TRICARE regions are served by one or more __________ who assist TRICARE sponsors with health care needs and answer questions about the program.

service centers

Which is the special group that requires states to pay Medicare Part B premiums for individuals with incomes between 100 and 120 percent of the federal poverty level

specified low-income Medicare beneficiaries

Which program helps low-income individuals by requiring states to pay their Medicare Part B premiums?

specified low-income Medicare beneficiary

The pelvic girdle is joined anteriorly at the _______ and posteriorly at the ______

symphysis pubis / sacrum