** Uncomplete** **True/False not answered** Medical Office Administration (EHR, Navigator+) OST-243 Chapter 8-13 (OST-280)

During the last quarter, New Hope hospital ended up with a number of records that were not completely coded until 6 days after the patient was discharged, mostly due to missing pathology reports. To address the issue, the HIM director needs to focus her attention on which of the following reports?

DNFB list

An Inpatient Prospective Payment System requires the following as a foundation for determining the hospital payment:

DRGs

Which of the following systems is used for the classification of psychiatric disorders?

DSM-5

This is a system that is used to code ancillary services and procedures.

HCPCS

A type of health insurance plan that usually limits coverage to include care only from doctors who work for or contract with the HMO is known as a(n):

HMO.

Mary is a medical coder for an outpatient bariatric center and typically codes gastrointestinal diseases and disorders, as well as procedures. Which coding system(s) does she use?

ICD and CPT

Which of the following systems is used for coding of inpatient procedures?

ICD-9

When do healthcare facilities initiate the billing process for patient visits or admissions?

Immediately following a patient's visit or patient's admission

The earliest international classification system was called the Bertillon Classification of Causes of Death. To what was this revised and changed?

International List of Causes of Death

What is a drawback of ICD-9-CM?

It does not reflect the updated codes for reporting diagnoses or in-patient hospital procedures.

Which of the following is a form of documentation for coding?

Operative report

Which of the following reports lists a practice's daily activity?

Patient Day Sheet

Which of the following is a standardized vocabulary of clinical terminology used for clinical documentation and reporting?

SNOMED-CT

Which of the following is NOT a responsible party for maintaining ICD-10-CM?

The Joint Commission

Which of the following is a hospital-acquired condition?

The patient fell from the hospital bed and broke his hip.

Which of the following best describes a clinical coder's responsibilities?

They translate medical information found in a patient's record into medical codes.

What was the main reason the disease classification system was originally developed?

To study infant mortality

Which of the following would be used to bill for services provided in a hospital?

UB04

What is the second step to reporting codes from an operative report?

Using several resources, such as code books and databases, to locate the correct codes.

In relation to EHR's, nomenclature is best described as:

a common system of clinical and medical terms.

Which of the following best describes Medigap?

a health insurance that supplements Medicare coverage

Which of the following services would be most likely covered by Medicare Part A?

a hospital admission

For the most part, ICD system categorizes diseases by:

anatomic site.

Patient bills are checked for errors via a process called

claim scrubbing

According to the revenue cycle management, which process(es) should be done before the claims submission?

coding and billing

The amount that the insured individual must pay to the healthcare provider before the health insurance company pays their portion is called which of the following?

deductible

A data dictionary

describes the content, format, and structure of data elements in a database.

Given the AHIMA Information Governance Principles for Healthcare, which of the following is an illustration of information protection?

designing a program to prevent data breach

The Production by Provider Report may be used for a variety of reasons, including all except

determining the amount due to insurance payers.

This report is monitored daily by health information managers, coders and others in a healthcare organization.

discharged not final billed (DNFB)

An itemized form that allows charges to be captured from a patient visit is called a(n):

electronic superbill.

ICD-10-CM is updated every October 1. The CPT coding manual is updated:

every January 1.

TRICARE is an example of a(n):

government-sponsored healthcare program.

The legal entitlement to payment or reimbursement for healthcare costs is known as

health coverage.

What is the goal of a Recovery Audit Contractor program?

healthcare

The billing aspect of a medical practice includes all of the following, except:

hiring billing personnel.

A traditional insurance plan is also

indemnity plan.

What is the difference between information governance and informatics?

information governance is a program for managing all of the data within an organization in order to provide effective and efficient care; informatics is the study of managing health information.

When a doctor enters a medication order and the system does not indicate that the patient is allergic to it, this indicates that the data ___________ is compromised?

integrity

What is the difference between internal data and external data?

internal data comes from within the organization; external data comes from outsider parties

To monitor health trends, nations track _____ which consists of illness statistics.

morbidity

_____________ are guidelines set up by the organization; ____________ are methods to implement such guidelines.

policies; procedures

Kaiser Foundation Group is an example of a(n):

private payer plan.

A _____ is an activity that is performed on an individual to improve health, treat disease or injury, or identify a diagnosis.

procedure

In order to clarify confusing documentation in the medical record and code the record accurately, a coder should do the following:

query the physician.

A classification system is different from a nomenclature in that it:

refers to coding methods for diagnoses and procedures.

Medicare uses the _____ to create the CMS Medicare Physician Fee Schedule (MPFS).

resource-based relative value scane (RBRVS)

The ACA provides Americans with better health security by putting in place comprehensive health insurance reforms that will do all of the following except:

restrict coverage.

A ______ is the person who pays for health insurance premiums; _______ are the people who benefit from the health insurance.

subscriber; covered dependents

Which of the following best describes integrated care?

systematic coordination of healthcare for patients

The biggest change from ICD-9 to ICD-10 is that:

the number of codes available in ICD-10 is much greater than in ICD-9.

In addition to accurate ICD codes, one important detail that needs to be reported to Medicare is the POA status. POA means that:

the patient had the condition(s) upon arrival.

A subscriber is

the person who usually pays for the cost of the insurance.

What is a characteristic of preferred provider organizations?

they provide more physician options for patients

Final bills are typically held in a suspended status for ____ after patient discharge to allow for final charge entry, documentation, insurance verification, and final coding.

three days

Documentation for the only purpose of claiming a higher paying DRG is considered :

upcoding

A fee schedule is a national price list of services and procedures that must be adopted by all healthcare providers.

.

A health record serves as legal documentation as long as it is in a paper format.

.

Fee for service is the average or maximum amount that may be reimbursed per service, procedure, or item to the provider from the insurance payer.

.

Frequent and routine of monitoring of billing and collections reports is necessary to ensure the practice is receiving the correct monies owed.

.

HIPAA regulations require that most claims now be processed electronically.

.

Health coverage is the legal entitlement to payment or reimbursement for healthcare costs, under a contract with a health insurance company or other payer.

.

Healthcare facilities typically only receive reimbursement from patients and the government payors such as Medicare and Medicaid.

.

Medicaid is a federal-administered health insurance program for low-income families and children, pregnant women, the elderly, people with disabilities, and in some states, other qualified adults.

.

Medicare Part B help cover hospital inpatient stays and outpatient physician office visits.

.

Not all healthcare providers are able to receive reimbursement from all insurance payers.

.

The official name for Obamacare is

Affordable Care Act.

Which of the following classification systems is used to code dental procedures?

CDT

The RBRVS sets fees for which of the following codes?

CPT® and HCPCS

Which of the following is an example of a third-party payer?

Commercial insurance

As the Sunrise hospital implements an EHR, the coding staff requests a new system that will enhance productivity, accuracy, and efficiency, as well as improve "discharged not final billed" status. What system are they most likely asking about?

Computer assisted coding

How can healthcare providers reduce the risk of inaccurate coding?

Conduct internal coding audits Provide intensive coder training Re-audit the coding areas that were subject to coder training

What is the final step to reporting codes from an operative report?

Entering the codes into the EHR to prepare the account for billing.

Which international classification of diseases is being used in the US?

ICD-10-CM

Which of the following is NOT considered a classification system?

MEDCIN

Which of the following vocabulary is mapped to the evaluation and management CPT codes?

MEDCIN

Which of the following Medicare programs helps pay for prescription drugs?

Medicare Part D

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers is called a(n):

PPO.

What is the first step to reporting codes from an operative report?

Read the report and verify the diagnosis and procedure.

Which of the following is NOT one of the parties involved in the care of the patient?

The coder

Which of the following services would be most likely covered by Medicare Part B?

a visit to a physician

If we need to find the matching ICD-10-CM code for an existing ICD-9-CM code, we would use:

data mapping

To monitor health trends, nations track _____, which consists of death statistics

mortality

Which of the following includes expenses for medical care that aren't reimbursed by the insurance company?

out-of-pocket amount

When did Medicare health coverage begin?

1965

When were ICD-10-CM and ICD-10-PCS finally implemented in the United States?

2015

When is ICD-11 likely to be adopted in the United States?

2025

What is the main difference between fraud and abuse?

Abuse is unintentional; fraud is intentional.

Big data can be used for

All ANswers Correct ----------------------- disease prevention disease treatment hospital decision making

Which of the following is an EHR benefit related to coding?

All Answers Correct ----------------------- Possibility for remote coding Possibility of more accurate documentation More complete documentation

A repository of patient's health information is made up of the following

All Answers Correct ----------------------- patient's vital signs physicians' diagnoses medication administration notes

Why are classification systems such as ICD and CPT specifically important in the US?

All Answers Correct. They are used for quality improvement. They are used for reimbursement. They are used for healthcare policy.

Clinical encoding software was adopted to:

All answers correct navigate through the coding pathways, assign appropriate codes, and result in DRG assignment. assist healthcare organizations with a high volume of health records to code. replace the use of hard-copy coding books with a computerized software coding program.

Which of the following is included in the revenue cycle management?

All of the answers are correct

Which report lists every patient account, allowing the billing staff to identify claims that need to be billed or rebilled and insurance payers that need to be contacted regarding lack of payment?

Billing/Payment Status Report

Which of the following is true about computer-assisted coding (CAC)?

CAC can increase coders' productivity.

Which of the following would be used to bill for services provided in a physician's office?

CMS-1500

A federal law that may allow individuals to temporarily keep health coverage after their employment ends is known as:

COBRA.

New Hope hospital has created a new coding position that requires the coder to start coding the patient's medical record while the patient is still receiving treatment. What type of coding are they using?

Concurrent coding