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