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AHL 110 Final Exam
| Question | Answer |
|---|---|
| What is "cash flow" in a medical practice? | The actual money available to a medical practice. |
| What level of education is generally required for one who seeks employment as an insurance coder? | Completion of an accredited program for coding certification. |
| Medical etiquette refers to: | Consideration for others. |
| Medical ethics refers to: | Standards of conduct. |
| The earliest written code of ethical principles for the medical profession is the: | Code of Hammurabi. |
| Confidential information includes: | Everything that is heard, read or seen regarding the patient. |
| What is the correct response when a relative calls asking about a patient? | Ask the relative to put the request in writing and include the patient's signed authorization. |
| Nonprivileged information about a patient consists of the patient's: | City of residence. |
| Exceptions to the right of privacy rule include: | Gunshot wound cases. |
| Confidentiality is automatically waived in cases of: | Gunshot wounds, child abuse, and extremely contagious diseases. |
| Most physician/patient contracts are: | Implied. |
| When a patient carries private medical insurance, the contract for treatment exists between: | The physician and the patient. |
| An emancipated minor is: | A person younger than the age of 18 who lives independently. |
| The reason for a coordination of benefits statement in a health insurance policy is: | To prevent duplication or overlapping of payments for the same medical expense. |
| Conditions that existed and were treated before the health insurance policy was issued are called: | Pre-existing. |
| The SOAP in a patient medical record charting is defined as: | S-subjective, O-objective, A-assessment, P-plan. |
| An established patient is one who: | Has previously received professional services from a physician or another physician of the same specialty who belongs to the group practice within the past 3 years. |
| Parts of the small and large intestines, right ovary, right uterine tube, appendix, and right ureter are found in the: | Right lower quadrant. |
| When is exclusion from program participation mandatory? | Once an individual has been found guilty of committing a Medicare or Medicaid program-related crime. |
| All of the following cases should NOT use fax transmission: | Transmission of documents relating to information on sexually transmitted diseases, any routine transmission of patient information, or transmission of documents relating to alcohol treatment. |
| What level of education is generally required for entry into an insurance billing or coding specialist accredited program? | High school diploma or GED. |
| To ensure continuous cash flow, what is an ideal amount of time in which an insurance claim should be submitted? | 48-72 hours. |
| What does the abbreviation MSHP designate? | Multiskilled health practioner. |
| A physician's legal responsibility for his/her own actions as well as his/her employees' is called? | Vicarious liability or respondeat superior. |
| Administrative medical office responsibilities include: | Claims submission. |
| In 1980, the American Medical Association (AMA) adopted a modern code of ethics called: | The Principles of Medical Ethics. |
| Medical ____________ are not laws, but generally accepted standards of conduct. | Ethics. |
| One of the eight C's of effective caller service is Contagious. This means to: | Model the behavior you want from your callers. |
| Compliance is the process of: | Meeting regulations, recommendations and federal and state expectations. |
| Tracnsactions in which health care information is accessed, processed, stored, and transferred using electronic trechnologies are known as: | E-health Information Management (eHIM). |
| An intentional misrepresentation of the facts to deceive or mislead another is called: | Fraud. |
| What is the primary purpose of HIPAA Title I: Insurance Reform? | To provide continuous insurance coverage for workers and their insured dependents when they change or lose jobs. |
| A third-party administrator who receives insurance claims from the physicians, performs, edits, and transmits claims to insurance carriers is known as a/an: | Clearinghouse. |
| If a physician contracts with an outside billing company to manage claims and accounts receivable under HIPAA guidelines, the billing company is considered: | A business associate. |
| A confidential communication realated to the patient's treatment and progress that may be disclosed only with the patient's permission is known as: | Priviledged communication. |
| The Office of Civil Rights enforces: | Privacy standards. |
| If you give, release, or transfer information to another entity, this is known as: | Disclosure. |
| Telephone conversations by providers in front of other patients should be: | Avoided. |
| What type of organization provides a wide range of comprehensive healthcare services for a specified group at a fixed periodic payment with an emphasis on preventive care? | HMO. |
| Why was diagnostic coding developed? | For medical research, evaluation of hospital use, and for the process of tracking diseases. |
| What must be paid each year by the policy holder before the insurance policy benefits begin? | Deductible. |
| What is the consequence when a medical practice does not use diagnostic codes? | It affects the physician's level of reimbursement for inpatient claims, claims can be denied, and fines or penalties can be levied. |
| A charge slip, fee ticket, and superbill are also known as: | An encounter form. |
| The_______ is a concise statement describing the symptom, problem, condition, diagnosis, physician-recommended return, or other factor that is the reason for the encounter. | A chief complaint. |
| The ICD-9-CM is updated______ and has _______ volume(s). | Annually, 3. |
| The underlying disease is always coded: | First. |
| The main reason for a patient encounter in a doctor's office or outpatient facility is termed the: | Primary diagnosis. |
| The largest section in the CPT book is the: | Surgery section. |
| Most states generally set a minimum time required for retention of medical records of: | 7-10 years. |
| The key to substantiating procedure and diagnostic code selections for proper reimbursement is: | Supporting documentation in the health record. |
| The chronologic recording of pertinent facts and observations about the patient's health is known as: | Charting. |
| Reasons for documentation are: | Defense of a professional liability claim and because insurance carriers require accurate documentation that supports procedure and diagnostic codes. |
| When a patient fails to return for needed treatment, documentation should be made: | In the patient's medical record, in the appoitment book and on the financial record or ledger card. |
| How should an entry in a patient's medical record be corrected? | Cross out the incorrect entry, substitute the correct information, date and the initial the entry. |
| A diseased condition or state is known as: | Morbidity. |
| What does comorbidity mean? | Underlying diseases or other conditions present at the time of visit. |
| A new patient is one who: | Has not received any professional servies from the physician within the past 3 years. |
| Who may accept a subpoena? | The prospective witness and another authorized person. |
| If it was documented, it was not ________ | Done. |
| Diagnoses that relate to a patient's previous medical problem that have no bearing on the patient's present condition should be _______ when coding. | Excluded. |
| A(n) ________ is a pathalogic reaction to a drugthat occurs when appropriate doses are given to humans for prophylaxis, diagnosis, and therapy. | Adverse affect. |
| The main code book used for reporting clinical information is called the: | International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM) |
| What type of code may be used when two diagnoses or a diagnosis with a secondary process is present? | Combination code. |
| An E code may be used in which of these circumstances: | Poisoning. |
| When is the principal diagnosis applicable? | Inpatient hospital coding. |
| The volume(s) of the ICD-9-CM used in the physician's office to code diagnoses is/are: | Volumes 1 and 2. |
| What is the table that contains a classification of substances for identifying poisoning states and external causes of adverse effects? | Tabled of drugs and chemicals. |
| Carcinoma in situ is used to describe: | Cancer that is confined to the site of origin. |
| Neoplasms are ________ , _________ , and _______ . | New growths, may be malignant, and they may be benign. |
| The term "malignant" in relation to blood pressure means: | Life-threatening. |
| In what case should a V code be used? | Sterilization. |
| Diagnostic codes have from ___ to ___ digits. | 3, 5. |
| Always code to the highest degree of: | Specificity. |
| A private insurance company might adopt which of the following methods as a basis for its payment of outpatient claims? | Fee schedule, usual, customary and reasonable, relative value of schedules. |
| In medical insurance coding, the acronym CPT stands for: | Current Procedural Terminology. |
| The direct delivery by a physician(s) of medical care for a critically ill or injured patient is: | Critical care. |
| Included in a global surgery policy and a surgical package is/are: | Postoperative visits in and out of the hospital, and digital block or topical anesthesia. |
| A clean claim: | Is subject to medical review with attached information or forwarded simultaneously with electronic medical claim records. |
| What type of clean calim is any Medicare claim that contains complete, necessary information but is illogical or incorrect? | Invalid claim. |
| The CMS-1500 (08-05) insurance claim form is almost always accepted by: | Private insurance carriers, Medicaid and Medicare, and worker's compensation. |
| What should you avoid using when typing a claim for scanning? | "N/A and DNA". |
| A(n) _______ claim is submitted to the insurance carrier via a CPU, tape diskette direct data entry, direct wire, dial-in telephone, or personal computer via modem. | Electronic. |
| When two insurance policies are involved in a claim, one is considered ___ and the other is ___> | Primary, secondary. |
| OCR guidelines for the CMS-1500 claim form state: | It should not be photocopied because it cannot be scanned. |
| To conform to CMS-1500 OCR guidelines: | Do not fold insurance claim forms when mailing, do not use symbols with data on insurance claim forms, do not strike over errors when making a correction on an insurance claim form. |
| A health insurance claim form (CMS-1500) is known as the: | Universal claim form. |
| An insurance claim form that contains no staples or highlighted areas and on which the bar code area has not been deformed is called: | A physically clean claim form. |
| If you receive a request, accompanied with the correct authorization, asking to abstract medical information from a patient's medical record: | Send only the information requested. |
| An insurance claim submitted with errors is referred to as: | A dirty claim. |
| Office visits may be grouped on the insurance claim form if each visit: | Is consecutive, uses the same procedure code, and results in the same fee. |
| How should blocks be treated on an OCR CMS-1500 claim form that do not need any information? | Leave the blcok blank. |
| An electronic claims professor (ECP) is: | An individual who converts to standardized electronic format and transmits electronic claims data. |
| The brain of the computer is called: | CPU. |
| What should you do often to prevent losing data you have entered? | Back up. |
| The most important function of a practice management system is: | Accounts receivable. |
| The employer's identification number is assigned by: | The Internal Revenue Service |
| A clearinghouse: | Transmits claims to the insurance payer, performs software edits, and separates claims by carrier. |
| A modem is a device used to: | Transmit electronic information over a dedicated phone line. |
| The Health Insurance Portability and Accountability Act (HIPAA) does not establish guidelines for: | Insurance claims. |
| Another name for the multipurpose billing form is: | Superbill. |
| The insurance claim was rejected because of an incorrect modifier, so: | Verify and submit valid modiiers with the correct procedure codes for which they are valid. |
| A group of insurance claims sent at the same time from on facility is known as a: | Batch. |
| Insurance claims transmitted electronically are usually paid in: | 2 weeks or less. |
| Back-up copies of office records should be stored: | Away from the office. |
| Assigning a code to represent data is known as: | Encryption. |
| A combination of letters, numbers, or symbols that each individual is assigned to access the computer system is called a/an: | Password. |
| The diagnosis listed first in submitting insurance claims for patients seen in a physician's office is the: | Primary diagnosis. |
| When is the principal diagnosis applicable? | Inpatient hospital coding. |
| When coding x-ray films taken of both knees, list: | The proper x-ray code twice and use the modifiers RT (right) with the first code and LT (left)with the second code. |
| The health insurance claim form (CMS-1500) is known as the: | Universal Claim Form. |
| The CPT publication is updated: | Annually. |
| An insurance claim form that contains no staples or highlighted areas and on which the bar code area has not been deformed is called. | A physically clean claim. |
| If you receive a request, accompanied with the correct authorization, asking to abstract medical information from a patient's record, | Send only the th information requested. |
| A group of insurance claims sent at the same time from one facility is known as a: | Bundle. |
| A clearinghouse is a/an: | Entity that receives transmission of insurance claims, separates the claims, and sends each one electronically to the correct insurance payer. |
| The most important function of practice management is: | Accounts receivable. |
| If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the: | State insurance commissioner. |
| If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow is to: | Ask if there is a backlog of claims at the insurace office. |
| What should you do if an insurance cattier requests information about another insurace carrier | Provide the information. |
| When downcoding occurs, payment will: | Be less. |
| The first level of appeal in the Medicare program is: | Redetermination. |
| How many levels of review exist for TRICARE appeal procedures? | Three. |
| What should be done to inform a new patient of office fees and payment policies? | Send a patient information brochure, send a confirmation letter, and discuss fees and policies at the time of the initial contact. |
| The patient is likely to be the most cooperative in furnishing details necessary for a complete registration process: | Before any services are provided. |
| The reason for a fee reduction must be documented in the patient's: | Medical record. |
| Professional courtesy means: | Writing off the balance of an account after an insurance company has paid its portion. |
| When collecting fees, your goal should always be to: | Collect the full amount. |
| Accounts receivable are usually aged in time periods of: | 30, 60, 90, and 120 days. |
| Messages included on statements to promote payment are called: | Dun messages. |
| A significant contribution to HMO development was the: | Health Maintenance Organization Act of 1973 |
| How does an HMO receive payment for the services its physicians provides? | Prepaid health plan. |
| How are physicians who work for a prepaid group practice model paid? | Salary paid by independent group. |
| In an independent practice association (IPA), physicians are: | Not employees and are not paid salaries. |
| An organization that gives members freedom of choice among physicians and hospital provides a higher level of benefits if the providers listed on the plan are used is called a/an: | Preferred Provider Organization (PPO). |
| When a physician sees a patient more thatn is medically necessary, it is called: | Churning. |
| Referral of a patient recommended by one specialist to another specialist is known as: | Tertiary care. |
| What is the correct procedure to collect a copayment on a managed care plan? | Collect the copayment when the patient arrives for the office visit. |
| When an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person, this is known as: | Capitation. |
| Practitioners in an HMO program may come under peer review by a professional group called a: | Quality improvement organization. |
| Medicare part A is run by: | The Centers for Medicare and Medicaid services. |
| Medicare is a: | Federal health insurance program. |
| Medicare provides a one-time baseline mammographic examination for women ages 35 to 39 and preventive mammogram screenings for women 40 years and older. | Once a year. |
| The frequency of pap tests that may be billed for a Medicare patient who is low risk is: | Every other year. |
| Some senior HMOs may provide services not covered by Medicare, such as: | Eyeglasses and prescription drugs. |
| A Medicare prepayment screen: | Identifies claims to review for medical necessity, and monitors the number of times given procedures can be billed during a specific time frame. |
| A claims assistance professional (CAP: | May act on the Medicare beneficiary's behalf as a client representative. |
| When a remittance advice (RA) is received from Medicare, the insurance billing specialist should: | Post each patient's name and the amount of payment on the day sheet and the patient's ledger card. |
| If a check is received from Medicare and it is obvious that it is an overpayment, the insurance billing specialist should: | Deposit the check and then write to Medicare to notify them of the overpayment. |
| The letter "D" following the identification number on the patient's Medicare card indicates a: | Widow. |
| The Social Security Act of 1935. | Set up the public assistance programs. |
| The federal Emergency Relief Administration made funds available to pay for: | Medical expenses of the needy unemployed. |
| The medically needy aged: | Require help in meeting costs of medical care. |
| The federal aspects of Medicaid are the responsibilty of the: | CMS. |
| Medicaid is administered by the: | State government with partial federal funding. |
| State children's health insurance programs (SCHIPs) | Operate with federal grant support under the Title V of the Social Security Act. |
| Medicaid is available to needy and low-income people such as: | The blind, the diabled, the aged (65 and older). |
| If a physician accepts Medicaid patients, the physician must accept: | The medicaid-allowed amount. |
| To control escalating health care costs by curbing unnecessary emergency department visits and emphasizing preventive care, Medicaid reform has involved. | Managed care programs. |
| TRICARE, formerly known as CHAMPUS, is funded through: | Congress. |
| The health maintenance organization provided for dependents of active duty military personnel is called: | Tricare PRIME. |
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