NHA NEW CBCS PRACTICE TESTS- study || ALL
POSSIBLE QUESTIONS WITH 100% CORRECT
ANSWERS!!
Medical Ethics correct answers Standards of conduct based on moral principles. Generally
accepted as a guide for behavior towards patients, physicians, co-workers, the government,
and insurance compaines.
Compliance Regulations correct answers billing-related cases are based on HIPAA and False
Claims Act.
Health Insurance Portability and Accountability Act of 1996 (HIPPA) correct answers
Created the Health Care Frad and Abuse Control Prpgram enacted nt check for fraud and
abuse in the Medicare and Medicaid programs, and private payers.
Two provisions of HIPPA correct answers Titile I: Insurance Reform
Title II: Administrative Simplification
Insurance Reform. -Primary purpose to provide continuous insurance coverage for workers
and their dependents when they change or lose their jobs. correct answers -Limits the use of
preexisting conditions exclusions
-Prohibits discrimination for part or present poor health
-Guarantees cetraom employees and individuals the right to purchase health insurance
coverage after losing a job
- Allows renewal of health insurance coverage regardless of an individual's health condition
that is covered under the particular policy
Administrative Simplification-The goal is to focus on the health care practice setting to
reduce administrative cost and burdens. correct answers Two parts:
1. Development and implementation of standardized health-related financial and
administrative activities electronically.
2. Implementation of privacy and security procedures to prevent the misuse of health
information by ensuring confidentiality.
False Claim Act (FCA) correct answers Federal law that prohibits submittimg a fraudulent
claim or making statement or representation in connection with a claim.
National Correct Coding Initiative (NCCI) correct answers Developed by the CMS to
promote national correct coding methodologies and to control improper coding that leads to
inappropriate payment of part B health insurance claims.
Two type of NCCA edits - 1. Column 1 /Column 2 or Comprehensive Component Edits:
identifies code pairs that should not be billed together because one code. Column 1 includes
all the services described by another code in Column 2. correct answers 2. Mutually
Exclusive Edits: identifies code pairs that, for clinical reason, are unlikely to be performed on
the same patient on the same day.
Office of Inspector General (OIG) correct answers Investigates and prosecute health care
fraud and abuse.
,Fraud correct answers Knowingly and intentionally deceiving or misrepresenting information
that may result in unauthorized benefits.
Abuse correct answers Defined as incidents or practices, not usually considered fradulaent
that are inconsistant with the accepted medical business or fiscal practices in the industry.
Patient Confidentiality- All patients have the right to privacy, and all information should
remain privileged. correct answers Discuss patient information with only the patient's
physician or office personnel that need cetain information to do their job. Obtained a signed
consent form to release medical infomation to the insurance company or other individual.
Under HIPPA Privacy Rule, providers may use patient's Protected Health Information (PHI)
without specific authorization for correct answers Treatment: primarily for the purpose of
discussion fo the patient's case with other providers.
Payment: providers submit claims on behalf of patients.
Operations: for purposes such as stafff training and quality improvment.
Employern Liability correct answers Physicians are legally responsible for their own conduct
and any action of their employees (their designee) perform within the context of their
employment. Refered to as "vacarious liability"also known as "respondent superior" which
means "let the master answer".
Employee Liabiltiy correct answers "Errors and omissions insurance" is protection against
loss of monies by failure through error or unintentional omission on the part of the individual
or service submitting the insurance claim.
Medical Records correct answers Documentaiton of the patient's social and medical history,
family history, physical examination findings, progress notes, radiology, and lab results,
consultation reports, and correspondence to patient.
Information needed when billing the insurance company correct answers Date of service
(DOS), place of service (POS), type of service (TOS), diagnosis (dx or DX), and procedures.
Retention of Medical Records correct answers Governed by state and local laws and may
bary from state-to-state. Most physicians are required to retain records indefinitley; deceased
patient records should be kept for at least (5) years.
New patient correct answers one who has not received any medical services within the last 3
years
Established patient correct answers someone who has received medical services in the last 3
years from the physician or another physician of the same specialty who belong to the same
group practice.
cheif complaint correct answers brief statement describing they symptom, problem,
diagnosis, or condition that is the reason a patient seeks medical care.
3 volumns of ICD-9 manal correct answers Volumn 1-Diseases: Tabular List
Volumn 2-Diseases: Alphabetic Index
, Volumn 1 and 2 are used in the inpatient and outpatient setting
Volumn 3- Procedures:Tabular List and Alphabetic Index
Volumn 1 - Diseases: Tabular List correct answers -contains the diease and condition code
and the descriptions
- also contains the V codes and E codes
Volumn 2 - Diseases: Alphabetic Index correct answers alphabetic index of volumn 1
Volumn 3 - Tabular List and Alphabetic Index correct answers contains codes for surgical,
therapeutic, and diagnostic procedures; used primarily by hospitals
Hypertension classifications: correct answers Maligant- an accelerated, severe form of
hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Benign- Mild or controlled hypertension and no damage to the vascular system or organs.
Unspecified- not specified as bengin or malignant in the diagnosis or medical record.
malignant neoplasm correct answers further classified as to primary , secondary, or cacinoma
in situ
primary malignancy correct answers original cancer site. Malignant tumors are considered
primary unless documented as secondary or metastatic
carcinoma in situ correct answers cancer that is localized and has not spread to adjacent tissue
or distant parts of the body
secondary malignacy correct answers cancer that has metasized (spread) to a secondary site
either adjacent or remote region of the body
3 sections of Alphabetic index correct answers Section 1: Index to Diseases: each term is
followed by the code or codes that apply to that term
Section 2: Table of Drugs and Chemiclas: contains list of drugs and chemicals with
corresponding poisoning codes and E codes.
Current Procedural Terminology (CPT) correct answers Codes used to report services and
procedures by physicians.
Published and updated anually by the American Medical Association (AMA) with a new one
coming out each November and becoming effective on January 1st of the following calendar
year.
Category I codes correct answers respresent services and procedures widely used by many
health care professional in clinical practice in multiple locations and have been approved by
the FDA
Category II codes correct answers supplemental codes used for performance measurements.
Category III codes correct answers temporary codes for emerging technology, services and
procedures. If a Category III code is available, it is reported instead of a Category I unlisted
code.
POSSIBLE QUESTIONS WITH 100% CORRECT
ANSWERS!!
Medical Ethics correct answers Standards of conduct based on moral principles. Generally
accepted as a guide for behavior towards patients, physicians, co-workers, the government,
and insurance compaines.
Compliance Regulations correct answers billing-related cases are based on HIPAA and False
Claims Act.
Health Insurance Portability and Accountability Act of 1996 (HIPPA) correct answers
Created the Health Care Frad and Abuse Control Prpgram enacted nt check for fraud and
abuse in the Medicare and Medicaid programs, and private payers.
Two provisions of HIPPA correct answers Titile I: Insurance Reform
Title II: Administrative Simplification
Insurance Reform. -Primary purpose to provide continuous insurance coverage for workers
and their dependents when they change or lose their jobs. correct answers -Limits the use of
preexisting conditions exclusions
-Prohibits discrimination for part or present poor health
-Guarantees cetraom employees and individuals the right to purchase health insurance
coverage after losing a job
- Allows renewal of health insurance coverage regardless of an individual's health condition
that is covered under the particular policy
Administrative Simplification-The goal is to focus on the health care practice setting to
reduce administrative cost and burdens. correct answers Two parts:
1. Development and implementation of standardized health-related financial and
administrative activities electronically.
2. Implementation of privacy and security procedures to prevent the misuse of health
information by ensuring confidentiality.
False Claim Act (FCA) correct answers Federal law that prohibits submittimg a fraudulent
claim or making statement or representation in connection with a claim.
National Correct Coding Initiative (NCCI) correct answers Developed by the CMS to
promote national correct coding methodologies and to control improper coding that leads to
inappropriate payment of part B health insurance claims.
Two type of NCCA edits - 1. Column 1 /Column 2 or Comprehensive Component Edits:
identifies code pairs that should not be billed together because one code. Column 1 includes
all the services described by another code in Column 2. correct answers 2. Mutually
Exclusive Edits: identifies code pairs that, for clinical reason, are unlikely to be performed on
the same patient on the same day.
Office of Inspector General (OIG) correct answers Investigates and prosecute health care
fraud and abuse.
,Fraud correct answers Knowingly and intentionally deceiving or misrepresenting information
that may result in unauthorized benefits.
Abuse correct answers Defined as incidents or practices, not usually considered fradulaent
that are inconsistant with the accepted medical business or fiscal practices in the industry.
Patient Confidentiality- All patients have the right to privacy, and all information should
remain privileged. correct answers Discuss patient information with only the patient's
physician or office personnel that need cetain information to do their job. Obtained a signed
consent form to release medical infomation to the insurance company or other individual.
Under HIPPA Privacy Rule, providers may use patient's Protected Health Information (PHI)
without specific authorization for correct answers Treatment: primarily for the purpose of
discussion fo the patient's case with other providers.
Payment: providers submit claims on behalf of patients.
Operations: for purposes such as stafff training and quality improvment.
Employern Liability correct answers Physicians are legally responsible for their own conduct
and any action of their employees (their designee) perform within the context of their
employment. Refered to as "vacarious liability"also known as "respondent superior" which
means "let the master answer".
Employee Liabiltiy correct answers "Errors and omissions insurance" is protection against
loss of monies by failure through error or unintentional omission on the part of the individual
or service submitting the insurance claim.
Medical Records correct answers Documentaiton of the patient's social and medical history,
family history, physical examination findings, progress notes, radiology, and lab results,
consultation reports, and correspondence to patient.
Information needed when billing the insurance company correct answers Date of service
(DOS), place of service (POS), type of service (TOS), diagnosis (dx or DX), and procedures.
Retention of Medical Records correct answers Governed by state and local laws and may
bary from state-to-state. Most physicians are required to retain records indefinitley; deceased
patient records should be kept for at least (5) years.
New patient correct answers one who has not received any medical services within the last 3
years
Established patient correct answers someone who has received medical services in the last 3
years from the physician or another physician of the same specialty who belong to the same
group practice.
cheif complaint correct answers brief statement describing they symptom, problem,
diagnosis, or condition that is the reason a patient seeks medical care.
3 volumns of ICD-9 manal correct answers Volumn 1-Diseases: Tabular List
Volumn 2-Diseases: Alphabetic Index
, Volumn 1 and 2 are used in the inpatient and outpatient setting
Volumn 3- Procedures:Tabular List and Alphabetic Index
Volumn 1 - Diseases: Tabular List correct answers -contains the diease and condition code
and the descriptions
- also contains the V codes and E codes
Volumn 2 - Diseases: Alphabetic Index correct answers alphabetic index of volumn 1
Volumn 3 - Tabular List and Alphabetic Index correct answers contains codes for surgical,
therapeutic, and diagnostic procedures; used primarily by hospitals
Hypertension classifications: correct answers Maligant- an accelerated, severe form of
hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Benign- Mild or controlled hypertension and no damage to the vascular system or organs.
Unspecified- not specified as bengin or malignant in the diagnosis or medical record.
malignant neoplasm correct answers further classified as to primary , secondary, or cacinoma
in situ
primary malignancy correct answers original cancer site. Malignant tumors are considered
primary unless documented as secondary or metastatic
carcinoma in situ correct answers cancer that is localized and has not spread to adjacent tissue
or distant parts of the body
secondary malignacy correct answers cancer that has metasized (spread) to a secondary site
either adjacent or remote region of the body
3 sections of Alphabetic index correct answers Section 1: Index to Diseases: each term is
followed by the code or codes that apply to that term
Section 2: Table of Drugs and Chemiclas: contains list of drugs and chemicals with
corresponding poisoning codes and E codes.
Current Procedural Terminology (CPT) correct answers Codes used to report services and
procedures by physicians.
Published and updated anually by the American Medical Association (AMA) with a new one
coming out each November and becoming effective on January 1st of the following calendar
year.
Category I codes correct answers respresent services and procedures widely used by many
health care professional in clinical practice in multiple locations and have been approved by
the FDA
Category II codes correct answers supplemental codes used for performance measurements.
Category III codes correct answers temporary codes for emerging technology, services and
procedures. If a Category III code is available, it is reported instead of a Category I unlisted
code.
