Billing and Coding – Final Exam Questions and Verified Answers, HIPAA, insurance claims, medical ethics, healthcare coding

This document contains verified and updated final exam questions and answers for Billing and Coding. It covers key topics such as HIPAA compliance, insurance claim processing, coding systems, medical ethics, and healthcare regulations. The material provides comprehensive preparation for certification and professional practice. A claims assistance professional (CAP) acts as an informal representative of patients and helps patients interpret insurance contracts. - answerFalse Which level of education is generally required for one who seeks employment as an insurance coder? - answerc) Completion of an accredited program for coding certification The amount of money an insurance billing specialist earns is dependent on which factors? - answerd) All of the above: knowledge, experience, size of employing institution Medical etiquette refers to... - answera) consideration for others A billing specialist is entrusted with.... - answerd) All of the above: holding patients' medical information in confidence, collecting monies, being a reliable resource for coworkers Standards of conduct by which an insurance billing specialist determines the propriety of his or her behavior in a relationship are know as medical _____. - answerethics It is _____ to report incorrect information to private insurance - 2 -: carriers because this can possible damage the individual and the integrity of the database. - answerunethical The Office of Civil Right enforces... - answerprivacy and security rules. Privileged information is related to the treatment and progress of patients. - answerTrue The focus on the health care practice setting and reducing administrative costs and burdens are the goals of... - answerHIPAA Title II Administrative Simplification Which 3 measures should be taken by a coder who has knowledge of fraud or abuse? - answerNotify the provider verbally and in writing; document the false statement or representation; don't discuss the problem with anyone who is not involved The contract is a worker's comp case exists between the... - answerphysician and insurance company In health insurance, the insured is also known as - answersubscriber, or member, or policyholder, or recipient. If a child has health insurance coverage from 2 parents, according to the birthday law... - answerthe health plan of the person whose birthday (month and day, not year) falls earlier in the calendar year pays first. If same b-day, person whose policy has been in effect longest. Conditions that existed and were treated before the health insurance policy was issued are called... - answerpre-existing conditions The act created to protect workers and their families so that they can get and maintain health insurance if they change or lose their jobs is called the - answerHIPAA Assignment of benefits is... - answerthe transfer of one's legal right to collect an amount payable under an insurance contract. The SOAP in patient medical record charting may be difined as - answerb) subjective, objective, assessment, paln How should an entry in a patient's electronic - 3 -: medical record be corrected? - answera) input a note of which section is in error and enter correct data with details of why the correction is necessary and authenticate with electronic signature, date, and time. The official American Hospital Association policy states that abbreviations should be totally eliminated from the more vital section of the record, such as the... - answerd) all of the above: final dx, operative notes, discharge summaries A new patient is one who - answerb) has not received any professional services from a physician or another physican of the same specialty who belongs to the group practice within the past 3 yrs. An established patient is one who - answerhas previously received professional services from a physician or another physician of the same specialty who belongs to the group practice