CCA Practice exam questions

according to CPT, a repair of a laceration that includes retention sutures would be considered what type of closure? - correct answer complex closure identify the 2 digit modifier that may be reported to indicate a doctor performed the postoperative management of a patient, but ANOTHER doctor performed the surgical procedure: - correct answer -55 according to the QHDDS, what is the definition of "other diagnoses"? - correct answer "other diagnoses" is interpreted as additional conditions that affect patient care in terms of requiring.......... -clinical evaluation, therapeutic treatment, Dx procedures, extended length of hospital stay, increasing nursing care, and monitoring what organization's duty is updating the procedure classification of ICD-10-CM? - correct answer CMS and NCHS. CMS- responsible for updating the procedure classification NCHS (national center for health statistics)- is responsible for updating the diagnosis classification Which volume of ICD-10-CM contains the numerical listing of codes that represent diseases and injury? - correct answer vol. 1 AKA the Tabular List which icd-10-cm code classifies environment events and circumstances as the cause of an injury, poisoning, or other adverse effect? - correct answer E codes which ICD-10-CM codes are always alphanumeric? - correct answer V codes These codes are used to assign a diagnosis to a patient who is seeking health services but is not necessarily sick: - correct answer V codes a denial of a claim is possible for the following reasons: - correct answer -not meeting medical necessity -billing too many units of a specific service -unbundling denials of outpatient claims are often generated from the following edits: - correct answer NCCI (national correct coding institute) OCE (outpatient code editor) National and local policies a request for reconsideration of a denied claim for insurance coverage for healthcare services is called a(n)? - correct answer appeal if a patients total outpatient bill is $500, insurance plan pays 80% of allowable charges, what is the amount the patient is responsible for? - correct answer $100 AKA the remaining 20% processing a medicare payment for outpatient radiology exams, a hospital outpatient services department would receive payment under which of these? - correct answer Radiology procedures are identified under the Outpatient Prospective Payment System (OPPS) with a Status Indicator "X". Status Indicator "X" identifies ancillary services that are separately paid the goal of coding compliance programs is to prevent: - correct answer prevent accusations of fraud and abuse what is the process that determines how a claim will be reimbursed based on the insurance benefit? - correct answer Adjudication The NCCI editing system used in processing OPPS claims is referred to as: - correct answer OCE aka Outpatient Code Editor what would a health record technician use to perform the billing function for a physician's office? - correct answer physicians submit claims via the electronic format (screen 837P), which take the place of the CMS-1500 billing form when a provider accepts assignment, this means: - correct answer the provider agrees to accept as payment in full the allowed charge from the fee schedule DRGs are classified by: - correct answer one of 25 major diagnostic categories common errors that delay, rather than prevent, payment, include the following: - correct answer -claims out of sequence -illogical demographic data -inaccurate or deleted codes These are essential data elements for a healthcare insurance claim: - correct answer 1. REVENUE CODE 2. PROCEDURE CODE 3. PROVIDER NAME good encoding software should include _______________________ to ensure data quality. - correct answer Edit Checks the protection measures and tools for safeguarding information and information systems is a definition of: - correct answer Data Security what makes data entry easier but may harm data quality? - correct answer Copy & Paste which task cant be performed in an Electronic Health Record system? - correct answer assembly the key data element for linking data about an individual who is seen in a variety of care settings is the: - correct answer Unique Patient Identifier