MEDICAL CODING EXAM 39&40
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
Covered entities are defined as businesses that: - ANSWER have access to the personal health
information of patients.
A ____ is usually a fixed amount of money that the individual will pay each time he or she goes to a
health care provider. - ANSWER co-payment
An insurance company pays a provider one flat fee to cover the entire course of treatment for an
individual's condition. This is known as ________. - ANSWER Episodic care
Choosing codes according to insurance company policies rather than what actually occurred with the
patient is called: - ANSWER coding for coverage.
____ reinforces accurate and proper coding in addition to preventing reimbursement of inaccurate
amounts as the result of noncompliance coding methods in Part B claims. - ANSWER NCCI
What are the two main coding professional organizations that have published a code of ethics guide? -
ANSWER AAPC and AHIMA
Providers are not permitted to use or disclose PHI without a patient's written permission in which
instance? - ANSWER Detailed data sets
______ is an individual or organization that is not directly involved in an encounter but has a connection
because of its obligation to pay, in full or part, for that encounter. - ANSWER third party payer
HIPAA violations are reported to which of the following agencies? - ANSWER Office of Civil Rights in the
Department of Health and Human Services
____ is the amount of money that patients must pay, out of their own pockets, before the insurance
benefits begin. - ANSWER deductible
, ____ is the act of knowing due to their job position, training, or responsibilities within the organization
with regard to filing the claim but purposely don't ask about the validity of the information, or ignoring
the falsity of the information. - ANSWER Willful ignorance
When Dr. Sanders "uses" PHI, according to HIPAA, it means he is discussing a patient with the: - ANSWER
appointment scheduler in his office.
What is protected health information? - ANSWER Any personal identifiable health information
A _____ is based on a percentage of the total charge rather than a fixed amount. - ANSWER co-insurance
A covered entity's workforce, under HIPAA, includes all except a(n): - ANSWER outside computer repair
company.
A $100 fine with no prison time is the penalty for a HIPAA - ANSWER civil violation.
As a coder, if you are involved in fraud in your facility, you can: - ANSWER both be fined and go to jail.
"It's not my concern. I just do what I am told" is an example of________. - ANSWER Disregard.
It is fraudulent for a coder to: - ANSWER All of these
By catching those who submitted fraudulent claims, approximately ______ was won or negotiated by the
federal government during fiscal year 2014. - ANSWER $2.3 billion
The Place of Service name is Assisted Living Facility. What is the POS code? - ANSWER 13
A release of information form must: - ANSWER all of these
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
Covered entities are defined as businesses that: - ANSWER have access to the personal health
information of patients.
A ____ is usually a fixed amount of money that the individual will pay each time he or she goes to a
health care provider. - ANSWER co-payment
An insurance company pays a provider one flat fee to cover the entire course of treatment for an
individual's condition. This is known as ________. - ANSWER Episodic care
Choosing codes according to insurance company policies rather than what actually occurred with the
patient is called: - ANSWER coding for coverage.
____ reinforces accurate and proper coding in addition to preventing reimbursement of inaccurate
amounts as the result of noncompliance coding methods in Part B claims. - ANSWER NCCI
What are the two main coding professional organizations that have published a code of ethics guide? -
ANSWER AAPC and AHIMA
Providers are not permitted to use or disclose PHI without a patient's written permission in which
instance? - ANSWER Detailed data sets
______ is an individual or organization that is not directly involved in an encounter but has a connection
because of its obligation to pay, in full or part, for that encounter. - ANSWER third party payer
HIPAA violations are reported to which of the following agencies? - ANSWER Office of Civil Rights in the
Department of Health and Human Services
____ is the amount of money that patients must pay, out of their own pockets, before the insurance
benefits begin. - ANSWER deductible
, ____ is the act of knowing due to their job position, training, or responsibilities within the organization
with regard to filing the claim but purposely don't ask about the validity of the information, or ignoring
the falsity of the information. - ANSWER Willful ignorance
When Dr. Sanders "uses" PHI, according to HIPAA, it means he is discussing a patient with the: - ANSWER
appointment scheduler in his office.
What is protected health information? - ANSWER Any personal identifiable health information
A _____ is based on a percentage of the total charge rather than a fixed amount. - ANSWER co-insurance
A covered entity's workforce, under HIPAA, includes all except a(n): - ANSWER outside computer repair
company.
A $100 fine with no prison time is the penalty for a HIPAA - ANSWER civil violation.
As a coder, if you are involved in fraud in your facility, you can: - ANSWER both be fined and go to jail.
"It's not my concern. I just do what I am told" is an example of________. - ANSWER Disregard.
It is fraudulent for a coder to: - ANSWER All of these
By catching those who submitted fraudulent claims, approximately ______ was won or negotiated by the
federal government during fiscal year 2014. - ANSWER $2.3 billion
The Place of Service name is Assisted Living Facility. What is the POS code? - ANSWER 13
A release of information form must: - ANSWER all of these
