Health Insurance
Processing - Final Exam
Questions And Answers
[COMPANY NAME] [Company address]
, Health Insurance Processing - Final
Exam Questions And Answers
As part of clinical documentation improvement, the review of a patient case who was discharged home
when he should have been transferred to home health care is part of a __________ audit. - correct
answer transfer
CMS develops national coverage determinations on an ongoing basis, and __________ create(s) edits for
NCD rules, which are local coverage determinations. - correct answer Medicare administrative
contractors
Coding compliance is the conformity to established coding __________. - correct answer guidelines and
regulations
The outpatient code editor (OCE) is software that edits outpatient __________ by hospitals, community
mental health centers, comprehensive outpatient rehabilitation facilities, and home health agencies. -
correct answer claims submitted
The Medicare coverage database (MCD) is used by Medicare administrative contractors, providers, and
other health care industry professionals to determine whether a procedure or service is __________ for
the diagnosis or treatment of an illness or injury. - correct answer reasonable and necessary
Which part of the SOAP note contains documentation of measurable observations made by a health care
provider during the physical examination and diagnostic testing? - correct answer Objective
As part of clinical documentation improvement, a physician query is generated by the __________ when
there is an issue with incomplete or inconsistent provider documentation. - correct answer coder
Which is part of an effective coding compliance program because it helps ensure accurate and thorough
patient record documentation? - correct answer CDI
, Which is a form required by Medicare for all outpatient and physician office procedures/services that are
not covered by the Medicare program? - correct answer advance beneficiary notice
Which part of the SOAP note contains the diagnostic statement and may include the physician's rationale
for the diagnosis? - correct answer Assessment
The procedure or service provided is linked with the _________ that provided medical necessity for
performing the procedure or service. - correct answer diagnosis
Which part of the SOAP note contains the chief complaint and the patient's description of the presenting
problem? - correct answer Subjective
A narrative clinic note is written in a(n) __________ format. - correct answer paragraph
As part of clinical documentation improvement, DRG coding validation assists in the recovery of
otherwise lost __________ to the health care facility. - correct answer revenue
A provider often considers diagnoses that do not receive direct treatment during an encounter because
they impact treatment of other conditions. It is appropriate to report codes for such diagnoses on the
CMS-1500 claim because they have been __________. - correct answer medically managed
Coding compliance programs include written policies and procedures, routine coding audits and
monitoring and compliance-based education and training. As a minimum, how often should written
policies and procedures be updated? - correct answer annually
Which were incorporated into the National Correct Coding Initiative to compare units of service (UOS)
with CPT and HCPCS level II codes reported on claims for the purpose of indicating the maximum
number of UOS allowable by the same provider for the same beneficiary on the same date of service
under most circumstances? - correct answer medically unlikely edits
Although it may vary from a short narrative description of a minor procedure to a more formal report
dictated by surgeons, all operative reports contain __________. - correct answer procedure performed
Processing - Final Exam
Questions And Answers
[COMPANY NAME] [Company address]
, Health Insurance Processing - Final
Exam Questions And Answers
As part of clinical documentation improvement, the review of a patient case who was discharged home
when he should have been transferred to home health care is part of a __________ audit. - correct
answer transfer
CMS develops national coverage determinations on an ongoing basis, and __________ create(s) edits for
NCD rules, which are local coverage determinations. - correct answer Medicare administrative
contractors
Coding compliance is the conformity to established coding __________. - correct answer guidelines and
regulations
The outpatient code editor (OCE) is software that edits outpatient __________ by hospitals, community
mental health centers, comprehensive outpatient rehabilitation facilities, and home health agencies. -
correct answer claims submitted
The Medicare coverage database (MCD) is used by Medicare administrative contractors, providers, and
other health care industry professionals to determine whether a procedure or service is __________ for
the diagnosis or treatment of an illness or injury. - correct answer reasonable and necessary
Which part of the SOAP note contains documentation of measurable observations made by a health care
provider during the physical examination and diagnostic testing? - correct answer Objective
As part of clinical documentation improvement, a physician query is generated by the __________ when
there is an issue with incomplete or inconsistent provider documentation. - correct answer coder
Which is part of an effective coding compliance program because it helps ensure accurate and thorough
patient record documentation? - correct answer CDI
, Which is a form required by Medicare for all outpatient and physician office procedures/services that are
not covered by the Medicare program? - correct answer advance beneficiary notice
Which part of the SOAP note contains the diagnostic statement and may include the physician's rationale
for the diagnosis? - correct answer Assessment
The procedure or service provided is linked with the _________ that provided medical necessity for
performing the procedure or service. - correct answer diagnosis
Which part of the SOAP note contains the chief complaint and the patient's description of the presenting
problem? - correct answer Subjective
A narrative clinic note is written in a(n) __________ format. - correct answer paragraph
As part of clinical documentation improvement, DRG coding validation assists in the recovery of
otherwise lost __________ to the health care facility. - correct answer revenue
A provider often considers diagnoses that do not receive direct treatment during an encounter because
they impact treatment of other conditions. It is appropriate to report codes for such diagnoses on the
CMS-1500 claim because they have been __________. - correct answer medically managed
Coding compliance programs include written policies and procedures, routine coding audits and
monitoring and compliance-based education and training. As a minimum, how often should written
policies and procedures be updated? - correct answer annually
Which were incorporated into the National Correct Coding Initiative to compare units of service (UOS)
with CPT and HCPCS level II codes reported on claims for the purpose of indicating the maximum
number of UOS allowable by the same provider for the same beneficiary on the same date of service
under most circumstances? - correct answer medically unlikely edits
Although it may vary from a short narrative description of a minor procedure to a more formal report
dictated by surgeons, all operative reports contain __________. - correct answer procedure performed
