MEDICAL CODING AND BILLING PRACTICUM
FINAL
_______ includes the removal of the eye and ocular adnexa.
evisceration
enucleation
exenteration
fistularization - answer-exenteration
________ is a condition that leads to the buildup of intraocular pressure. - answer-
glaucoma
________ services are provided to patients in a life- threatening situation, when loss of
life or limb is imminent - answer-emergency department
________ the act of coding an E/M service at a level lower than what was performed. -
answer-undercoding
_________ is a mental health disorder that manifests with the symptoms of delusions,
hallucinations, paranoia, confused speech, isolation, outbursts of anger, and catatonic
behavior? - answer-schizophrenia
A ____ is a monthly payment to purchase and continue insurance coverage. A ______
is how much money you must pay before your insurance begins to pay for medical
services. A ______ is a flat fee you must pay every time you see the doctor and ______
is a percentage you must pay in addition to other fees.
deductible, premium, coinsurance, copay
premium, deductible, copay, coinsurance
premium, copay, deductible, coinsurance
copay, coinsurance, deductible, premium - answer-premium, deductible, copay,
coinsurance
A Medicare patient calls. She's been seeing Dr. Hamilton for 10 years for her chronic
conditions. It's January and her furnace just broke and it will be $500- and she's on a
fixed income and just can't swing the furnace as it is. She wants to know if there's any
,way you could give her a break and waive the deductible. How should the billing
professional respond?
Sorry, you cannot waive the deductible
You must come in and fill out a financial hardship form
You have to make payments, but you have 3 months to pay per company policy
I'll speak to Dr. Hamilton and see if there isn't anything that can be done to help you -
answer-You must come in and fill out a financial hardship form
-According to OIG, you may waive the patient's deductible for Medicare if the patient
demonstrates financial hardship. You must keep a record of this form in the patient's
records
A Medicare RAC sends you a letter demanding that you repay Medicare $1,500 for 10
patient accounts. You must:
repay the RAC within 10 days
send the RAC a letter stating why you cannot pay right now
do nothing and let CMS take their money back as they please
either a or b - answer-do nothing and let CMS take their money back as they please
A patient calls and asks that you send them their chart for their most recent visit. How
much time do you have to send them their records?
5 days
7 days
10 days
30 days - answer-30 days
A patient calls in, upset about their bill. They say they've been billed twice for the x-ray
that they received last month. You review the patient's chart and see that they have
indeed been charged for the same code twice, one with TC and one with 26 modifiers.
Why is this?
it's a mistake and you should submit a corrected claim right away
, one charge is the facility charge for the x-ray. the other charge is the reading of the x-
ray by the radiologist
this is fraud and you should report it to your supervisor
one charge is for the x-ray technician and one charge for the x-ray film - answer-one
charge is the facility charge for the x-ray. the other charge is the reading of the x-ray by
the radiologist
A patient comes in for a consultation on back pain and ends up scheduling the surgery
for next week. What modifier should be added to the evaluation and management
service?
26
57
54
59 - answer-57
A patient comes in for a follow up on their dressing. Three days before the patient had
an incision and drainage of a hematoma from their wrist, which was paid by the
insurance. The follow up visit was denied. Why?
the follow up procedure should have a modifier 24 to be paid
the diagnosis code was most likely wrong. It needs to reflect "postoperative care"
the procedure has a 90 day global period and covers all related services within 90 days,
so this will not be paid
the provider needed a referral for the follow up visit since it was a different person
applying dressings - answer-the procedure has a 90 day global period and covers all
related services within 90 days, so this will not be paid
A patient comes in with a piece of metal shavings in his eye that he got while welding at
his job. He has Anthem health insurance through his work. Which of the following
insurances would cover his visit?
Medicaid
Anthem
Worker's compensation
FINAL
_______ includes the removal of the eye and ocular adnexa.
evisceration
enucleation
exenteration
fistularization - answer-exenteration
________ is a condition that leads to the buildup of intraocular pressure. - answer-
glaucoma
________ services are provided to patients in a life- threatening situation, when loss of
life or limb is imminent - answer-emergency department
________ the act of coding an E/M service at a level lower than what was performed. -
answer-undercoding
_________ is a mental health disorder that manifests with the symptoms of delusions,
hallucinations, paranoia, confused speech, isolation, outbursts of anger, and catatonic
behavior? - answer-schizophrenia
A ____ is a monthly payment to purchase and continue insurance coverage. A ______
is how much money you must pay before your insurance begins to pay for medical
services. A ______ is a flat fee you must pay every time you see the doctor and ______
is a percentage you must pay in addition to other fees.
deductible, premium, coinsurance, copay
premium, deductible, copay, coinsurance
premium, copay, deductible, coinsurance
copay, coinsurance, deductible, premium - answer-premium, deductible, copay,
coinsurance
A Medicare patient calls. She's been seeing Dr. Hamilton for 10 years for her chronic
conditions. It's January and her furnace just broke and it will be $500- and she's on a
fixed income and just can't swing the furnace as it is. She wants to know if there's any
,way you could give her a break and waive the deductible. How should the billing
professional respond?
Sorry, you cannot waive the deductible
You must come in and fill out a financial hardship form
You have to make payments, but you have 3 months to pay per company policy
I'll speak to Dr. Hamilton and see if there isn't anything that can be done to help you -
answer-You must come in and fill out a financial hardship form
-According to OIG, you may waive the patient's deductible for Medicare if the patient
demonstrates financial hardship. You must keep a record of this form in the patient's
records
A Medicare RAC sends you a letter demanding that you repay Medicare $1,500 for 10
patient accounts. You must:
repay the RAC within 10 days
send the RAC a letter stating why you cannot pay right now
do nothing and let CMS take their money back as they please
either a or b - answer-do nothing and let CMS take their money back as they please
A patient calls and asks that you send them their chart for their most recent visit. How
much time do you have to send them their records?
5 days
7 days
10 days
30 days - answer-30 days
A patient calls in, upset about their bill. They say they've been billed twice for the x-ray
that they received last month. You review the patient's chart and see that they have
indeed been charged for the same code twice, one with TC and one with 26 modifiers.
Why is this?
it's a mistake and you should submit a corrected claim right away
, one charge is the facility charge for the x-ray. the other charge is the reading of the x-
ray by the radiologist
this is fraud and you should report it to your supervisor
one charge is for the x-ray technician and one charge for the x-ray film - answer-one
charge is the facility charge for the x-ray. the other charge is the reading of the x-ray by
the radiologist
A patient comes in for a consultation on back pain and ends up scheduling the surgery
for next week. What modifier should be added to the evaluation and management
service?
26
57
54
59 - answer-57
A patient comes in for a follow up on their dressing. Three days before the patient had
an incision and drainage of a hematoma from their wrist, which was paid by the
insurance. The follow up visit was denied. Why?
the follow up procedure should have a modifier 24 to be paid
the diagnosis code was most likely wrong. It needs to reflect "postoperative care"
the procedure has a 90 day global period and covers all related services within 90 days,
so this will not be paid
the provider needed a referral for the follow up visit since it was a different person
applying dressings - answer-the procedure has a 90 day global period and covers all
related services within 90 days, so this will not be paid
A patient comes in with a piece of metal shavings in his eye that he got while welding at
his job. He has Anthem health insurance through his work. Which of the following
insurances would cover his visit?
Medicaid
Anthem
Worker's compensation
