MEDICAL CODING EXAM 39 & 40
QUESTIONS AND ANSWERS
In which instance will state law allow disclosure of patient information? - Answer-
Both the reporting of suspected abuse and the reporting of STDs and other
contagious diseases
The total management of an individual's well-being by a health care professional is
known as _______. - Answer-Health care
What are professional coding specialists obligated to do? - Answer-Comply with the
Privacy Rule
Most third-party payers, including Medicare, prefer claim forms to be submitted
________. - Answer-electronically
What is an example of a health plan, under HIPAA? - Answer-Aetna health
insurance
Agreements between a physician and a managed care organization that pay the
physician a predetermined amount of money each month for each member of the
plan who identifies that provider as his or her primary care physician are known
as_____. - Answer-Capitation Plans
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.
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
The Place of Service name is Telehealth. What is the POS code? - Answer-02
When Dr. Mason speaks to Nurse Adams about a patient, he is using - Answer-
protected health information.
Essentially, there are ______ participants in each health care encounter. - Answer-3
An example of a health care provider, under HIPAA, is: - Answer-a dentist
_______ is/are to prevent improper payments when services are reported with
incorrect units of service. - Answer-Medically Unlikely Edits
What must written approvals to release PHI include? - Answer-Specifically identify
the person or organization that will be disclosing the information
It is illegal to bill for a component service when: - Answer-a comprehensive code or
combination code is available.
In the health care encounter, party 2 is considered the _____. - Answer-patient
___ codes are also used to ensure that procedures, services, and treatments, along
with the Place-of-Service codes, are used to determine appropriateness of location
and service. - Answer-TOS
QUESTIONS AND ANSWERS
In which instance will state law allow disclosure of patient information? - Answer-
Both the reporting of suspected abuse and the reporting of STDs and other
contagious diseases
The total management of an individual's well-being by a health care professional is
known as _______. - Answer-Health care
What are professional coding specialists obligated to do? - Answer-Comply with the
Privacy Rule
Most third-party payers, including Medicare, prefer claim forms to be submitted
________. - Answer-electronically
What is an example of a health plan, under HIPAA? - Answer-Aetna health
insurance
Agreements between a physician and a managed care organization that pay the
physician a predetermined amount of money each month for each member of the
plan who identifies that provider as his or her primary care physician are known
as_____. - Answer-Capitation Plans
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.
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
The Place of Service name is Telehealth. What is the POS code? - Answer-02
When Dr. Mason speaks to Nurse Adams about a patient, he is using - Answer-
protected health information.
Essentially, there are ______ participants in each health care encounter. - Answer-3
An example of a health care provider, under HIPAA, is: - Answer-a dentist
_______ is/are to prevent improper payments when services are reported with
incorrect units of service. - Answer-Medically Unlikely Edits
What must written approvals to release PHI include? - Answer-Specifically identify
the person or organization that will be disclosing the information
It is illegal to bill for a component service when: - Answer-a comprehensive code or
combination code is available.
In the health care encounter, party 2 is considered the _____. - Answer-patient
___ codes are also used to ensure that procedures, services, and treatments, along
with the Place-of-Service codes, are used to determine appropriateness of location
and service. - Answer-TOS
