Certified Professional Coder Coding Test
Study online at https://quizlet.com/_hq9fwx
1. Coding is: the process of translating this written or dictated fmedical record into a series of numeric or
alpha-numeric codes
2. Proper code assignment is determined by: content of the medical record and by the unique
rules that governs each code set
3. what are 3 things that Coder must master: 1. anatomy
2. medical terminology
3. must be detail-oriented
4. Medical coders assign a code to what: 1. Each diagnosis
2. service/procedure
3. Supply, using the classification system when applicable
5. The classification system determines what: the amount health care providers will be reim-
bursed if the patient is covered by Medicare, Medicaid, or other insurance programs using the system
6. A coder must evaluate the medical record for: 1. completeness and accuracy
2. communicate regularly with physicians and othe health care professional to clarify DX or obtain additonal PT info.
7. Techicians who speciallize in coding inpatient hospital services are referred
as: 1. Health information coders
2. medical record coders
3. Coder/abstractors
4. Coding Specialist
8. What is MS-DRGs and what is it: 1. Medicare Severity-Diagnosis Related Groups
2. Determines the amt the hospital will be reimbursed if the PT is covered by Medicare or other insurance programs
9. What is EHR: Electronic health record
10. Skill coders may become: consulatants, educators or medical auditors
11. What is the difference between Hospital and Physican Services: 1. Outpatient
coding (physician services)- learning CPT, HCPCS, LEVEL II, ICD-9 CM codes Volume 1 and 2
2. Inpatient coding (Hospital services)- Learning CPT, ICD-9 CM codes Volumes 1,2,3 and MS-DRGS
12. What is APC and who uses it: Ambulatory Payment Classification- outpatient facility coders (physician
services
13. What is the coder role in a physician's office: Extremely important to proper reimbursement
and the livelihood of the physican
14. What is a physican degree of education: 4 years of college, 4 years of medical school plus 3 to
5 years of residency.
, Certified Professional Coder Coding Test
Study online at https://quizlet.com/_hq9fwx
15. What is a mid-level providers and who: 1. Mid-level providers are know as physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
16. What are the requirement for a PA and what: 1. 26 1/2 month to complete
2. Lincense to practice medicine with physician supervision
17. NP must have: A Master Degree in Nursing
18. How many payers in the most simplest form?: 2
Private insurance plans and government insurance plans
19. Commerical carriers are considered what: Private payers that offer both group and individua
plans.
20. Private Payers contracts may: Vary but may include hospitalization, basic and major medical cover-
age.
21. What is the most significant government insurer: Medicare
22. What is Medicare: Federal health insurance program- Administerd by the Center for Medicare &Medicaid
Services (CMS)
23. What is CMS and what does it provide: Center for Medicare & Medicaid Services (CMS) provides
coverage for people over the age of 65, blind, or disabled individuals, people with end -stage renal disease
24. CMS regulations often serves as ____ word in coding requirement for
Medicare and Non-Medicare payers alike: Last
25. What are the parts of Medicare: Medicare A
Medicare B
Medicare C
Medicare D
26. What is Medicare Part A: Covers inpatient hospital care, as well as care provided in skilled nursing
facilites, hospice care, and home health care
27. What is Medicare Part B: Covered Medically necessary doctors' services, outpatient care, other medica
services (including some preventive service not covered under Medicare Part A
28. Medicare Part B is considered what: A optional benefit for which the patient must pay a premium
and which generally requires a yearly copay
29. Where is Medicare Part B usually used: Physician offices (Outpatient Facility)
30. What is Medicare Part C: Combines the benefits of Medicare Part A, Part B, and sometimes Part D.
31. What is Medicare Part C also called: Medicare Advantage
32. What is PPO: Preferred Provider Organizations
, Certified Professional Coder Coding Test
Study online at https://quizlet.com/_hq9fwx
33. What is HMO: Health Maintenace Organizations
34. Which plan covers PPO and HMO: Medicare Part C
35. What is the CMS-HCC: Center for Medicare & Medicaid Services-Hierarchical condition category
36. What does the CMS-HCC provide: Risk adjument model provides adjusted payment based on a
patient's disease and demographic factors.
37. If a coder does not include all pertinent diagnoses and co-morbidities, the
provider may lose out on what: additional reimbursement for which he/she is entitled.
38. What is Medicare Part D: Prescription drug coverage program available to all Medicare beneficiaries.
Private companies approved by Medicare provide the coverage.
39. What is Medicaid: A health insurance assistance program for some low income people (especially children
and pregnant women) sponsored by federal and state governments
40. Medicaid administed on: a state-by-state basis and coverage varies- although each of the state
programs adheres to certain federal guidelines
41. When is a physican considered a "participating physician": When contracted with a
insurance carrier whether that be a private insurance company or a governmental.
42. Participating Providers (Par Providers are required to accept: the allowed payment
amount determined by the insurance carrier as the fee for payment and follow all other guidelines stipulated by the
contract
43. The difference between the physican's fee and the insurance carriers allowed
amount is: adjusted by the participating provider
44. Non-participating Providers are: 1. providers not contracted with the insurance carriers
2. not required to make the adjustment
45. What is limiting charge: Limits set on what can be charged for each CPT code, no matter if the physican
is Par or Non-Par
46. What is a medical record: Documentation is the recording of pertinent facts and observation about an
individual's health history, including past and present illness, tests, treatments and outcomes
47. Medical record chronologically: documents patient care to assist in continuity of care between
providers, facilitate claims review and payment
48. Can a Medical record serve as legal document: YES
49. All services provided to a patient is: supported and documented in the medical record
50. What is the coders required to with the medical records: to read and understand the
documentation in the medical record in order to accurately code the services rendered.
Study online at https://quizlet.com/_hq9fwx
1. Coding is: the process of translating this written or dictated fmedical record into a series of numeric or
alpha-numeric codes
2. Proper code assignment is determined by: content of the medical record and by the unique
rules that governs each code set
3. what are 3 things that Coder must master: 1. anatomy
2. medical terminology
3. must be detail-oriented
4. Medical coders assign a code to what: 1. Each diagnosis
2. service/procedure
3. Supply, using the classification system when applicable
5. The classification system determines what: the amount health care providers will be reim-
bursed if the patient is covered by Medicare, Medicaid, or other insurance programs using the system
6. A coder must evaluate the medical record for: 1. completeness and accuracy
2. communicate regularly with physicians and othe health care professional to clarify DX or obtain additonal PT info.
7. Techicians who speciallize in coding inpatient hospital services are referred
as: 1. Health information coders
2. medical record coders
3. Coder/abstractors
4. Coding Specialist
8. What is MS-DRGs and what is it: 1. Medicare Severity-Diagnosis Related Groups
2. Determines the amt the hospital will be reimbursed if the PT is covered by Medicare or other insurance programs
9. What is EHR: Electronic health record
10. Skill coders may become: consulatants, educators or medical auditors
11. What is the difference between Hospital and Physican Services: 1. Outpatient
coding (physician services)- learning CPT, HCPCS, LEVEL II, ICD-9 CM codes Volume 1 and 2
2. Inpatient coding (Hospital services)- Learning CPT, ICD-9 CM codes Volumes 1,2,3 and MS-DRGS
12. What is APC and who uses it: Ambulatory Payment Classification- outpatient facility coders (physician
services
13. What is the coder role in a physician's office: Extremely important to proper reimbursement
and the livelihood of the physican
14. What is a physican degree of education: 4 years of college, 4 years of medical school plus 3 to
5 years of residency.
, Certified Professional Coder Coding Test
Study online at https://quizlet.com/_hq9fwx
15. What is a mid-level providers and who: 1. Mid-level providers are know as physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
16. What are the requirement for a PA and what: 1. 26 1/2 month to complete
2. Lincense to practice medicine with physician supervision
17. NP must have: A Master Degree in Nursing
18. How many payers in the most simplest form?: 2
Private insurance plans and government insurance plans
19. Commerical carriers are considered what: Private payers that offer both group and individua
plans.
20. Private Payers contracts may: Vary but may include hospitalization, basic and major medical cover-
age.
21. What is the most significant government insurer: Medicare
22. What is Medicare: Federal health insurance program- Administerd by the Center for Medicare &Medicaid
Services (CMS)
23. What is CMS and what does it provide: Center for Medicare & Medicaid Services (CMS) provides
coverage for people over the age of 65, blind, or disabled individuals, people with end -stage renal disease
24. CMS regulations often serves as ____ word in coding requirement for
Medicare and Non-Medicare payers alike: Last
25. What are the parts of Medicare: Medicare A
Medicare B
Medicare C
Medicare D
26. What is Medicare Part A: Covers inpatient hospital care, as well as care provided in skilled nursing
facilites, hospice care, and home health care
27. What is Medicare Part B: Covered Medically necessary doctors' services, outpatient care, other medica
services (including some preventive service not covered under Medicare Part A
28. Medicare Part B is considered what: A optional benefit for which the patient must pay a premium
and which generally requires a yearly copay
29. Where is Medicare Part B usually used: Physician offices (Outpatient Facility)
30. What is Medicare Part C: Combines the benefits of Medicare Part A, Part B, and sometimes Part D.
31. What is Medicare Part C also called: Medicare Advantage
32. What is PPO: Preferred Provider Organizations
, Certified Professional Coder Coding Test
Study online at https://quizlet.com/_hq9fwx
33. What is HMO: Health Maintenace Organizations
34. Which plan covers PPO and HMO: Medicare Part C
35. What is the CMS-HCC: Center for Medicare & Medicaid Services-Hierarchical condition category
36. What does the CMS-HCC provide: Risk adjument model provides adjusted payment based on a
patient's disease and demographic factors.
37. If a coder does not include all pertinent diagnoses and co-morbidities, the
provider may lose out on what: additional reimbursement for which he/she is entitled.
38. What is Medicare Part D: Prescription drug coverage program available to all Medicare beneficiaries.
Private companies approved by Medicare provide the coverage.
39. What is Medicaid: A health insurance assistance program for some low income people (especially children
and pregnant women) sponsored by federal and state governments
40. Medicaid administed on: a state-by-state basis and coverage varies- although each of the state
programs adheres to certain federal guidelines
41. When is a physican considered a "participating physician": When contracted with a
insurance carrier whether that be a private insurance company or a governmental.
42. Participating Providers (Par Providers are required to accept: the allowed payment
amount determined by the insurance carrier as the fee for payment and follow all other guidelines stipulated by the
contract
43. The difference between the physican's fee and the insurance carriers allowed
amount is: adjusted by the participating provider
44. Non-participating Providers are: 1. providers not contracted with the insurance carriers
2. not required to make the adjustment
45. What is limiting charge: Limits set on what can be charged for each CPT code, no matter if the physican
is Par or Non-Par
46. What is a medical record: Documentation is the recording of pertinent facts and observation about an
individual's health history, including past and present illness, tests, treatments and outcomes
47. Medical record chronologically: documents patient care to assist in continuity of care between
providers, facilitate claims review and payment
48. Can a Medical record serve as legal document: YES
49. All services provided to a patient is: supported and documented in the medical record
50. What is the coders required to with the medical records: to read and understand the
documentation in the medical record in order to accurately code the services rendered.
