Professional Medical Coding and Billing Final Exam Questions and Answers Graded A

Professional Medical Coding and Billing Final Exam Questions and Answers Graded A Health Information Management: - ANS- - In reference to a medical report, the acronym SOAP stands for: - ANS- Subjective, Objective, Assessment, and Plan (SOAP) A review of the medical record to determine its completeness. - ANS- Quantitative analysis This documentation provides an opinion about a patient's condition from a physician other than the primary care (attending) physician. - ANS- Consultation Which of the following is true in regard to the release of protected health information (ROI)? - ANS- A covered entity must provide access to PHI in the manner requested by the individual A review of the medical record to ensure the standards are met and to determine accuracy of record documentation. - ANS- Qualitative analysis ____ is a bill introduced by the federal government to include health record security regulations and protect patient rights. - ANS- Health Insurance Portability and Accountability ACT (HIPAA) Ben works in the HIM department. He is contacted by Mr. Allen's insurance company who wants to know the admit and discharge dates for Mr. Allen's most recent admission to the hospital. Where is the best place for Ben to look for this information? - ANS- The master patient index Healthcare Delivery Systems: - ANS- - Which of the following is another name for outpatient care? - ANS- Ambulatory Care This department provides image-guided procedures such as CT scans and MRIs: - ANS- Radiology Which physician specialty treats patients in the management of pain and other symptoms related to joints and other parts of the musculoskeletal system? - ANS- Rheumatology Which of the following would receive the data collected by a birth certificate clerk? - ANS- National Center for Health Statistics (NCHS) Which department is responsible for the maintenance and care of health records? - ANS- Health Information Management In order for a facility to receive federal healthcare funding (Medicare and Medicaid), they must comply with regulations called: - ANS- Conditions of Participation (CoP) After suffering a stroke, a patient requires therapy to assist in performing activities of daily living such as getting dressed and cooking. Which department would assist this patient? - ANS- Occupational therapy Legal And Compliance: - ANS- - Which of the following is true about a patient's rights related to accessing and managing their protected health information (PHI)? - ANS- Covered entities are required to agree to requests for restriction on uses and disclosures of PHI ______ is the practice of assigning a diagnosis or procedure code specifically for the purpose of obtaining a higher level of reimbursement (payment). - ANS- Upcoding Which organization did HIPAA authorize to investigate cases of healthcare fraud that involve private and federally funded programs? - ANS- Office of Inspector General (OIG) AHIMA recommends that healthcare records for adults be retained for how long? - ANS- 10 years from the most recent episode Health records for minors should be retained until the patient_____. - ANS- reaches the age of majority plus the time required for the statute of limitations The legal process lawyers use to obtain information regarding all aspects in a case. - ANS- discovery What must be obtained from a patient before a covered entity can disclose protected health information? - ANS- Written authorization Reimbursement Methodologies: - ANS- - Which of the following uses the UB-04 claim form? - ANS- Urgent care clinic The third-party payer's process of checking the details of the claim against the information they have for the patient and his/her insurance benefits. - ANS- Adjudication Which of the following is a payment methodology under OPPS that uses a coding and reimbursement hierarchy to pay for hospital outpatient services? - ANS- Ambulatory Payment Classification (APC) Generally, facility outpatient charges are billed on the ____ claim form. - ANS- UB-04 Jane is auditing CMS-1500 claim forms for medical necessity. The form she is reviewing includes CPT codes and Jane must determine which diagnosis each procedure was intended to treat. Which of the following items on the CMS-1500 could Jane use to help her complete her audit? - ANS- 24E Diagnosis Pointer Bob was an inpatient at ABC hospital for three days. Which of the following will be used to bill for the room and board he received during his admission? - ANS- Revenue Code A pre-existing condition which, because of its presence, causes an increase in length of stay by at least one day in approximately 75% of cases. - ANS- Comorbid condition The final step of the healthcare reimbursement process begins____. - ANS- when the claim is resolved Based on the table below, what is the facility's expected reimbursement? CPT CodeAPC ClassificationAPC PSICPT Code PSIPayment Rate Level 4 Skin ProcedureTT$1,372. Level 1 Excision/Biopsy/Incision and DrainageTT$483.91 - ANS- 1, 614.25 Billing for two or three codes when one comprehensive code is more appropriate? - ANS- Unbundling Medical Terminology: - ANS- - The word that means difficult breathing. - ANS- dyspnea The word which means loss of hearing due to the natural aging process. - ANS- Presbycusis Which of the following is NOT a prefix meaning lungs? - ANS- Rhin/o