FINAL EXAM: MEDICAL BILLING AND CODING

An aging population will use more healthcare services to manage a multitude of chronic diseases. - ANS Which of the following is a reason for why the field of medical billing and coding is in high demand? Medical coding - ANS What is the process of reporting diagnoses and procedures/services as numeric and alphanumeric characters on the insurance claim? Telehealth - ANS What is the two-way, real time video visit between the patient and the physician at a distant site? Deductible - ANS What is the amount for which the patient is financially responsible before an insurance policy provides payment? Commercial - ANS What type of health insurance is provided through your employer or purchased directly from an insurance company? Documented - ANS What is the missing word in the following phrase: "If it wasn't __________, it wasn't done." Subjective - ANS What section of the SOAP note containers the chief complaint and the patient's description of the presenting problem? Electronic Health Record (EHR) - ANS What is health information in a digital format that is created and shared by providers across more Thant one healthcare setting? Bundled payment - ANS What is the reimbursement method where one payment covers all services during an episode of care? Referral - ANS What is a written order from you primary care provider for you to see a specialist or get certain medical services? Consumer-directed health plans - ANS What health plans are designed to put more responsibility on the employee for their healthcare spending? Accounts receivable - ANS In a physician practice, revenue cycle management is also called what? Electronic Data Interchange (EDI) - ANS What is the computer to computer transfer of data between providers and third-party payers? Rejected claim - ANS What type of claim was never entered in to the computer system of the insurance company because it failed to meet specific data requirements? Allowable charge - ANS What is the maximum amount that an insurer will reimburse for a covered service or procedure? Patients are informed about what charges to expect. - ANS What is the price transparency in healthcare? Emancipated minor - ANS What is the term for an individual who has not reached the age of majority (usually 18) but is no longer under the care and control of parents? Protected Health Information (PHI) - ANS What is any information that can link a specific individual to medical records? The patient allows insurance benefits to be paid directly to the provider. - ANS Which of the following is an example of consent? Electronic - ANS The HIPAA security rule provides standards for health information maintained or transmitted in what format? Falsifying patient records to justify the medical necessity of services. - ANS Which of the following is an example of fraud? Original records should never be released. - ANS Which of the following s true concerning the release of patient information? Neoplasm - ANS What is the main term for primary pancreatic neoplasm of the head of the pancreas? October 1 - ANS ICD coding changes, additions and deletions are effective on what date every year? R07.89 - ANS The patient was evaluated in the emergency room for anterior chest wall pain, suspect unstable angina. What is the ICD-10-CM code? I12.0, N18.5 - ANS The patient was seen in follow up for hypertension and chronic kidney disease, stage 5. What is the ICD-10-CM code? Z01.810 - ANS The patient was seen for pre-operative cardiovascular examination undergoing cholecystectomy. What is the correct ICD-10-CM code? M41.23 - ANS The patient's diagnosis is idiopathic scoliosis of the cervicothoracic region. What is the correct ICD-10-CM code? Surgery - ANS In which main section of the CPT codebook would you find the code for a cholecystectomy? 11200, 11201 - ANS The patient requested removal of 20 skin tags. What is the CPT code? 64719-LT - ANS The hand surgeon performed a neuroplasty of the ulnar nerve of the left wrist. What is the CPT code? 58 - ANS The surgeon performed debridement of an open leg wound. Two days later the surgeon performed a more extensive debridement of the same wound. What modifier is reported with the second service? 77080-26 - ANS The patient with a history of osteopenia was referred for a DXA scan of the axial skeleton. What is the correct CPT code, professional component only? 97035 - ANS The patient was seen in the outpatient physical therapy department for 15 minutes of ultrasound therapy for bursitis of the hip. What is the correct CPT code? 99283 - ANS A visit in the E/M involved an expanded problem focused history and physical exam with decision making of moderate complexity. What is the correct CPT code? Codes for reporting procedures, services, medical equipment, and supplies not included in CPT. - ANS What does the HCPCS level II coding classification system provide to medical providers and suppliers? J2270 - ANS Using the table of drugs and biological in the HCPCS level II codebook, what is the code for a 10 mg injection of morphine sulfate? E0561 - ANS The durable medical equipment dealer supplied the patient with a non heated humidifier to be used with his CPAP device. What is the correct HCPCS level II code? A4500 - ANS Following surgery the patient was provided with below knee length surgical stockings. What is the correct HCPCS level II code? AS - ANS What is the correct level II modifier used for a PA's role to assist a surgeon during a procedure? Intravenous - ANS What is the fastest but also most dangerous route of drug administration? Generic - ANS What is a chemically equivalent lower cost version of a brand name drug? Medication list - ANS Where are the names, dosages, and all reasons for all drugs that patient currently takes documented in a medical record? Physician query - ANS What is a written request to a physician to clarify or complete the information in clinical documentation to ensure accurate health records? Laboratory report - ANS A test that screens for antibodies in the cloud would be reported on what medical report? It provides an opportunity for physicians to demonstrate the quality of care that was provided. - ANS Which of the following is one reason why clinical documentation improvement (CDI) efforts are necessary? Breast cancer - ANS The patient was referred for a bone scan to check for metastatic disease. Which diagnosis would support medical necessity for this procedure? Place of service - ANS What is the physical location where healthcare services are provided to patients? National Provider Identifier (NPI) - ANS What is the standard unique health identifier that is mandated by HIPAA for each healthcare provider and used for claims processing, patient eligibility inquiries, claims inquiries, patient referrals, and generation of remittance advices? Group practice - ANS What is the term for two or more physicians who share space, equipment, supplies, and personnel and may represent a single specialty or multiple specialities? Commercial - ANS What is health insurance issued by private companies? Consolidated Omnibus Budget Reconciliation Act (COBRA) - ANS Which of the following allows employees to continue healthcare coverage beyond the benefit termination date? usual, customary, and reasonable (UCR) - ANS What is defined as the amount commonly charged for a particular medical service by providers with a certain geographic area? The local BCBS plan where the services were provided - ANS Where are BCBS claims submitted for processing? Preauthorization - ANS What is a review by BCBS that grants prior approval for reimbursement of a healthcare service? Deductible - ANS Which of the following is an example of an out of pocket cost? Medicare part B - ANS Which Medicare program pays for physic services, outpatient care, and durable medical equipment? Advance Beneficiary Notice (ABN) - ANS What is the form required for all physician services or procedures that might not be covered by the Medicare program? Medigap - ANS What type of coverage can Medicare beneficiaries obtain to help with the costs not reimbursed by their original Medicare plan? National Correct Coding Initiative (NCCI) - ANS Because CMS has a financial incentive to ensure coding accuracy, what did they create to reduce inappropriate payments of Medicare part B claims? Unbundling - ANS What is the fraudulent coding practice of deliberately submitting multiple CPT codes when just one code should have been submitted? Medicare administrative contractors (MACs) - ANS What are the private companies that are assigned jurisdiction and serve as the primary contract between the original Medicare program and the participating providers? Medicaid - ANS The federal name for the Title XIX medical assistance program is what? OSHA - ANS Which of the following was created to protect employees against injuries from hazards in the workplace? Medicare and Medicaid - ANS Medicare beneficiaries who are referred to as dual eligible same entities to which of the following? Medicaid - ANS Which of the following is always the payer of last resort when the patient has multiple third party payer coverage? The federal government - ANS Individual states administer the children's health insurance program (CHIP) with matching funds provided from? continuing education units (CEUs) - ANS What is usually required after attaining a certification? Reviewing the certification study guide from cover to cover - ANS What is considered mandatory when preparing for a certification exam? The organization's website - ANS For a certification exam, where can you find the eligibility requirements and exam specifications?