Certified Professional Coder Coding Test| 361
QUESTIONS| WITH COMPLETE SOLUTIONS
Coding is Correct Answer: the process of translating this written or dictated fmedical record into
a series of numeric or alpha-numeric codes
Proper code assignment is determined by Correct Answer: content of the medical record and by
the unique rules that governs each code set
what are 3 things that Coder must master Correct Answer: 1. anatomy
2. medical terminology
3. must be detail-oriented
Medical coders assign a code to what Correct Answer: 1. Each diagnosis
2. service/procedure
3. Supply, using the classification system when applicable
The classification system determines what Correct Answer: the amount health care providers
will be reimbursed if the patient is covered by Medicare, Medicaid, or other insurance programs
using the system
A coder must evaluate the medical record for Correct Answer: 1. completeness and accuracy
2. communicate regularly with physicians and othe health care professional to clarify DX or
obtain additonal PT info.
Techicians who speciallize in coding inpatient hospital services are referred as Correct Answer:
1. Health information coders
2. medical record coders
3. Coder/abstractors
4. Coding Specialist
What is MS-DRGs and what is it Correct Answer: 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
What is EHR Correct Answer: Electronic health record
Skill coders may become Correct Answer: consulatants, educators or medical auditors
What is the difference between Hospital and Physican Services Correct Answer: 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
,What is APC and who uses it Correct Answer: Ambulatory Payment Classification- outpatient
facility coders (physician services
What is the coder role in a physician's office Correct Answer: Extremely important to proper
reimbursement and the livelihood of the physican
What is a physican degree of education Correct Answer: 4 years of college, 4 years of medical
school plus 3 to 5 years of residency.
What is a mid-level providers and who Correct Answer: 1. Mid-level providers are know as
physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
What are the requirement for a PA and what Correct Answer: 1. 26 1/2 month to complete
2. Lincense to practice medicine with physician supervision
NP must have Correct Answer: A Master Degree in Nursing
How many payers in the most simplest form? Correct Answer: 2
Private insurance plans and government insurance plans
Commerical carriers are considered what Correct Answer: Private payers that offer both group
and individual plans.
Private Payers contracts may Correct Answer: Vary but may include hospitalization, basic and
major medical coverage.
What is the most significant government insurer Correct Answer: Medicare
What is Medicare Correct Answer: Federal health insurance program- Administerd by the
Center for Medicare &Medicaid Services (CMS)
What is CMS and what does it provide Correct Answer: 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
CMS regulations often serves as ____ word in coding requirement for Medicare and Non-
Medicare payers alike Correct Answer: Last
What are the parts of Medicare Correct Answer: Medicare A
Medicare B
Medicare C
Medicare D
, What is Medicare Part A Correct Answer: Covers inpatient hospital care, as well as care
provided in skilled nursing facilites, hospice care, and home health care
What is Medicare Part B Correct Answer: Covered Medically necessary doctors' services,
outpatient care, other medical services (including some preventive service not covered under
Medicare Part A
Medicare Part B is considered what Correct Answer: A optional benefit for which the patient
must pay a premium and which generally requires a yearly copay
Where is Medicare Part B usually used Correct Answer: Physician offices (Outpatient Facility)
What is Medicare Part C Correct Answer: Combines the benefits of Medicare Part A, Part B,
and sometimes Part D.
What is Medicare Part C also called Correct Answer: Medicare Advantage
What is PPO Correct Answer: Preferred Provider Organizations
What is HMO Correct Answer: Health Maintenace Organizations
Which plan covers PPO and HMO Correct Answer: Medicare Part C
What is the CMS-HCC Correct Answer: Center for Medicare & Medicaid Services-Hierarchical
condition category
What does the CMS-HCC provide Correct Answer: Risk adjument model provides adjusted
payment based on a patient's disease and demographic factors.
If a coder does not include all pertinent diagnoses and co-morbidities, the provider may lose out
on what Correct Answer: additional reimbursement for which he/she is entitled.
What is Medicare Part D Correct Answer: Prescription drug coverage program available to all
Medicare beneficiaries. Private companies approved by Medicare provide the coverage.
What is Medicaid Correct Answer: A health insurance assistance program for some low income
people (especially children and pregnant women) sponsored by federal and state governments
Medicaid administed on Correct Answer: a state-by-state basis and coverage varies- although
each of the state programs adheres to certain federal guidelines
When is a physican considered a "participating physician" Correct Answer: When contracted
with a insurance carrier whether that be a private insurance company or a governmental.
QUESTIONS| WITH COMPLETE SOLUTIONS
Coding is Correct Answer: the process of translating this written or dictated fmedical record into
a series of numeric or alpha-numeric codes
Proper code assignment is determined by Correct Answer: content of the medical record and by
the unique rules that governs each code set
what are 3 things that Coder must master Correct Answer: 1. anatomy
2. medical terminology
3. must be detail-oriented
Medical coders assign a code to what Correct Answer: 1. Each diagnosis
2. service/procedure
3. Supply, using the classification system when applicable
The classification system determines what Correct Answer: the amount health care providers
will be reimbursed if the patient is covered by Medicare, Medicaid, or other insurance programs
using the system
A coder must evaluate the medical record for Correct Answer: 1. completeness and accuracy
2. communicate regularly with physicians and othe health care professional to clarify DX or
obtain additonal PT info.
Techicians who speciallize in coding inpatient hospital services are referred as Correct Answer:
1. Health information coders
2. medical record coders
3. Coder/abstractors
4. Coding Specialist
What is MS-DRGs and what is it Correct Answer: 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
What is EHR Correct Answer: Electronic health record
Skill coders may become Correct Answer: consulatants, educators or medical auditors
What is the difference between Hospital and Physican Services Correct Answer: 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
,What is APC and who uses it Correct Answer: Ambulatory Payment Classification- outpatient
facility coders (physician services
What is the coder role in a physician's office Correct Answer: Extremely important to proper
reimbursement and the livelihood of the physican
What is a physican degree of education Correct Answer: 4 years of college, 4 years of medical
school plus 3 to 5 years of residency.
What is a mid-level providers and who Correct Answer: 1. Mid-level providers are know as
physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
What are the requirement for a PA and what Correct Answer: 1. 26 1/2 month to complete
2. Lincense to practice medicine with physician supervision
NP must have Correct Answer: A Master Degree in Nursing
How many payers in the most simplest form? Correct Answer: 2
Private insurance plans and government insurance plans
Commerical carriers are considered what Correct Answer: Private payers that offer both group
and individual plans.
Private Payers contracts may Correct Answer: Vary but may include hospitalization, basic and
major medical coverage.
What is the most significant government insurer Correct Answer: Medicare
What is Medicare Correct Answer: Federal health insurance program- Administerd by the
Center for Medicare &Medicaid Services (CMS)
What is CMS and what does it provide Correct Answer: 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
CMS regulations often serves as ____ word in coding requirement for Medicare and Non-
Medicare payers alike Correct Answer: Last
What are the parts of Medicare Correct Answer: Medicare A
Medicare B
Medicare C
Medicare D
, What is Medicare Part A Correct Answer: Covers inpatient hospital care, as well as care
provided in skilled nursing facilites, hospice care, and home health care
What is Medicare Part B Correct Answer: Covered Medically necessary doctors' services,
outpatient care, other medical services (including some preventive service not covered under
Medicare Part A
Medicare Part B is considered what Correct Answer: A optional benefit for which the patient
must pay a premium and which generally requires a yearly copay
Where is Medicare Part B usually used Correct Answer: Physician offices (Outpatient Facility)
What is Medicare Part C Correct Answer: Combines the benefits of Medicare Part A, Part B,
and sometimes Part D.
What is Medicare Part C also called Correct Answer: Medicare Advantage
What is PPO Correct Answer: Preferred Provider Organizations
What is HMO Correct Answer: Health Maintenace Organizations
Which plan covers PPO and HMO Correct Answer: Medicare Part C
What is the CMS-HCC Correct Answer: Center for Medicare & Medicaid Services-Hierarchical
condition category
What does the CMS-HCC provide Correct Answer: Risk adjument model provides adjusted
payment based on a patient's disease and demographic factors.
If a coder does not include all pertinent diagnoses and co-morbidities, the provider may lose out
on what Correct Answer: additional reimbursement for which he/she is entitled.
What is Medicare Part D Correct Answer: Prescription drug coverage program available to all
Medicare beneficiaries. Private companies approved by Medicare provide the coverage.
What is Medicaid Correct Answer: A health insurance assistance program for some low income
people (especially children and pregnant women) sponsored by federal and state governments
Medicaid administed on Correct Answer: a state-by-state basis and coverage varies- although
each of the state programs adheres to certain federal guidelines
When is a physican considered a "participating physician" Correct Answer: When contracted
with a insurance carrier whether that be a private insurance company or a governmental.
