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Which of the following is considered the final determination of the issues involving the settlement of an insurance claim? - correct answer Adjudication - is the process of putting an insurance claim through a series of edits for final determination. Chapter 4 A form that contains charges, DOS, CPT codes, fees, and copayment information is called which of the following? - correct answer Encounter form is a form that contains charges, DOS, CPT code, ICD codes, fees, and copayment information...

Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - correct answer National Coverage Determination (NCD) A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? - correct answer Denied A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? - correct answer Aging repo...

Which of the following sections of the medical record is used to determine the correct evaluation and management code used for billing and coding? - correct answer history and physical A billing and coding specialist is reviewing a CMS-1500 claim form. The "assignment of benefits" box has been checked "yes." The checked box indicates which of the following? - correct answer The provider receives payment directly from the payer Which of the following do physicians use to electronically ...

Medical Ethics - correct answer Standards of conduct based on moral principals. Acting within ethical behavior boundries means carrying out one's responsibilities with integrity, decency, respect, honesty, competence, fairness and trust. Compliance Regulations - correct answer Most billing related cases are based on HIPAA and the False Claims Act. HIPAA is an acronym for - correct answer Health Insurance Portability and Accountability Act of 1996. Category 1 CPT codes - correct answer ...

The attending physician - correct answer A nurse is reviewing a patients lab results prior to discharge and discovers an elevated glucose level. Which of the following health care providers should be altered before the nurse can proceed with discharge planning? The patients condition and the providers information - correct answer On the CMS-1500 Claims for, blocks 14 through 33 contain information about which of the following? Problem focused examination - correct answer A provider perform...

Which of the following is considered the final determination of the issues involving settlement of an insurance claim? - correct answer Adjudication A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called which of the following? - correct answer Encounter form A patient comes to the hospital for an inpatient procedure. Which of the following hospital staff members is responsible for the initial patient interview, obtaining demographic and insurance...

A patient's health plan is referred to as the payer of last resort. The patient is covered by which of the following health plans? Medicaid CHAMPA Medicare TRICARE - correct answer Medicaid A provider charged $500 to a claim that had an allowable amount of $400. In which of the following columns should the CBCS apply the non allowed charge? -Reference column (For notations) -Description column -Payment column -Adjustment column of the credits - correct answer Adjustment column of the...

Medical Billing & Coding as a Career - correct answer *Claims assistant professional or claims manager, *Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance Billing Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical & Financial Records Manager, * Billing & Coding Specialist What are Medical Ethics? - correct answer Standards of conduct based on moral principle. They are generally accepted as a guide for behavior towards pt's, dr...

A phlebotomy technician should identify that which of the following additives is used to prevent the breakdown of glucose? - correct answer Sodium fluoride A Phlebotomy technician in an outpatient setting is identifying a patient before performing a venipuncture procedure. To confirm the patient's identity, which of the following questions should the technician ask? - correct answer "Would you please state and spell your full name and provide your date of birth" Which of the following i...

A phlebotomy technician is explaining a phlebotomy procedure to a patient who wears hearing aids. The patient seems distracted. Which of the following questions should the technician ask to ensure the patient understands the procedure? A. "Did you hear what I said?" B. "Do you understand what you need to do?" C. "Do you need me to talk slower?" D. "Would you like me to repeat the directions?" - correct answer D. "Would you like me to repeat the directions?" (The technician should a...

A phlebotomy technician is preparing to draw blood from a patient's arm and observes a sore at the site where the tourniquet is to be placed. Which of the following actions should the technician take? - correct answer Tie the tourniquet over the patient's sleeve to prevent any further damage to the skin. The Joint Commission recommends using the patient's full name and which of the following pieses of information to ensure accurate inpatient identification? - correct answer Medical record ...

The single most important way to prevent the spread of infection while performing phlebotomy is by? - correct answer Washing Hands After drawing blood from a patient, the phlebotomist should dispose of the needle by? - correct answer Deposit it in an approved "Sharps Container" Negligence by a professional person is called? - correct answer Malpractice Which of the following is the single most common source of HIV and HBV in the workplace? - correct answer Blood The heart, lymphati...

What agency regulates workplace safety? - correct answer OSHA biologic hazard / biohazard - correct answer any biological risk to organisms Bloodborne Pathogens Standard - correct answer OSHA-mandated set of requirements concerning pathogenic micro-organisms and their transmission Exposure control plan - correct answer An OSHA-compliant plan that explains ways to minimize or eliminate exposure of humans to bloodborne pathogens. What type of PPE would be essential for airborne pathoge...

What test results are affected when Povidone iodine is used to cleanse the site for a dermal puncture? - correct answer Potassium (Povidone-iodine is contraindicated for potassium tests because it can cause a false elevation of potassium in a specimen What actions should a phlebotomy Technician take to locate a vein using the warming technique? - correct answer Encase the warm towel in a plastic bag A Phlebotomy technician is applying a tourniquet prior to collecting a blood specimen from ...

Hand washing - correct answer Which of the following is the most important procedure in the prevention of disease transmission in heath care institutes? Gloves, googles or face shield, gown, and mask - correct answer Which of the following is the proper sequence for removal of isolation apparel after blood collection in an isolation room? Gown, mask, goggles or face shield, and gloves - correct answer Which of the following is the proper sequence for putting on a complete set of PPE? Ma...

Characteristics imperative to a phlebotomist - correct answer Dependability, honesty, integrity, empathy and compassion, professional appearance, interpersonal skills Circulatory system function - correct answer deliver oxygen, nutrients, hormones, & enzymes to cells and transport cellular waste (CO2) to organs where they can be expelled The two circulations - correct answer Pulmonary & Systemic Pulmonary circulation - correct answer carries deoxygenated blood from the right ventricle t...

A term used to describe a blood sample in which the red blood cells have ruptured is: - correct answer Hemolyzed Which of the following Vacutainer tubes is routinely used for hematology testing? - correct answer Lavender No anticoagulants are found in which tube? - correct answer Plain Red Which type of tube should be used to collect blood specimens during a glucose tolerance test? - correct answer Gray What is the anticoagulant that prevents platelets from clumping and preserves the...

Role Of The Phlebotomist - correct answer -Collect routine capillary and venous specimens for testing as requested -Prepare specimen for transport, ensuring its stability -Transport specimen to the laboratory - Promote good public relations with hospital staff and patients -Comply with new and revised procedures as described in he procedure manual -Assist in collecting and documenting monthly workload and recording data -Maintain safe working conditions -Perform laboratory computer operat...

OSHA - correct answer Establishes regulations and guidelines to direct phlebotomists to work at the highest level of safety possible when handling bio hazards and chemicals. The blood borne pathogens standard (OSHA) - correct answer - addresses use of PPE - availability to the Hep B immunization - Each workplace must have a exposure control plan - has guidelines to ensure safety - provides standard plans for after an exposure. - engineering controls and record keeping protocols PPE...

A Phlebotomist has a requisition to draw blood on a patient who has severe Down syndrome. Which of the following steps should the Phlebotomist take? A) Explain the procedure to the patient in simple terms, then proceed with venipunture. B) Speak with the patients guardian before performing the venipuncture to ensure the explanation is understood C) Draw the Patient's blood without trying to explain the procedure D) Ask the patient's guardian to assist in holding the patient's arm...