Tulloch

Data security policies and procedures should be reviewed at least: a. Semi-annually b. Annually c. Every two years d. Quarterly - Correct Answer: B All data security policies and procedures should be reviewed and evaluated at least every year to make sure they are up-to-date and still relevant to the organization (Johns 2011, 995). 2. Identify the correct ICD-9-CM diagnosis code(s) for a patient with near-syncope event and nausea. a. 780.2 b. 780.2, 787.02 c. 780.2, 787.01 d. 780.4, ...

The patient owes $25.00 for the visit. The amount collected for the office visit is called what? - Copayment The insurance carrier rate is 80% the remaining 20% is called what? - Coinsurance A third party payer made an error when adjudicating a claim which of the following should the specialist do? - resubmit the claim with an attachment explaining the error A claim submitted with all the necessary and accurate information so that it can be processed and paid is called? - A clean claim A ...

Which of the following sections of the medical record is used to determine the correct evaluation and management code used for billing and coding? - 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? - The provider receives payment directly from the payer Which of the following do physicians use to electronically submit a claim? - Clearinghouse...

What are the headings under the table of drugs and chemicals - Poisoning, accident, therapeutic use, suicide attempt, assault and undetermined What is S.T.A.T. - immediately What is certified mail - mail sent requiring a signature and return receipt How do you provide patient confidentiality - avoid using fax transmissions containing confidential material, don't discuss patients case, close patients files, turn computer screens away from others How do you answer incoming calls - use natur...

What 2 groups of persons were added to those eligible for Medicare benefits after the initial establishment of the Medicare program? - 1. Persons eligible for disability benefits from Social Security 2. Persons with permanent kidney failure requiring dialysis or transplant To what government organization did the Secretary of the Department of Health and Human Services delegate the responsibility for administering the Medicare program? - CMS (Centers for Medicare and Medicaid Services) Wha...

This patient was admitted for chemotherapy due to a primary hepatocellular carcinoma of the transplanted liver. What codes are assigned? a. Z51.11, C22.0 b. Z51.11, C22.0, C80.2 c. Z51.11, T86.49, C80.2, C22.0 d. T86.49, C80.2, C22.0 - Correct Answer: C Code T86.49 should be assigned for complication of liver transplant along with code C80.2 for malignancy associated with organ transplant. A malignant neoplasm of a transplanted organ should be coded as a transplant complication (CMS 2018...

For continuity of care, ambulatory care providers are more likely than providers of ACS to rely on the documentation found in the - Problem list (PCPs, pharmacy consultations and transfer summaries are likely to be found on the records of longterm care patients). All of the following organizations make up the Cooperating Parties for the approval of ICD-9-CM coding guidelines EXCEPT: - Americal Medical Association Define Status asthmaticus - An acute asthmatic attack in which the degree of b...

An insurance and coding specialist is reviewing a patient's encounter form that is documented in the medical record prior to competing a CMS-1500 form. She notices that the physician upcoded the encounter form. The specialist has the ethical obligation to first - query the physician A patient had surgery two weeks ago to repair a dislocated ankle, and returns today to have a flexor tendon in the hand repaired. Which of the following modifiers should be reported for today's service? - -79 ...

c. Edit checks Edit checks help ensure data integrity by allowing only reasonable and predetermined values to be entered into the computer (Rinehart-Thompson 2016a, 265). - A coding analyst consistently enters the wrong code for patient gender in the electronic billing system. What data quality or data integrity measures should be in place to ensure that only allowable code numbers are entered? a. Access controls b. Audit trail c. Edit checks d. Password controls b. Delinquent record A...

StartNow Implementation Methodology - Fill in the blank: 6 phases of _____ from ServiceNow 1. Plan 2. Discover 3. Prepare 4. Deploy 5. Operate 6. Transform Single-tenant- What of the unique architectural tenants of ServiceNow which allows dedicated instances and databases. - Is ServiceNow a single-tenant or multi-tenant Software as a Service (SAAS) environment? Domain separation - Fill in the blank: _____ allows organizations to: • Enforce data separation between business entities ...

107. Which of the following styles should a billing and coding specialist use to format a patient's date of birth on a CMS-1500 claim form? - O MMDDYYYY 106. A Medicare provider submits a CMS-1500 claim form that is rejected for payment. Which of the following should be a reason for the form's rejection? - O Medical coverage was cancelled In which of the following locations should a billing and coding specialist find the contract information to appeal a claim? - O Insurance company file ...

ICD 10-CM MANUAL HAS AN ESTMATED OF HOW MANY CODES - 72,000 ICD 10-CM MANUAL GUIDELINES ARE DIVIDED INTO HOW MANY SECTION(S) - FOUR (4) ICD 10-CM MANUAL DIVIDED INTO HOW MANY APPENDIX (S) - ONE (1) ICD 10-CM MANUAL SECTION (I) HAS HOW MANY PRIMARY SETS OF GUIDELINES - THREE (3) WHAT ARE THE THREE (3) PRIMARY GUIDELINES IN SECTION ONE (1) OF THE ICD 10-CM MANUAL - CONVENTIONS, GENERAL, SPECIFIC CODING (Applies to ALL ICD-10-CM code assignment unless otherwise indicated) WHAT ARE (IS) THE G...

What is the Level of Detail in Coding - ICD-10 codes are to be used and reported at their highest number of characters possible (specificity) What is the Level of Detail in Coding Example - (in this example do not stop at "Hypertension 110" go to the highest level specificity (I12.9 Hypertensive Chronic Kidney Disease) What is a guideline? - A guideline is a rule In the guidelines how many CATEGORIES are set up in the Alphabetic Index - Three In the guidelines how many SECTIONS are there...

Encounter and Visit are often used interchangeably in describing ____________ - Outpatient Service (Diagnostic Coding and Reporting Guidelines for Outpatient Services) In the outpatient setting, the term _______diagnosis is used in lieu of principal diagnosis. - FirstListed (Selection of first-listed condition) In determining the first-listed diagnosis the coding conventions of ICD-10-CM, as well as the general and disease specific guidelines take precedence over ______ - Outpatient guideli...

In order to work competently as a medical claims specialist in a physician's office, one needs - to know procedural and diagnostic coding In addition to medical data, the medical record may include - personal data, financial data, social data Medical ethics will typically address standards of - conduct Everything that a medical claims specialist learns about a patient's condition must remain - confidential Which of the following skills would NOT be required for accurate filing of claims...

Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? - Yes According to TJC, who may amend the medical staff bylaws? - Governing body/board. Failure to meet the established qualifications and criteria for appointment should be reported to whom? - The applicant NCQA requires the MCO to obtain a minimum of how may years of work history? - Five years According to the NCQA what policy must an organization have in place to obtain approval to...

Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? - Yes According to TJC, who may amend the medical staff bylaws? - Governing body/board. Failure to meet the established qualifications and criteria for appointment should be reported to whom? - The applicant NCQA requires the MCO to obtain a minimum of how may years of work history? - Five years According to the NCQA what policy must an organization have in place to obtain approv...

Commissioner of (CBP) is filled by - presidential nomination, subject to the advice and consent of the Senate. CBP gave rise to which of the following agencies? - National Institute of Standards and Technology U.S. Coast Guard Department of Veterans Affairs not a component of the Department of Homeland Security - Bureau of the Census CBP's responsibilities do not encompass - Licensing imported firearms not a Homeland Security mission - Supporting U.S. commercial interests Mod Act 3 conc...

Coding is - the process of translating this written or dictated medical record into a series of numeric or alpha-numeric codes Proper code assignment is determined by - content of the medical record and by the unique rules that governs each code set What are 3 things that Coder must master - 1. anatomy 2. medical terminology 3. must be detail-oriented Medical coders assign a code to what - 1. Each diagnosis 2. Service/procedure 3. Supply, using the classification system when applicable ...

The symbol "O" in the Current Procedural Terminology reference is used to indicate what? - Reinstated or recycled code In the anesthesia section of the CPT manual, what are considered qualifying circumstances? - Addon codes As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the CMS-1500 claim form before a further claim is required? - 12 What is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - Operative...