MEAS 137 Midterm exam review ch 1-8   

MEAS 137 Midterm exam review ch 1-8
Question:
The process of reporting ____________ as numeric and alphanumeric characters on the insurance claim is called coding.

a. dates of service for procedures
b. diagnoses and procedures / services
c. health insurance claims identifiers
Answer:
diagnoses and procedures / services
Question:
Which guarantees repayment for financial losses resulting from an employee's act or failure to act?

a. bonding insurance
b. liability insurance
c. property insurance
d. workers' compensation insurance
Answer:
bonding insurance
Question:
The Financial Services Modernization Act (FSMA) (or Gramm-Leach-Bliley Act) prohibits sharing of medical information among health insurers and other financial institutions for use in making ____________decisions.

a. credit
b. financial
c. payment
d. reimbursement
Answer:
credit
Question:
Electronic Health Records are not intended to provide continuity of care.

a. True
b. False
Answer:
False
Question:
Which defines a profession, delineates qualifications and responsibilities, and clarifies supervision requirements?

a. job description
b.policy and procedure
c. scope of practice
d. workforce development
Answer:
scope of practice
Question:
Which coding system is used to report procedures and services on inpatient hospital claims?

a. CPT
b. HCPCS level II
c. ICD-10-CM
d. ICD-10-PCS
Answer:
ICD-10-PCS
Question:
Health Insurance Specialists are also called reimbursement specialists.

a. True
b. False
Answer:
True
Question:
All insurance policies contain a hold harmless clause.

a. True
b. False
Answer:
False
Question:
Which documents health care services provided to a patient and includes patient demographic (or identification) data, documentation to support diagnoses and justify treatment provided, and the results of treatment provided?

a. accounting system
b. financial documents
c. health insurance claim
d. patient record
Answer:
patient record
Question:
Which type of insurance covers employees and their dependents against injury and death that occurs during the course of employment?

a. bonding
b. liability
c. property
d. workers compensation
Answer:
workers compensation
Question:
A health maintenance organization (HMO) is an alternative to traditional group health insurance coverage and provides comprehensive health care services to voluntarily enrolled members on a __________basis.

a. fee-for-service
b. per diem
c. prepaid
d. retrospective
Answer:
prepaid
Question:
A nonparticipating provider (nonPAR) is an out-of-network provider who does not contract with the insurance plan, and patients who elect to receive care from non-PARs will incur higher out-of-pocket expenses. The patient ___________expected to pay the difference between the insurance payment and the provider's fee.

a. is not
b. is usually
Answer:
is usually
Question:
Which is associated with health care that is provided in an HMO-owned center or satellite clinic or by physicians who belong to a specially formed medical group that serves the HMO?

a. closed-panel HMO
b. open-panel HMO
Answer:
closed-panel HMO
Question:
Which person is responsible for paying the charges?

a. enrollee
b. guarantor
c. patient
d. payer
Answer:
guarantor
Question:
The computer-to-computer transfer of data between providers and third-party payers (or providers and health care clearinghouses) in a data format agreed upon by sending and receiving parties is called electronic ________.

a. data interchange
b. flat file format
c. media claim
d. remittance advice
Answer:
data interchange
Question:
Which claims are filed according to year and insurance company and include those for which all processing including appeals, has been completed?

a. clean claims
b. closed claims
c. open claims
d. unassigned claims
Answer:
closed claims
Question:
Which is the insurance plan responsible for paying health care insurance claims first?

a. primary insurance
b. secondary insurance
c. supplemental insurance
d. tertiary insurance
Answer:
primary insurance
Question:
An integrated provider organization (IPO) manages the delivery of health care services offered by hospitals, physicians, and other health care organizations. Physicians associated with an IPO are considered ______________.

a. employees
b. independent contractors
c. self-employed
d. temporary staff
Answer:
employees
Question:
Covered entities are required to use mandated national standards when conducting any of the defined transactions covered under HIPAA. Which is an example of a covered entity?

a. banks that handle medical office payroll
b. companies that perform human resources
c. ERISA-covered health benefit plans
d. outsourced physical plant management
Answer:
ERISA-covered health benefit plans
Question:
With manged care's capitation financing method, if the physician provides services that cost less than the capitation amount, there is a profit, which the physician __________.

a. distributes to all patients in the practice
b. keeps to reinvest in the medical practice
c. pays back to the managed care organization
d. reimburses to government third-party payers
Answer:
keeps to reinvest in the medical practice
Question:
Federal and state ______are laws passed by legislative bodies, such as federal Congress and state legislatures.

a. policies
b. procedures
c. regulations
d. statutes
Answer:
statutes
Question:
Which instruction directs the coder to the ICD-10-CM tabular list, where a code can be selected from the options provided there?

a. See
b. See also
c. See category
d. See condition
Answer:
See category
Question:
The ICD-10-CM Index to Diseases and Injuries is a(n)________, which include specific illnesses, injuries, eponyms, abbreviations, and other descriptive diagnostic terms.

a. alphabetical listing of terms and corresponding codes
b. group of boldfaced procedure terms with sub terms
c. set of tables organized according to body system
d. tabular list of codes and their code descriptions
Answer:
alphabetical listing of terms and corresponding codes
Question:
Which punctuation is used in the ICD-10-CM index and tabular list to enclose nonessential modifiers, which are supplementary words that may be present in or absent from the physician's statement of a disease or procedure without affecting the code number to which it is assigned?

a.braces
b. colons
c. parentheses
d. slanted brackets
Answer:
parentheses
Question:
Which is routinely completed prior to an inpatient admission or outpatient surgery to facilitate the patient's treatment and reduce the length of stay?

a. history and physical exam
b. preadmission testing
c. preauthorization
d. routine follow-up
Answer:
preadmission testing
Question:
The ICD-10-CM Diagnostic Coding and Reporting Guidelines for Outpatient Services--Hospital-Based Outpatient services and Provider-Based Office Visits were developed by the federal government and approved for use by hospitals and providers for coding and reporting _________services and provider-based office visits.

a. ambulatory surgical center
b. home health care/hospice
c. hospital-based outpatient
d. skilled nursing facility
Answer:
hospital-based outpatient
Question:
Civil law deals with all areas of the law that are not classified as ________law.

a. administrative
b. case
c. criminal
d. standard
Answer:
criminal
Question:
Which requires documents, such as a patient record, to be produced in court?

a. deposition
b. interrogatory
c. subpoena
d. subpoena duces tecum
Answer:
subpoena duces tecum
Question:
Which is a legal newspaper published every business day by the national Archives and Records Administration (NARA) and available in paper form, on microfiche, and online?

a. Coding Clinic
b. Code of Federal Regulations
c. Federal Register
d. Medicare Bulletin
Answer:
Federal Register
Question:
Hospital outpatient _______codes are submitted for reimbursement purposes.

a. ICD-9-CM and CPT
b. ICD-10-CM, CPT, and HCPCS level II
c. ICD-10-CM and ICD-10-PCS
d. ICD-10-PCS, CPT, and HCPCS level II
Answer:
ICD-10-CM, CPT, and HCPCA level II
Question:
Main terms in the CPT index are printed in ______.

a, all capitals
b. boldface type
c. italics
d. underlined type
Answer:
boldface type
Question:
What is HCPCS used to code?

a. Products and supplies included in CPT book
b. Products and Supplies
c. Products, supplies, and services not included in CPT book
Answer:
Products, supplies, and services not included in CPT book
Question:
What does the acronym DME represent?

a. Durable Medical Equivalent
b. Durable Medical Equipment
c. Doing Medical Equations
Answer:
Durable Medical Equipment
Question:
When coding drugs (medications) in the HCPCS book we need to be careful to use the proper dosage administration and quantities.

a. True
b. False
Answer:
True
Question:
Category 1 in the CPT coding book is used to what?

a. Track performance measures
b. Provide temporary code for new services and procedures
c. Locate the 5-digit main body code
Answer:
locate the 5-digit main body code
Question:
The CPT coding book is used to code diagnosis

a. True
b. False
Answer:
False
Question:
A new patient is considered a patient that

a. has not been seen in the last year
b. Has never been seen
c. has not been seen in over 3 years
d. Both B and C
Answer:
Both B and C
Question:
Why are contrast materials sometimes administered prior to radiological testing?

a. To put the patient to sleep
b. Highlight the areas of study
c. Calm the patient
d. Both A and B
Answer:
highlight the areas of study
Question:
What does the term outpatient stand for?

a. had a procedure in a medical facility but went home afterwards
b. Had surgery, but got to go home after 3 days
c. Patients procedure was cancelled
Answer:
Had a procedure in a medical facility but went home afterwards
Question:
What is the Chief Complaint

a. Description of illness from the first sign of symptom
b. Patients history of problems
c. When a patient is seen prior to any other patients
d. Why the patient needs to be seen
Answer:
Why the patient needs to be seen
Question:
What is the CPT code (E/M) for "Office consultation, low complexity medical decision making"?
Answer:
99243
Question:
Initial inpatient hospital visit, level 2
Answer:
99222
Question:
What is the ICD-10-CM code for "chronic blood loss anemia"?
Answer:
D50.0
Question:
What is the ICD-10 CM code (table of drugs and chemicals) for "Allergic reaction to Benadryl"?
Answer:
T45.0X5A
Question:
A patient undergoes an ablation of a lesion on her leg in her physician's office. The physician's fee is $580. The patient's co payment is $27, and the patient is not required to pay any additional amount to the provider. The payer reimburses the physician $320.

a. Enter the amount the patient pays the provider
b. Enter the amount the payer reimbuses the provider
c. Enter the amount the provider "writes off" the account
Answer:
$27 (co-pay) b. $320 c. $233 ($580-$320-$27)
Question:
The patient underwent surgery on December 31, and the third-party payer determined the reasonable charge to be $100 after annual deductible of $250 has been met. She has only paid $100 toward her deductible this year. The patient is responsible for paying 20 percent for her coinsurance. The physician will receive 80 percent for accepting assignment. Rita will need to pay ______at today's visit.
Answer:
$100 (the visit was only $100 and she still needs to meet $150 of deductible. If she paid the 20% as well as her deductible, there would be an overpayment)
Question:
Index to external causes. Altitude sickness
Answer:
W94.11XA
Question:
ICD-10-CM (table of drugs and chemicals) "Suicide attempt due to carbon monoxide poisoning"
Answer:
T58.92XA
48 flash cards