Billing And Insurance Final Exam

Front 1

The creation of an opening of a portion of the colon through the abdominal wall to an outside surface is called a(n):

Back 1

Colostomy

Front 2

A physician suspects that his patient , Mr. Jones, may have bladder cancer. He wants to visually examine Mr. Jones' bladder. This procedure is called a(n):

Back 2

Cystoscopy

Front 3

Three year old Alyssa Walker was referred to an endocrinologist by her pediatrician with symptoms of chronic respiratory infections, pancreatic insufficiency, and a growing intolerance to heat. The endocrinologist plans to order a series of tests including a sweat test, hoping to rule out a hereditary disorder called:

Back 3

Cystic Fibrosis

Front 4

When a thrombus travels through the vascular system, it is called a(n):

Back 4

Embolus

Front 5

A leiomyoma is a tumor of the:

Back 5

Smooth Muscle

Front 6

A patient is prescribed albuterol. The patient has been experiencing SOB during times of stress and during exercise. When this occurs, audible wheezing is another sign. Which of the disorders listed below could be the medical term to describe this patient's medical condition?

Back 6

Asthma

Front 7

Karen Davis presents to the ED with severe abdominal pain. It is determined after laboratory and ultrasound testing that she has an abdominal pregnancy. This type of pregnancy could also be termed as:

Back 7

Ectopic

Front 8

An allergic reaction of the skin that is manifested by the presence of hives is called:

Back 8

Urticaria

Front 9

The removal of foreign material, dead tissue, or damaged tissue is called:

Back 9

Debridement

Front 10

SPECT, PET, MRI, and CT scan are all types of:

Back 10

Radiology Procedures

Front 11

Which group of organs listed below is associated with the lymph system?

Back 11

Spleen, Thymus Gland, and Tonsils

Front 12

The formed elements of plasma include:

Back 12

Thrombocytes, Erythrocytes and

Leukocytes

Front 13

Which organ listed below is known as the "master gland"?

Back 13

Pituitary

Front 14

Which of the following is the first part of the small intestine?

Back 14

Duodenum

Front 15

Melanin is produced by the skin epithelial cells called melanocytes. Where are melanocytes located?

Back 15

Stratum Basale

Front 16

Which of the following structures is part of the lower respiratory tract?

Back 16

Bronchi

Front 17

The large arteries of the human cardiovascular system have three layers. What is the function of arteries?

Back 17

Carry blood from the heart to the body cells

Front 18

The axial skeleton is composed of:

Back 18

Skull, Rib Cage and

Vertebral Column

Front 19

Nephrons are present in kidney tissue. What is the function of nephrons?

Back 19

Maintaining homeostasis by regulating water, salts and glucose

Front 20

Which of the following is an internal structure of the female reproductive system?

Back 20

Oviducts

Front 21

What is the name used to identify medical coding software? The software assists in the assignment of ICD-10-CM and/or HCPCS codes.

Back 21

Encoder

Front 22

What is the definition of the acronym LAN?

Back 22

Local Area Network

Front 23

Which group listed below are input devices?

Back 23

Keyboards, Scanners, Pointing Devices, and Light Pen

Front 24

What is the acronym used to define a health record that is stored in a digital format and is accessible to providers and health care professionals via computer software? This format is able to record and have medical data entered into it for updating medical events and as a record of care.

Back 24

EHR

Front 25

What is the term given to a computerized information station that allows facility visitors and patients to access information on health-related topics or a map of the facility?

Back 25

Information Kiosk

Front 26

What federal legislation details provision for the transmission of health data electronically?

Back 26

HIPAA

Front 27

What is the acronym given to a group or network in a community or region that is sharing clinical information? This group may not be within the same health care facility or hospital.

Back 27

RHIO

Front 28

Virus protection software and data recovery software are considered what type of computer programs?

Back 28

Utility Programs

Front 29

Which of the following is a secondary storage device?

Back 29

All of the above

Front 30

Which of the following is correct for defining an intranet?

Back 30

An intranet is a network that works like the Internet but is limited to certain people (e.g., company employees)

Front 31

What is the definition of the acronym ISP?

Back 31

Internet Service Provider

Front 32

Which website address below is the correct onr for the Centers for Medicare and Medicaid Services?

Back 32

www.cms.gov

Front 33

What is the definition of the acronym FTP?

Back 33

File Transfer Protocol

Front 34

What is the definition of the acronym ASCII?

Back 34

American Standard Code Information Interchange

Front 35

Which of the following codes is from the E/M section of CPT?

Back 35

99281

Front 36

CPT code 47550 has a plus sign (+) in front of it; this means that:

Back 36

This procedure is an add-on code

Front 37

If a patient has CPT code 99205 circled on his encounter form, that means that the patient was seen:

Back 37

In the Office

Front 38

What level of exam is required for a 99215 E/M code to be assigned?

Back 38

Comprehensive

Front 39

Code 4013F is what type of CPT code?

Back 39

Category II

Front 40

What is a clearinghouse?

Back 40

A company that processes paper claims into electronic claims

Front 41

What is an advantage of a value-added network (VAN)?

Back 41

Efficiency and less cost to the provider

Front 42

What agency can providers check with to see if a clearinghouse is accredited?

Back 42

EHNAC

Front 43

What is the third stage of a claim's life cycle?

Back 43

adjudication

Front 44

What federal legislation mandated national standards for electronic data?

Back 44

HIPAA

Front 45

A CMS-1500 claim must be converted into what type of file for electronic processing?

Back 45

Electronic Flat File

Front 46

Which of the following would be performed during the claim adjudication process?

Back 46

The claim is screened to ensure that it is not a duplicate claim

Front 47

Which item would result in the denial of a claim?

Back 47

Noncovered benefit

Front 48

Which definition best describes a claim attachment?

Back 48

An authorization letter from the insurance company

Front 49

What is the difference between an extranet claims submission and internet claims submission?

Back 49

If using an extranet, the provider can access information about payers and various data elements on a claim.

Front 50

Which statement could be listed in Box 12 of the CMS-1500 claim?

Back 50

Signature on File

Front 51

If a procedure is done multiple times during an office visit, how is this reflected on the CMS-1500 claim?

Back 51

Number of units is completed in Box 24G

Front 52

CMS-1500 claims are designed for

Back 52

Optical Scanning

Front 53

What is the unique 10-digit number that identifies a provider and is placed on a CMS-1500 CLAIM?

Back 53

NPI

Front 54

Where are ICD-10-CM diagnosis(es) code(s) entered on a CMS-1500 claim?

Back 54

Box 21

Front 55

The abbreviation for POS

Back 55

Place of Service

Front 56

The legal business name of the practice that is entered in Box 33 is called?

Back 56

Billing entity

Front 57

What is the maximum number of procedures that can be reported on one CMS-1500 claim?

Back 57

Six

Front 58

Which of the following is the correct date pattern to be used in Block 24A on a CMS-1500 claim?

Back 58

MM DD YY

Front 59

When entering information on a CMS-1500 claim, which of the following statements is true?

Back 59

When entering a nine-digit zip code, enter the hyphen.

Front 60

The rule stating that a policyholder whose birth day and month occur earlier in the year is the primary policyholder for dependent children is called the ______ rule.

Back 60

Birthday

Front 61

Which Medicare program is designed to pay for prescription drugs?

Back 61

Part D

Front 62

What form is important for Mr. Martin to complete for workers' compensation coverage?

Back 62

First Report of Injury

Front 63

To which part of Medicare should the billing specialists submit the claims for Mrs. Wilson's care in this facility?

Back 63

Part A

Front 64

For hospital billing, what form is used to file medical claims?

Back 64

UB-04

Front 65

What was the impact of TEFRA on medical billing?

Back 65

TEFRA required the implantation of PPS systems in the US health care reimbursement arena

Front 66

What situation may be covered by liability insurance
?

Back 66

claim for $100,000 in lost wages

Front 67

Medicare provides health care coverage to Americans over the age of 65. Medicare is a type of _____________ health plan.

Back 67

Government

Front 68

What legislation impacted managed care plans by requiring them to follow reporting and disclosure requirements?

Back 68

ERISA

Front 69

What was the impact of HIPAA on medical billing?

Back 69

HIPAA has established national code sets, which include ICD-10-CM and CPT

Front 70

Which of the following is a feature unique to a BCBS plan?

Back 70

In their negotiated contract with providers, they agree to provide educational seminars on health topics to providers and enrollees.

Front 71

What is a QMBP? What services does it provide for an individual?

Back 71

QMBP is a program that provides funds to pay for individuals' Medicare Part A & Part B premiums.

Front 72

What has replaced the EOMB form from Medicare?

Back 72

MSN

Front 73

What are the four factors of medical necessity?

Back 73

purpose, scope, evidence, and value

Front 74

Which of the following is a managed care option health plan for military officers and their dependents?

Back 74

Tricare Prime

Front 75

What is the term used for updated medical information on a patient who is receiving workers' compensation coverage and/or workers' disability coverage?

Back 75

Progress Report

Front 76

Which of the following is the insurance program administered by states that expands health care coverage for children?

Back 76

SCHIP

Front 77

Which of the following is a typically covered service under Medicare Part B?

Back 77

DME, ambulatory hospital care and physician services

Front 78

Which patient could be a Medicare eligible recipient?

Back 78

A 35-year-old diagnosed with end-stage renal disease

Front 79

What is the focus of PACE?

Back 79

To provide community-base services for individuals who require nursing care

Front 80

Which of the governmental agencies or departments provides compliance program guidelines?

Back 80

Office of Inspector General

Front 81

Per the OIG, what is the first step of compliance plan?

Back 81

Establishment of an audit program for claims review

Front 82

Which of the following is an important component of a compliance plan?

Back 82

Establishment of a reporting method for employees to report alleged compliance violations

Front 83

Which of the following was established to provide CPT coding information, especially on the issue of unbundling?

Back 83

CCI

Front 84

What is meant by the term upcoding?

Back 84

Submitting a claim for a level of reimbursement that is not documented in the health record

Front 85

Accreditation by The Joint Commission or another health care agency is

Back 85

Voluntary

Front 86

Per OIG compliance guidelines for small group physician practices, which statement is true?

Back 86

Conduction of audits internally is recommended

Front 87

What is a focus of the OIG work plan?

Back 87

Duplicate patient claims

Front 88

What is meant by the term unbundling?

Back 88

Separating the components of a surgical procedure into multiple CPT codes when it should have been billed under one CPT code

Front 89

What federal legislation governs improper billing practices?

Back 89

FCA

Front 90

Peer Review Organizations, which are contracted by CMS to perform claim audits, are now known as:

Back 90

QIO

Front 91

Which of the following could be considered abuse under the False Claims Act?

Back 91

E/M documentation in patient record that agrees with CPT code level billed to CMS only 2.5 percent of the time

Front 92

Which of the following could be considered fraud under the False Claims Act?

Back 92

Submission of claims for office visits that were not rendered

Front 93

Which health care provider system or employer has the largest settlement to date under the False Claims Act?

Back 93

GlaxoSmithKline

Front 94

Which website address is correct to report suspected Medicare fraud?

Back 94

[e-mail]

Front 95

The simplified ____________ billing process was developed to enable Medicare beneficiaries to participate in mass PPV and influenza virus vaccination programs offered by public heath clinics and other entities that bill Medicare payers.

Back 95

Roster

Front 96

What is a Medicare Ombudsman?

Back 96

an individual who works with Medicare beneficiaries to provide them with information on their options under the Medicare system

Front 97

Qui tam is a legal phrase that relates to:

Back 97

the Federal False Claims Act

Front 98

What is the definition of UCR?

Back 98

Uncovered, Costly and Reasonable

Front 99

There are three major types of managed care plans; one of them is a point-of-service plan. What are the other two major types?

Back 99

HMO and PPO

Front 100

Which of the following is a component of an HMO?

Back 100

PCP as gatekeeper

Front 101

What is an actuarial calculation?

Back 101

Calculation used to determine the managed care companies' rates and premiums

Front 102

How can relative value units be used by physician practice management?

Back 102

To compare physician performance within a group practice

Front 103

What is a Management Service Organization?

Back 103

A company owned by a hospital or physician practice that provides administrative and managerial services

Front 104

Which of the following is a component of a health risk appraisal?

Back 104

Personal and family health history of an enrollee

Front 105

When employees have the opportunity to choose which benefit(s) they want under an employer sponsored plan, this is called a(n):

Back 105

Cafeteria plan

Front 106

What is the purpose of underwriting?

Back 106

Assumption of risk

Front 107

What best describes the role of a case manager?

Back 107

to coordinate care for a patient by working with doctors and insurance for a plan that meets the patient's needs based on medical necessity