Chapter 1 CIMO – Flashcards
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What does a PMP require to create and transmit healthcare claims?
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collection of information from various databases and create a claim file
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What method of filing a claim has replaced paper claim forms?
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electronic transmission
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Which of these are computerized records of one physician's encounters with a patient over time?
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electronic medical records (EMRs)
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According to the Institute of Medicine, which of the following core functions should be included in an EHR?
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-decision support -order management -population reporting and management
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Which records offer a broad focus on a patient's total health experience over the lifespan, rather than the documentation of episodes of illness or injury?
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electronic health records (EHRs)
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What is NOT a common element of reporting and population management within EHRs?
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patient's identity
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What term refers to medical care that uses the latest and most accurate clinical research in making decisions about the care of patients?
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evidence-based medicine
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Reminding patients about preventive care screenings is an example of which advantage of EHRs?
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quality
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The ten-step cycle that results in the timely payment for patients' medical services is the
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medical documentation and billing cycle
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Which of the following information should be collected from new patients during preregistration?
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-the patient's name -the patient's contact information -the patient's reason for the visit
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What must be in place in a medical office to provide medical care to patients and collect payment for these services?
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work flow
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A steady flow of income into a practice is known as what?
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revenue
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What expenses is not necessarily paid on a regular, recurring basis?
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legal services
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Which information is contained in office visit documentation?
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the diagnosis and procedures
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Which of the following refers to diagnosis codes?
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ICD
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Which of the following refers to procedure codes?
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CPT
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An encounter form is also known as a
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superbill
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The provider's fees for services are listed on the medical practice's
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fee schedule
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What is a series of steps designed to determine whether a claim should be paid?
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adjudication
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The remittance advice provides details about each patient transaction, including
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-the date of service -the services provided -the patient identification number
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When a medical practice receives an overpayment from a health plan, it
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issues a refund
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What document lists all services performed, along with the charges for each service?
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statement
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A company that receives electronic claims and forwards the claim to the payer is known as
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a clearinghouse
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Revenue cycle management refers to
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managing the activities associated with a patient encounter to ensure the provider is paid
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Which of the following are rules created under HIPAA?
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-HIPAA Privacy Rule -HIPAA Electronic Transaction and Code Sets standards -Final Enforcement Rule
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What describes a particular electronic format that providers and health plans must use to send and receive healthcare transactions?
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HIPAA Electronic Transaction and Code Sets
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Electronic data interchange involves sending information from computer to
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computer
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In most physician practices, the claim format is the HIPAA-standard
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X12-837 Health Care Claim
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Health information that can be used to find out a person's identification is referred to as
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protected health information
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Which term refers to the acquisition, access, use, or disclosure of unsecured PHI in a manner not permitted under the HIPAA Privacy Rule, thus compromising the security or privacy of the PHI?
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breach
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Recognizing that existing HIPAA laws did not provide adequate protection in an increasingly electronic healthcare environment, Congress included additional privacy and security regulations in the
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HITECH Act of 2009
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What government regulation is intended to promote the use of EHRs in physician practices and hospitals through the use of financial incentives?
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the HITECH Act
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Under HITECH, which government body is required to conduct audits to ensure compliance with HIPAA rules?
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Office of Civil Rights (OCR)
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The utilization of certified EHR technology to improve quality, efficiency, and patient safety in the healthcare system is known as what?
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meaningful use
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A network of doctors and hospitals that shares responsibility for managing the quality and cost of care provided to a group of patients is known as
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an accountable care organization
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What is health information technology?
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record, store,and manage patient healthcare information
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Practice management programs (PMP)
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software that automate many administrative and financial tasks in the medical practice
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Medical documentation and billing cycle
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a ten step process that results in timely payment for medical services
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Diagnosis
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physicians opinion of the nature of the patients illness or injury
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Procedure
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medical treatment provided by a physician or other healthcare provider
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ICD-9-CM
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International Classification of Disease, Ninth Revision, Clinical Modification. The source of codes used for reporting diagnosis until October 1, 2014
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ICD-10-CM
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International Classification of Disease, Tenth Revision, Clinical Modification, which will be used beginning on October 1, 2014
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Current Procedural Terminology (CPT)
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standardized classification system for reporting medical procedures and services
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HCPCS
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codes used for supplies, equipment, and services not included in CPT codes
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encounter forms
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a list of procedures and diagnoses for a patients visit
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Explanation of Benefits (EOB)
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paper document from a payer that shows how the amount of a benefit was determined
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Revenue cycle management (RCM)
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ensure full payment
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