Chapter 6 Review part 2

The amount charged for each service provided in a medical practice is known as a/an:
A. chargemaster
B. fee schedule
C. ledger
D. day sheet
Which of the following is a true statement about using practice management software for an office’s claims management process?
A. it ensures a more accurate electronic health record
B. insurance verification is completed automatically
C. it is required by Medicare
D. it allows for more efficient tracking and reporting of daily transactions
The type of insurance plan that promotes quality, cost-effective healthcare by monitoring patients, encouraging preventive care, and requiring performance measures of physicians is known as:
A. Medicare Part C
B. managed care
C. fee-for-service
D. consumer driven
In many managed care plans, patients are responsible for paying a portion of the charges at the time services are rendered. This is known as the:
A. deductible
B. coinsurance
C. co-pay
D. balance
The source document for completing the actual insurance claim form is the:
A. medical record
B. CMS-1500
C. UB-04
D. encounter form
Which of the following is not part of a paper encounter form (Superbill)?
A. name of the medical practice
B. CPT codes for procedures
C. the medical history
D. ICD-9-CM diagnosis codes
Nick Malone underwent an appendectomy by Dr. Lopez on September 5. Dr. Lopez documented appendicitis as Mr. Malone’s diagnosis. The diagnosis was documented ______________________.
A. to show medical necessity
B. to avoid fraud charges
C. to prove why he missed work
D. to prove what procedure was done
An advantage of practice management software is review of the electronic claim for diagnosis and procedure code errors or inconsistencies. Catching any errors prior to the claim being sent to the insurance carrier improves _______________.
A. amount of reimbursement
B. billing processes
C. cash flow
D. quality of care
The actual claim process begins when the patient:
A. is discharged
B. makes the appointment
C. is seen by the care provider
D. pays the bill
Converting narrative diagnoses and procedures into numeric form is known as:
A. conversion
B. coding
C. statistics
D. reporting
In a physician’s office, procedures and services are converted into numeric form using which coding system?
The coding system used in illustrating the tangible items such as supplies is:
B. HCPCS level 2
As of October 1, 2015, the coding system used to code diagnoses in any healthcare setting is:
rev: 02_27_2015_QC_CS-9167
B. HCPCS level 2
D. ICD-10-CM
Of the following, which is not a reason that the United States did not implement ICD-10 at the time other countries did?
A. costly to convert from one coding system to the other
B. decision whether ICD-10 or CPT would be used to code diagnoses
C. increased training needs
D. unknown whether ICD-10 would meet the needs of the United States
Billing for services that are not medically necessary or that did not happen at all is ____________.
A. unintentional
B. intentional
C. fraud
D. abuse
ICD-10-CM/PCS is being implemented because:
A. the American Medical Association has requested it.
B. ICD-9-CM no longer meets the needs of healthcare organizations.
C. it is already in use in Canada.
D. ICD-9-CM is out of print.
Which of the following is a true statement about ICD-10-CM/PCS?
A. It will only be used in physicians’ office settings.
B. Current coders will need to re-learn how to code.
C. Healthcare facilities will have the choice to either continue to use ICD-9-CM or convert to ICD-10-PCS.
D. The adoption of ICD-10-CM/PCS was endorsed by the American Medical Association in 1990.
As a result of which piece of legislation are hospitals and providers reimbursed based on proof that they are rendering high quality, coordinated care to their patients?
A. Health Information Technology for Economic and
Clinical Health Act (HITECH).
B. Health Insurance Portability and Accountability Act (HIPAA)
C. Affordable Care Act (ACA)
D. Amendment to the Social Security Act
Groups of doctors and other healthcare providers and facilities who voluntarily form a partnership that results in high quality, coordinated healthcare is known as a/an:
A. Accountable Healthcare Organization
B. Managed care plan
C. Fee-for-service plan
D. Accountable Care Organization
Which is not true of ACOs?
A. There are currently two models: Medicare Shared
Savings and Advance Payment Model.
B. Sharing of patient information through an EHR is necessary
C. Data can be in structured or unstructured form
D. Participation in an ACO is voluntary
An insurance company submits payment to a medical practice, along with a document that details the patients and accounts for which payment is made. This document is called the:
A. Superbill
B. Encounter form
C. Remittance advice
D. Subscriber benefits notice
Of the following, which would be included on a remittance advice or explanation of benefits?
A. total charges for a patient’s account
B. subscriber’s address
C. effective date of insurance
D. employer’s information
The primary person covered by an insurance plan is the:
A. patient
B. prescriber
C. subscriber
D. provider
CPT codes are used to capture the face-to-face time spent between a patient and the care provider.
A. revenue
B. diagnosis
C. evaluation and management
D. physical exam
The last step in the medical billing cycle is:
A. Review coding compliance
B. pre-register patients
C. follow-up payments and collections
D. establish financial responsibility
Coding practices that are inconsistent with typical practice are known as:
A. fraud
B. abuse
C. illegal activity
D. incorrect coding
Of the following, which would be a library used in the accounts receivable functions of a practice management system?
A. insurance company names
B. patient names
C. patient addresses
D. patient telephone numbers
Common forms of Medicare fraud are listed on the ____________ Network.
A. Resipsa Loquitor
B. Whistle Blower’s
C. Qui Tam
D. Compliance
Dr. Simmons’ office has been notified that they are being audited due to a complaint that was filed by a Medicare patient regarding their billing practices. The audit will be conducted by:
A. The Office of Civil Rights
B. Centers for Medicare and Medicaid Services
C. Internal Revenue Service
D. Office of Inspector General
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