Integrated Electronic Health Records Chapter 6
Unlock all answers in this set
Unlock answersquestion
The amount charged for each service provided in a medical practice is known as a/an:
answer
fee schedule
question
Which of the following is a true statement about using practice management software for an office's claims management process?
answer
it allows for more efficient tracking and reporting of daily transactions
question
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:
answer
managed care
question
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:
answer
co-pay
question
The source document for completing the actual insurance claim form is the:
answer
encounter form
question
Which of the following is not part of a paper encounter form (Superbill)?
answer
the medical history
question
Nick Malone underwent an appendectomy by Dr. Lopez on September 5. Dr. Lopez documented appendicitis as Mr. Malone's diagnosis. The diagnosis was documented ______________________.
answer
to show medical necessity
question
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 _______________.
answer
cash flow
question
The actual claim process begins when the patient:
answer
makes the appointment
question
Converting narrative diagnoses and procedures into numeric form is known as:
answer
coding
question
In a physician's office, procedures and services are converted into numeric form using which coding system?
answer
CPT
question
The coding system used in illustrating the tangible items such as supplies is:
answer
HCPCS level 2
question
As of October 1, 2014, the coding system used to code diagnoses in any healthcare setting is:
answer
ICD-10-CM
question
Of the following, which is not a reason that the United States did not implement ICD-10 at the time other countries did?
answer
decision whether ICD-10 or CPT would be used to code diagnoses
question
Billing for services that are not medically necessary or that did not happen at all is ____________.
answer
fraud
question
ICD-10-CM/PCS is being implemented because:
answer
ICD-9-CM no longer meets the needs of healthcare organizations.
question
Which of the following is a true statement about ICD-10-CM/PCS?
answer
Current coders will need to re-learn how to code
question
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?
answer
Affordable Care Act (ACA)
question
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:
answer
Accountable Care Organization
question
Which is not true of ACOs?
answer
Data can be in structured or unstructured form
question
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:
answer
Remittance advice
question
The primary person covered by an insurance plan is the:
answer
subscriber
question
____________________ CPT codes are used to capture the face-to-face time spent between a patient and the care provider.
answer
evaluation and management
question
The last step in the medical billing cycle is:
answer
follow-up payments and collections
question
Coding practices that are inconsistent with typical practice are known as:
answer
abuse
question
\"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
answer
total charges for a patient's account
question
Of the following, which would be a library used in the accounts receivable functions of a practice management system?
answer
insurance company names
question
Common forms of Medicare fraud are listed on the ____________ Network.
answer
Qui Tam
question
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:
answer
Office of Inspector General
question
Philip James has been a patient at Greensburg Medical Center for three years. During that time he has been seen twice for annual physical exams, three times for ear infections, and four times for follow-up of his hypertension. How many encounters does Mr. James have at Greensburg Medical Center?
answer
nine (9)
question
Roberta is a billing coordinator at Greenway Medical Center. She is in the process of determining whether a patient is covered by insurance, whether a co-payment is due, and whether the patient has met his deductible. What function is Roberta performing?
answer
insurance verification
question
Roberta is going over the form with a patient; the form includes such information as the name of the patient, the provider's name and NPI number, the date of the visit, numeric codes corresponding to the patient's diagnoses and procedures performed that day. This form is called a Superbill, and is otherwise known as what?
answer
encounter form
question
An alpha-numeric code which corresponds to each diagnosis made by the care provider, and is included on every claim form is known as what kind of code?
answer
An ICD-10-CM code
question
ICD-9-CM had been the coding system used prior to ICD-10-CM. In what year did ICD-9-CM go into effect?
answer
1979
question
Dr. Markunas saw Drew Panek in his office today. Drew was diagnosed with strep pharyngitis. The diagnosis is otherwise known as what in a SOAP note?
answer
assessment
question
Once ICD-10-CM/PCS is implemented, the coding system that will be used to code services and procedures in a physician's office will be _____________.
answer
CPT
question
Describe accounts receivable.
answer
Accounts receivable tracks the flow of money into a practice from collected payments.
question
What is the name of the document typically sent by insurance companies to a subscriber detailing the services and charges submitted for payment by the medical office, the allowed amount, the co-pay satisfied by the patient, any deductible due, the amount paid by the insurance company and the amount owed by the subscriber?
answer
An Explanation of Benefits (EOB)
question
Jeannie Lopez has never been seen in Greensburg Medical Center. The evaluation and management code assigned will be based on the fact that she is a/an ___________ patient.
answer
new
question
All of the insurance companies and the individual plans of patients in the medical practice are included in what database of the practice's practice management software?
answer
library of insurance companies
question
The charge for each service (by CPT code) provided in a medical practice is known as the fee ________________.
answer
schedule
question
A formal, written document that describes how a physician's practice or hospital ensures that rules, regulations, and standards are being adhered to is known as what kind of plan?
answer
compliance plan
question
Mrs. Lam was sent from her doctor's office to the outpatient laboratory for a urinalysis. Her insurance company denied the claim stating that the procedure was not necessary. The healthcare professional reviewed the claim and saw that a urinalysis was ordered, and the diagnosis listed on the encounter form was upper respiratory infection. Why was this claim denied?
answer
This claim was denied because a diagnosis of upper respiratory infection would not show medical necessity for a lab test to be run on a urine sample.
question
Dr. Lewis's office collects patients' co-pays at the time of arrival; Dr. Mbadu's office collects the co-pay as the patient is leaving the visit. Is one method more advisable than the other? Explain your answer.
answer
It may be more advisable to collect the co-pay prior to care being given because if the patient is not able to pay the co-pay at that time, the appointment can be rescheduled. Once the services are given, if the patient says they do not have the money, then nothing can be done at that point.
