Integrated Electronic Health Records Chapter 6

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question
The amount charged for each service provided in a medical practice is known as a/an:
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fee schedule
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Which of the following is a true statement about using practice management software for an office's claims management process?
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it allows for more efficient tracking and reporting of daily transactions
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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:
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managed care
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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:
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co-pay
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The source document for completing the actual insurance claim form is the:
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encounter form
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Which of the following is not part of a paper encounter form (Superbill)?
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the medical history
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Nick Malone underwent an appendectomy by Dr. Lopez on September 5. Dr. Lopez documented appendicitis as Mr. Malone's diagnosis. The diagnosis was documented ______________________.
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to show medical necessity
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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 _______________.
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cash flow
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The actual claim process begins when the patient:
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makes the appointment
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Converting narrative diagnoses and procedures into numeric form is known as:
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coding
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In a physician's office, procedures and services are converted into numeric form using which coding system?
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CPT
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The coding system used in illustrating the tangible items such as supplies is:
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HCPCS level 2
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As of October 1, 2014, the coding system used to code diagnoses in any healthcare setting is:
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ICD-10-CM
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Of the following, which is not a reason that the United States did not implement ICD-10 at the time other countries did?
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decision whether ICD-10 or CPT would be used to code diagnoses
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Billing for services that are not medically necessary or that did not happen at all is ____________.
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fraud
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ICD-10-CM/PCS is being implemented because:
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ICD-9-CM no longer meets the needs of healthcare organizations.
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Which of the following is a true statement about ICD-10-CM/PCS?
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Current coders will need to re-learn how to code
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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?
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Affordable Care Act (ACA)
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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:
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Accountable Care Organization
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Which is not true of ACOs?
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Data can be in structured or unstructured form
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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:
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Remittance advice
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The primary person covered by an insurance plan is the:
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subscriber
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____________________ CPT codes are used to capture the face-to-face time spent between a patient and the care provider.
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evaluation and management
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The last step in the medical billing cycle is:
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follow-up payments and collections
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Coding practices that are inconsistent with typical practice are known as:
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abuse
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\"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
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total charges for a patient's account
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Of the following, which would be a library used in the accounts receivable functions of a practice management system?
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insurance company names
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Common forms of Medicare fraud are listed on the ____________ Network.
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Qui Tam
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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:
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Office of Inspector General
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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?
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nine (9)
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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?
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insurance verification
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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?
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encounter form
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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?
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An ICD-10-CM code
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ICD-9-CM had been the coding system used prior to ICD-10-CM. In what year did ICD-9-CM go into effect?
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1979
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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?
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assessment
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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 _____________.
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CPT
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Describe accounts receivable.
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Accounts receivable tracks the flow of money into a practice from collected payments.
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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?
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An Explanation of Benefits (EOB)
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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.
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new
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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?
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library of insurance companies
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The charge for each service (by CPT code) provided in a medical practice is known as the fee ________________.
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schedule
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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?
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compliance plan
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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?
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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.
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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.
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