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Clinical Aspects of Billing and Coding > Final > Flashcards

Final Flashcards

1
Q

Which of these would most likely be considered a noncovered service at a primary care medical office?

A

employment-related injuries

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2
Q

What kind of medical services are annual physical examinations and routine screening procedures?

A

preventative

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3
Q

ICD-10-CM diagnosis coding can have __________ - __________ characters.

A

3-7

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4
Q

Assignment of benefits authorizes:

A

physician to file claims for patient & receive direct payments from payer

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5
Q

CPT Level I modifiers are made up of how many digits?

A

two digits

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6
Q

Durable medical equipment (DME), such as wheelchairs, is reported using:

A

HCPCS codes

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7
Q

HCPCS Level II codes begin with:

A

an alphabetic character

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8
Q

How would a payer respond to a claim that does not contain at least one diagnosis code?

A

the payer will deny the claim

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9
Q

In CPT, a plus sign (+) next to a code indicates:

A

add-on code

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10
Q

Main term in the Alphabetic Index is:

A

the word that identifies a disease and appears in boldface

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11
Q

Only the codes that are supported by the _____ should be reported.

A

documentation

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12
Q

The last step in the coding process for CPT is:

A

determine the need for modifiers

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13
Q

What are the consequences of inaccurate coding and incorrect billing?

A

-fines
-denied claims and reduced payments
-prison sentences

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14
Q

What does a provider complete during/after a patient’s visit to summarize their billing information?

A

encounter form

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15
Q

What is another term for prior authorization?

A

precertification

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16
Q

What type of coding uses a procedure code that provides a higher reimbursement rate than the correct code?

A

upcoding

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17
Q

When billing with the CMS program, what will happen to a claim if the most specific code available is not used

A

the claim will be rejected/denied

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18
Q

Which part of the ICD-10-CM coding book is made up of 21 chapters of disease descriptions and their codes?

A

Tabular List

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19
Q

In order to correctly code a diagnosis you must first look in the Alphabetic Index and then confirm in the __________.

A

Tabular List

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20
Q

The first step in ICD-10-CM coding is to:

A

locate the main term in the Alphabetic Index

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21
Q

What is the first step in CPT coding?

A

identify the procedure or service

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22
Q

With E/M coding, which type of examination is the most extensive and complete?

A

comprehensive

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23
Q

What type of coding uses a lower level code?

A

downcoding

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24
Q

What is the definition of revenue cycle?

A

ensure sufficient monies flow into practice to pay bills

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25
Q

patient owes this amount for noncovered service of $900. Insurance policy coinsurance rate is 80-20 & deductible is met

A

$900

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26
Q

A patient who has seen the provider within the last 3 years is considered a/an:

A

established patient

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27
Q

Transactions and code standards for ICD-10-CM are mandated by:

A

HIPAA

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28
Q

How many characters is a category code in ICD-10-CM?

A

three

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29
Q

In ICD-10-CM coding, when a code needs a seventh character and no sixth character exists, you need to

A

use a placeholder “x” in the sixth character

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30
Q

Excludes 1 in ICD-10-CM is an indication that:

A

two conditions could not exist together

31
Q

When a diagnosis is not established, you should code the:

A

signs and symptoms

32
Q

Which of the following is the HIPAA Mandated code set for physician’s procedures and services?

A

CPT

33
Q

CPT codes are used to report:

A

-anesthesia
-lab tests
-surgical procedures

34
Q

Unbundling is:

A

separating the components of a procedure and coding them separately

35
Q

The connection between the diagnostic and procedural information on a claim is called ____.

A

code linkage

36
Q

Which of the following is not a medically necessary procedure?

A

cosmetic nasal surgery

37
Q

Which of these are common billing errors?

A

-upcoding
-billing for noncovered services
-unbundling

38
Q

What provision explains how insurance policies will pay if more than one policy applies?

A

coordination of benefits

39
Q

How many digits are CPT codes?

A

five

40
Q

What is typically collected at the time of service?

A

copay

41
Q

The three key components of E/M coding are:

A
  • history
  • exam
  • medical decision-making
42
Q

provider performs same procedure on right & left side of body during same operative session. What is a correct modifier?

A

-50 Bilateral Procedure

43
Q

The key to receiving coverage and payment from a payer is the payer’s definition of:

A

medical necessity

44
Q

How is premium defined?

A

periodic payment the insured is required to make to keep a policy in effect

45
Q

Coinsurance is:

A

the percentage of each claim that the insured pays

46
Q

A person who helps guide a patient through the healthcare system is known as a healthcare navigator

A

True

47
Q

The AAMA is the organization responsible for providing CMA credentialing every 3 years.

A

False

48
Q

organization provides MA’s with RMA (registered medical assistant) & requires recertification every 3 years

A

AMT

49
Q

hard skills include

A

-technical skills
-operational skills
-being bilingual

50
Q

respect, dependability, integrity and attitude are all considered

A

good work ethics

51
Q

An MA should provide resources, education and anticipation of patient needs. This is known as patient advocacy

A

True

52
Q

Reaching conclusions that go beyond the obvious is known as common sense.

A

False

53
Q

The reason for ICD Coding include all except:

A

to make sure the doctor is reimbursed the maximum amount

54
Q

In front of the ICD manual, you will find which of the following?

A

Alphabetic Index

55
Q

Contains 21 chapters on specific diseases and their codes

A

Tabular List

56
Q

The coding structure for ICD codes is

A

3-7 characters with the first three being alphanumeric followed by decimal

57
Q

guidelines for using code set w/abbreviations, punctuation, symbols, typefaces & instructional notes is known as HCPCS

A

False

58
Q

indicates code is excluded and never should be used at the same time as the code above

A

Excludes 1

59
Q

Means “not included here” and that both codes may be used since patient can have both at the same time

A

Excludes 2

60
Q

5 digit numeric codes followed by description of procedure and can include semicolon

A

CPT

61
Q

one or more 2-digit codes assigned to the 5 digit main code to show special circumstance applied to service or procedure

A

modifiers

62
Q

any code that includes more than one procedure in its description is called

A

bundled code

63
Q

the insurance carrier bases reimbursement on a code lower than the one submitted by the provider

A

downcoding

64
Q

breaking a bundled code into its component parts for higher reimbursement and is NOT allowed is called upcoding

A

False

65
Q

coding procedure or service at higher level than provided to receive a higher level of reimbursement is called upcoding

A

True

66
Q

These are divided by new or established patient and found in front of the CPT manual

A

E/M codes

67
Q

The most common type of patient histories and has all four components of CC, HPI, ROS and PFSH documented is called

A

comprehensive

68
Q

These types of codes are used for DME (durable medical equipment)

A

HCPCS

69
Q

fixed amount to be paid or met by insured before third party payer begins to cover medical expenses

A

deductible

70
Q

fixed percentage of covered charges after the deductible is met (Example: 80-20)

A

coinsurance

71
Q

fixed fee collected at time of visit

A

copayment

72
Q

receipt of confirmation from pt insurance plan that proposed procedure will be considered a covered service

A

-preauthorization
-precertification

73
Q

legal clauses in insurance policies that prevent payment duplication by restricting payment of no more than 100% of cost

A

coordination of benefits

74
Q

the determination on whether the procedures provided and the accompanying diagnosis are compatible

A

medical necessity

Clinical Aspects of Billing and Coding (5 decks)

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