MDA 145 Final

Question 1

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

Answer 1

2 digits

Question 2

ICD-10 codes are made up of how many digits per category?

Answer 2

3 /7 digits

Question 3

What is the last step in the coding process for CPT’s?

Answer 3

Determine the need for modifiers

Question 4

In what format are healthcare claims sent?

Answer 4

Electronic & hard copy

Question 5

What is the term for someone who is financially responsible for payment?

Answer 5

Guarantor, policy holder, insured

Question 6

In ICD-10-CM coding, when a code needs a seventh character and no sixth character exists, how should you code it?

Answer 6

X place holder/dummy placeholder

Question 7

Insurance policies can be written up for what type of individuals?

Answer 7

Insured

Question 8

ICD-10 codes can have up to how many digits in total?

Answer 8

3-7 digits

Question 9

CPT codes have how many digits?

Answer 9

5 digits

Question 10

What can assignment of benefits authorize?

Answer 10

Physician submits claim for a patient in order to receive reimbursement for their services

Question 11

Define down coding

Answer 11

Cost that us lower than what the procedure costs

Question 12

What code would you use for DME’s (durable medical equipment)

Answer 12

HCPCS/CPT

Question 13

List some common billing errors that can be made

Answer 13

Up-coding unbundling, no signature present, assumption coding, truncated coding, incorrect code linkage

Question 14

How much would a patient owe for a noncovered service costing $900 if their insurance policy has a coinsurance rate of 80-20, and they have already met their deductible?

Answer 14

$900

Question 15

Managed care organizations and indemnity plans typically offer what kind of plans?

Answer 15

lower deductibles

Question 16

Define coinsurance

Answer 16

What you pay after your deductible

Question 17

What is considered “out-of-network” for insurance

Answer 17

Out of state, hospital, & clinics that are not contracted with your insurance

Question 18

What are the three key components of E/M coding?

Answer 18

History, exam, & medical decision making

Question 19

How should you code if a diagnosis is not established

Answer 19

Code signs & symptoms

Question 20

Where do medical insurance companies summarize the payments they may make for medically necessary medical services?

Answer 20

Schedule of benefits document

Question 21

List the steps of the Revenue Cycle

Answer 21

preregister patients, establish financial responsibility, check in patient, review coding compliance, review billing compliance, check out patient, prepare and transmit clam, monitor payer adjudication, generate patient statement, remanence and collections.

Question 22

Which type of insurance covers patients who are age 65 and over?

Answer 22

Medicaid

Question 23

Define preauthorization

Answer 23

Approval of insurance company and referring physician

Question 24

A computerized lifelong health care record for an individual is known as a? Electronic health record (EHR)

Answer 24

Electronic health record (EHR)

Question 25

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

Answer 25

Comprehensive

Question 26

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

Answer 26

Rejected

Question 27

When is a deductible paid?

Answer 27

Before benefits begin

Question 28

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

Answer 28

Check alphabetical index first followed by tabular list

Question 29

Define the Tabular List. How many chapters are within the list?

Answer 29

21 chapters and all diseases

Question 30

What does Medical part B cover that is considered medically necessary?

Answer 30

Outpatient services, doctor visits

Question 31

When billing a Centers for Medicare and Medicaid Services (CMS) program, what will happen to a claim if the most specific code available is not used?

Answer 31

Claim will be rejected

Question 32

What program covers people who cannot otherwise afford medical care?

Answer 32

Medical/Medicare

Question 33

Name the 3 parties involved in the insurance plan.

Answer 33

Policy holder, insurance, & provider

Question 34

What are CPT codes used for?

Answer 34

procedures

Question 35

What does the (+) sign indicate when added into CPT coding?

Answer 35

An add on code

Question 36

Referrals are not required for which type of insurance plan? PPO

Answer 36

PPO

Question 37

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

Answer 37

Up-coding

Question 38

Define unbundling.

Answer 38

Coding separately to get a higher reimbursement