- There are several professional organizations that are dedicated to serving health insurance specialists in physicians' and other health care providers' practices. Which of the following professional organizations do not serve this group?
Your answer:
American Health Information Management Association (AHIMA)
American Association of Medical Transcriptionists (AAMT)
American Academy of Procedural Coders (AAPC)
Alliance of Claims Assistance Professionals, Inc. (ACAP, Inc.)
- Which of the following are duties of an insurance specialist?
Your answer:
Abstract patient charts and other source documents to accurately code all procedures and diagnoses.
Operate the office bookkeeping system properly.
Correct all data errors and refile claims returned as unprocessable.
All of the above.
- What are some of the new career opportunities available for health insurance specialists.
Your answer:
Employment with malpractice and liability companies.
Employment with government agencies, legal offices, pivate billing companies
Employment with companies specializing in meical publications.
All of the above
- Each facsimile transmission of sensitive material should have a cover sheet including what information?
Your answer:
The name and phone number of the person to receive the transmission.
The name and phone number of the original sender.
A confidentiality notice or disclaimer.
All of the above.
- Which of the following activities fall under the category of abuse rather than fraud?
Your answer:
Violations of participating provider agreements with insurance companies.
isrepresenting the services performed by using a higher level of service code in order to increase revenue.
Billing for services that were not provided.
Submitting duplicate claim forms to obtain a multiple reimbursement for identical services or procedures.
- What are some of the steps to prevent errors in data entry and electronic claims processing?
Your answer:
Double check the EOB statement that accompanies all direct payments of insurance.
Carefully proofread all diagnostic and procedure codes.
Verify social security number and date of birth.
All of the above.
- Which insurance was originally designed to cover individuals aged 65 or older and retired on either Social Security or the Railroad Retirement program.
Your answer:
edicaid
Champus
Champva
edicare
- Which program is jointly funded by the state and local governments to provide health care benefits to indigent persons on welfare, the aged, and/or the disabled?
Your answer:
edicare
edicaid
Champus
Champva
- Which insurance program was designed as a benefit for dependents of personnel serving in the armed forces, and the uniformed branches of the Public Health Service and the National Oceanic and Atmospheric Administration.
Your answer:
Champva
Blue Cross Blue Shield
Champus
edicaid
- Which of the following health care plans has a network of physicians and hospitals that have joined together to contract with insurance companies or regional organizations to provide health care to subscribers?
Your answer:
Exclusive Provider Organization (EPO)
Point-of Service Plan (POS)
Preferred Provider Organization (PPO)
None of the above
- In which of the following health plans does the patient have the freedom of choice to use the HMO panel of providers or to self-refer to non-HMO providers?
Your answer:
Point-of-Service Plan (POS)
Preferred Provider Organization (PPO)
Exclusive Provider Organization (EPO)
None of the above
- Which of the following plans is a closed-panel PPO plan where the enrollees receive no benefits if they opt to receive care from a provider who is not in the EPO?
Your answer:
Exclusive Provider Organization (EPO)
Preferred Provider Organization (PPO)
Point-of-Service Plan (POS)
None of the above
- If after completing the EOB and the claim form, an error in processing is found, the following steps should be taken:
Your answer:
Write an immediate appeal for reconsideration of the payment.
ake a copy of the orginal claim, the EOB, and the written appeal.
Attach a copy of the orginal claim and the EOB to the appeal.
All of the above.
- The following third-party reimbursement method used by HMOs and some managed care plans to pay the health care provider a fixed amount on a per capita (per person) basis is:
Your answer:
Fee-for-service Reimbursement
Fee-for-service with Utilization
Capitation
Episode of Care
- The third-party reimbursement method in which the health care provider receives one lump sum for all services rendered to the patient for a specific illness is:
Your answer:
Capitation
Fee-for-service reimbursement
Fee-for-service utilization
Episode of Care
- A patient comes to the health care provider's office with an injury to the right leg that is determined to be a fractured tibia. While the patient is in the office, the physician also reviews the current status and treatment of the patient's diabetes and essential hypertension. What is the primary diagnosis?
Your answer:
Essential hypertention
Fracture, shaft, right tibia
Diabetes mellitus
All of the above
- What is the concurrent diagnosis for the patient listed in Question 16?
Your answer:
Fracture, shaft, right tibia
Diabetes mellitus
Essential hypertension
None of the above
- Using the information for the same patient found in Question 16, what is the secondary diagnosis?
Your answer:
Fracture, shaft, right tibia
Diabetes mellitus
Essential hypertension
None of the above
- A patient was admitted to the hospital because of a fractured left hip. During the hospital stay, the patient developed a pulmonary embolism. The following procedures were performed: an X-ray of the right and left hips, a lung scan, and a surgical pinning of the hip. What is the principal procedure?
Your answer:
Pinning of the hip
Lung Scan
Both of the above
None of the above
- A V code could be used in which of the following situations?
Your answer:
Removal of a cast applied by another physician.
Routine follow-ups for possible recurrence of a tumor.
Well-baby checkups
All of the above
- E codes are used to report:
Your answer:
Environmental events
Industrial accidents
Both of the above
None of the above
- Which of the following office procedures contribute to inaccurate diagnostic coding?
Your answer:
Diagnostic codes on encounter forms, routing slips, and code lists that do not indicate when a fifth digit must be assigned.
Computer diagnostic codes lists that have not been proofread.
Both of the above
None of the above
- Principles of a managed care system include:
Your answer:
Use of Drug Formularies
Strong patient health and preventative care education
Use of treatment plan guidelines for high cost disorders
All of the above
- Which of the following are basic skill requirements needed to become a health insurance specialist.
Your answer:
Strong foundation in medical terminology
Critical reading skills
Ability to enter data into the patient data base
All of the above
- What are some of the things a health insurance specialist can do to prevent fraud?
Your answer:
Never honor requests to change or alter information stated in the legal records of the patient.
Never add a procedure to an insurance claim form that is not recorded in both the patients chart and the ledger/account.
Both of the above
None of the above
- A contract between the patient and a health care provider for medical services in exchange for the insurance company's agreement to pay promptly that physician's usual fee for the services performed is:
Your answer:
Coordination of Benefits
Explanation of Benefits
Contract
None of the above
- A statement acompanying all claims payments that explains how the insurance company determined its share of the reimbursement is called:
Your answer:
An Explanation of Benefits Form
A Deductible
A Copayment
None of the above
- A policy that covers losses to a third party caused by the insured, by an object owned by the insured, or on the premises owned by the insured is:
Your answer:
Liability insurance
edicaid
edicare
Health Insurance
- When coding for the excision of lesions the coder must know:
Your answer:
The site
The size (in centimeters)
Both of the above
None of the above
- To code fractures correctly the coder must know:
Your answer:
The location of the fracture
If the treatment was "open" or "closed"
If internal or external fixation was required
All of the above
- When coding for multiple surgical procedures performed on the same day the coder must:
Your answer:
List the major procedure first and the lesser surgeries listed in decending order of expense
List surgeries in any order
List only the major surgery
All of the above
- Which of the following diagnostic codes is incorrect?
Your answer:
Irritable bowel syndrome 564.1
Tinnitus 388.30
Ulcerative colitis 556.9
PMS 564.1
- Which of the following diagnostic codes is incorrect?
Your answer:
Acute appendicitis with peritoneal abscess 540.1
Whiplash 847.0
Dysthymic disorder 300.4
Otitis media, acute effusion 540.3
- According to optical scanning rules, the patient Lisa R. Jones should be entered how?
Your answer:
LISA R JONES
JONES R LISA
JONES LISA R
Lisa R. Jones
- According to optical scanning rules, the total charge of $400.00 should be entered how?
Your answer:
$400.00
400.00
40000
400 00
- According to optical scanning rules, the social security number 229-44-2582 should be entered how?
Your answer:
229 44 2582
229442582
229-44-2582
Both 1 & 2 are correct
- Numerical identifiers assigned to each health care provider to be used on all health insurance claim forms is:
Your answer:
Social security Number
National Provider Number
Telephone Number
Patient's Insurance Number
- A numerical identification assigned to all third party payers who pay health care benefits is:
Your answer:
Social Security Number
National Provider Identifiers
PayerID
Patient's Insurance Number
- A clause written into an insurance policy that states: When a policyholder has two or more medical insurance policies, the insurance companies will pay up to 100% of the covered benefits is:
Your answer:
Coordination of Benefits
Breach of Confidentiality
Both of the above
None of the above
- HCPCS: Health Care Procedural Coding System. An alphanumeric coding system devised by HCFA as a supplement to the CPT code.
Your answer:
True
False
- CPT CODE MODIFIERS: A specific two-digit number that is added to the five-digit CPT code to indicate additional factors should be considered before coverage issues are determined.
Your answer:
True
False
- NEW PATIENT (as used in CPT coding): A patient who is new to the practice or has not received any professional services by the physician for three or more years.
Your answer:
True
False
- ESTABLISHED PATIENT (as used in CPT coding): A patient who has received professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the last three years, or the on-call physician seeing the patient.
Your answer:
True
False
- GLOBAL FEE: The all-inclusive fee for total medical care for the hospitalized surgical case (patient)
Your answer:
True
False
- CONSULTATION: An examination of a patient by a health care provider for the purpose of advising the patient and the referring/attending physician about the establishment or confirmation of a diagnosis, or the medical management of the case. Consultants may initiate diagnostic and/or therapeutic services as necessary.
Your answer:
True
False
- An Encounter form is the financial record source document used by health care providers and other personnel to record diagnoses and services rendered to a patient during the current visit.
Your answer:
True
False
- The understanding of medical terminology is very important for health insurance coding professionals.
Your answer:
True
False
- The ability of the health insurance coding professional to code accurately is vital to the operation of the medical office.
Your answer:
True
False
- The use of computers has not changed the opportunities available to health insurance coding professionals in any way.
Your answer:
True
False
- A good understand of the use of computers is important to the health insurance coding professional.
Your answer:
True
False