. A coder acquires a working knowledge of coding systems, coding conventions and guidelines, government regulations, and third-party payer requirements to ensure that documented diagnoses, services, and procedures are coded accurately for __________, research, and statistical purposes.
a.
compliance
b.
continuity of care
c.
quality assurance
d.
reimbursement
ANSWER:
d
POINTS:
1
DIFFICULTY:
Easy
2. During internships (or professional practice experiences) at health care facilities, coding students receive __________ training.
continuing education
on-the-job
paid
virtual
b
Easy
3. Which is the person to whom the student reports at the health care facility internship site?
college instructor
department manager
internship supervisor
volunteer coordinator
c
4. Which is the most likely reason a student would be terminated from the internship site, fails internship course, or suspended and/or expelled from the academic program?
arriving late due to weather conditions
breaching patient confidentiality
contacting the site about an absence
dressing in a business casual style
Easy
5. Coders also have the opportunity to work at home for employers who partner with an Internet-based organization called a(n) __________, which is a third-party entity that manages and distributes software-based services and solutions to customers using the Internet.
application service provider (ASP)
knowledge process outsourcing (KPO)
third-party logistics (TPL)
wide area network (WAN)
a
6. Which professional is employed by third-party payers to review health-related claims to determine whether the costs are reasonable and medically necessary based on the patient’s diagnosis?
health information technician
insurance specialist
liability underwriter
medical assistant
7. Students who join a professional association for a reduced membership fee often receive most of the same benefits as active members. Which is an example of a benefit of joining a professional association?
guaranteed receipt of academic scholarship and grants
opportunity to network with members of the association
placement by the association at an internship facility
waiver provided for certification examination fees
8. Which represents an online professional network about a variety of topics and issues?
application service provider
listserv
place-bound conference
wide area network
9. Which organizes a medical nomenclature according to similar conditions, diseases, procedures, and services, and contains codes for each?
classification system
data dictionary
hybrid record
medical nomenclature
10. Which is a vocabulary of clinical and medical terms used by health care providers to document patient care?
11. Which includes numeric and alphanumeric characters that are reported to health plans for health care reimbursement, to external agencies for data collection, and internally for education and research?
codes
dictionary
nomenclature
placeholders
12. Coding is the assignment of codes to diagnoses, services, and procedures based on __________.
federal government regulations
health information management
patient record documentation
third-party payer requirements
13. Which is used to classify diagnoses in any health care setting?
CPT
HCPCS level II
ICD-10-CM
ICD-10-PCS
14. Which is used to classify procedures in an inpatient hospital setting?
15. Which is published by the AMA and used to classify procedures and services in an outpatient setting?
16. Which is managed by CMS and used to classify medical equipment, injectable drugs, transportation services, and other services in an outpatient setting?
17. The Centers for Medicare & Medicaid Services (CMS) is a(n) __________ in the federal Department of Health and Human Services (DHHS).
administrative agency
compliance section
private organization
third-party payer
18. Which is an example of a medical nomenclature?
DSM-5
ICD-10-CM/PCS
SNOMED CT
19. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is federal legislation that amended the Internal Revenue Code of 1986 to __________.
create privacy and security standards for health information
eliminate standards for electronic health information transactions
limit access to long-term care services and coverage
produce waste, fraud, and abuse in health insurance and health care delivery
20. The process of standardizing data by assigning alphanumeric values to text or other information is called __________.
encoding
mapping
potentiating
sequencing
21. The HIPAA small code set collects information concerning _____.
actions taken to prevent, diagnose, treat, and manage diseases and injuries
causes of injury, disease, impairment, or other health-related problems
diseases, injuries, impairments, and other health-related problems
race, ethnicity, type of facility, and type of unit
Difficult
22. The HIPAA large code set collects information concerning _____.
privacy and security standards for health information
waste, fraud, and abuse in health insurance and health care delivery
23. HIPAA requires health plans that do not accept standard code sets to modify their systems to accept all valid codes or to contract with a(n) _____.
electronic data interchange
health care clearinghouse
insurance company
third-party administrator
Moderate
24. Which is an insurance company that establishes a contract to reimburse health care facilities and patients for procedures and services provided?
clearinghouse
health plan
provider
25. Which is an example of a third-party payer?
Blue Cross/Blue Shield
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Workers’ compensation
26. Which is an example of another health care professional who performs procedures or provides services to patients?
clearinghouse staff
nurse practitioner
27. Health plans that do not accept standard code sets are required to modify their systems to accept all valid codes or to contract with a __________ that does accept standard code sets.
health care provider
28. Adopting HIPAA’s standard code sets has improved data quality and simplified claims submission for health care providers who routinely deal with multiple __________.
clearinghouses
health plans
markets
physicians
29. A third-party administrator (TPA) is an entity that __________ and may contract with a health care clearinghouse to standardize data for claims processing.
combats waste, fraud, and abuse in health insurance and health care delivery
improves portability and continuity of health insurance coverage in group/individual markets
processes health care claims and performs related business functions for a health plan
simplifies the administration of health insurance by creating unique identifiers
30. The medical coding process requires the __________ of patient record documentation to identify diagnoses, procedures, and services for the purpose of assigning ICD-10-CM, ICD-10-PCS, HCPCS level II, and/or CPT codes.
correction
entry
omission
review
31. Professional associations establish a code of ethics to help members understand how to differentiate between “right” and “wrong” and apply that understanding to __________.
credentialing
decision making
documentation
focused review
32. Concurrent coding is the review of records and/or use of encounter forms and chargemasters to assign codes __________.
after the patient has been discharged from care
during an inpatient stay or outpatient encounter
following the submission of health insurance claims
that results in continuity of the patient’s health care
33. Which is used to record data about office procedures and services provided to patients?
chargemaster
encounter form
insurance claim
uniform bill
34. Which contains a computer-generated list of procedures, services, and supplies and corresponding revenue codes along with charges for each?
35. Coders are prohibited from performing assumption coding, which is the assignment of codes based on assuming, from a review of clinical evidence in the patient’s record, that the patient has certain diagnoses or received certain procedures/services even though the __________.
responsible physician was contacted to confirm diagnoses, procedures, and services
physician query process was not implemented by the health care facility or physician
provider did not specifically document those diagnoses or procedures and services
risk for health care fraud and abuse is assumed by the health care facility or physician
36. When coders have questions about documented diagnoses or procedures/services, they use a physician query process to contact the responsible physician to __________.
confirm diagnoses, procedures, and services already documented in the record
eliminate the risk for fraud and abuse even though assumed by the facility or physician
request clarification about documentation and the code(s) to be assigned
document diagnoses, procedures, or services that will increase reimbursement
37. Integrating the __________ physician query process with the electronic health record allows physicians to more easily receive and reply to queries, which results in better and timely responses from physicians.
automated
complete
legible
precise
38. A physician lists “viral pneumonia” as the final diagnosis. However, the coder notes that laboratory results state “gram-negative bacteria.” There is also documentation of chest pain, fever, and dyspnea due to pneumonia. What should the coder do?
Assign a code to the final diagnosis of viral pneumonia
Code bacterial pneumonia, chest pain, fever, and dyspnea
Query the physician regarding the diagnosis of pneumonia
Report symptom codes for chest pain, fever, and dyspnea
39. The purpose of a clinical documentation improvement (CDI) program is to help health care facilities comply with government programs and other initiatives with the goal of improving health care quality. Thus, a CDI specialist initiates concurrent and retrospective reviews of inpatient records to identify __________ provider documentation.
abusive and fraudulent
conflicting, incomplete, or nonspecific
illegible physician queries and
redacted health insurance claims and
40. A coding compliance program ensures that the assignment of codes to diagnoses, procedures, and services follows established coding guidelines, and health care organizations write policies and procedures to assist in implementing the coding compliance stages of __________.
detection, correction, prevention, verification, and comparison
portability, continuity, and combating waste, fraud, and abuse
legibility, completeness, clarify, consistency, and precision
unbundling, upcoding, overcoding, jamming, and downcoding
41. An effective coding compliance program monitors coding processes for __________.
completeness, reliability, validity, and timeliness
diagnostic/management, therapeutic, and education plans
record formats, whether automated or manual
reporting hospital data for health data collection
42. Computer assisted coding uses software to automatically generate __________ by “reading” transcribed clinical documentation provided by health care practitioners.
data entry
insurance claims
medical codes
validation/audit reviews
43. A patient record is the business record for a patient encounter that documents __________.
encounter forms data sent to third-party payers
inaccurate information that cannot be altered
health care services provided to a patient
insurance claims submitted to health care plans
44. Demographic data is patient identification information that is collected according to facility policy and includes information such as the __________.
insurance claim submitted
medical codes reported
patient’s date of birth
quality of patient care
45. The primary purpose of the record is to provide for __________.
facility medicolegal interests
health care reimbursement
patient continuity of care
quality review studies
46. A secondary purpose of the patient record is to __________.
assist in planning patient care
evaluate patient quality of care
provide patient continuity of care
serve as a communication method
47. Patient record documentation must be __________.
dated and authenticated by the responsible provider
evaluated prior to patient discharge from the facility
provided to third-party payers for reimbursement
stored using an automated electronic record format
48. A teaching hospital is engaged in an approved graduate medical education __________ program in medicine, osteopathy, dentistry, or podiatry.
health care
medicolegal
residency
third-party
49. Residents are supervised by a(n) __________ physician during patient care.
admitting
attending
responsible
teaching
50. Which type of physician participates in an approved GME program?
emergency
resident
51. A hospitalist is a physician whose practice emphasizes providing care for hospital __________, and they are often internal medicine specialists who handle a patient’s entire admission process.
clinic patients
ED patients
inpatients
outpatients
52. For medical necessity purposes, the patient record must support codes submitted for third-party payer reimbursement, and patient diagnoses must __________.
evaluate the quality of patient care received in the health care facility
justify diagnostic and/or therapeutic procedures or services provided
provide clinical evidence for a higher degree of specificity or severity
serve the medicolegal interests of the patient, facility, and providers of care
53. Which type of record is paper based?
hybrid
manual
systematized
54. Which type of record uses computer technology?
55. Patient records that consist of handwritten progress notes and automated laboratory results are an example of __________ records.
56. In a source-oriented record, reports are organized according to __________ in labeled sections.
documentation source
procedures and services
reimbursement type
57. Which is a systematic method of documentation that consists of four components: database, initial plan, problem list, and progress notes?
integrated record
problem-oriented record
sectionalized record
source-oriented record
58. Chief complaint, social data, and past medical history are considered part of the problem-oriented record __________.
database
initial plan
problem list
progress note
59. The table of contents for the problem-oriented record is called the __________, and it is filed at the beginning of the record and contains a numbered list of the patient’s problems, which helps to index documentation throughout the record.
60. The problem-oriented record __________ contains the strategy for managing patient care and any actions taken to investigate the patient’s condition and to treat and educate the patient.
61. Which is documented about each problem assigned to the patient, using the SOAP structure of the problem-oriented record?
62. To learn more about the patient’s condition and the management of the conditions, review the __________ plans in the problem-oriented record.
diagnostic/management
follow-up
patient education
therapeutic
63. To determine how the patient will be informed about conditions for which he or she is being treated, review the __________ plans in the problem-oriented record.
64. To learn more about specific medications, goals, procedures, therapies, and treatments used to treat the patient, review the __________ plans in the problem-oriented record.
patient education
65. Observations about the patient’s physical findings or lab results would be found in the __________ portion of a problem-oriented SOAP note.
assessment
objective
plan
subjective
66. The patient’s statement about how he or she feels would be found in the __________ portion of a problem-oriented SOAP note.
67. The judgment, opinion, or evaluation made by the health care provider would be found in the __________ portion of a problem-oriented SOAP note.
68. Diagnostic, therapeutic, and education plans to resolve the problems would be found in the __________ portion of a problem-oriented SOAP note.
69. The progress notes section of the POR contains a(n) __________ note to summarize the patient’s care, treatment, response to care, and condition on release from the facility.
discharge
transfer
70. The progress notes section of the POR contains a(n) __________ note when the patient is relocated to another facility, and it summarizes the reason for admission, current diagnoses and medical information, and reason for relocation.
71. Integrated record reports are arranged in strict chronological date order (or in reverse date order), which allows for __________, and many facilities integrate only physician and ancillary services progress notes, which require entries to be identified by appropriate authentication.
collection of information by a number of providers at different facilities about a patient
linking of information created at different locations using a unique patient identifier
observation about how the patient responds to treatment based on test results
summarization of patient care, treatment, response to care, condition on discharge
72. The electronic health record is a(n) __________.
summarization of patient care, treatment, response to care, and condition on discharge
73. The electronic medical record is a(n) __________.
created using vendor software, which also assists in provider decision making
linking of information generated at different locations using a unique patient identifier
practice management software solution for acute and long-term care hospitals
74. Optical disk imaging provides an alternative to traditional microfilm or remote storage systems because patient records are __________.
converted to an electronic image and saved on storage media
linked using a unique patient identifier assigned by the government
paper-based solutions for facilities that cannot afford automated records
stored on computers at regional health care centers in each state
75. Which is used during the document imaging process to create images of patient reports?
index
jukebox
optical disk
scanner
76. During the optical disk imaging process, each patient report is __________ with a unique identification number assigned by the facility.
documented
indexed
scanned
tabulated
77. Which is used in conjunction with the document imaging process to store optical disks?
78. Which is performed by health care facilities and providers for the purpose of administrative planning, submitting statistics to state and federal government agencies, and reporting health claims data to third-party payers?
health data collection
provider documentation
reimbursement processing
statistical analysis
79. Automated case abstracting software is used by hospitals to __________.
collect data for statistical analysis
generate accounting aging reports
register patients for encounters
schedule patient appointments
80. The UB-04 claim is submitted by __________ to health plans for reimbursement purposes.
departments of health
hospitals
physician offices
third-party payers
81. The CMS-1500 claim is submitted by __________ to third-party payers for processing.
government agencies
82. Medical management software is used to _____.
automate physician office workflow
collect hospital data for analysis
generate patient satisfaction surveys
process UB-04 outpatient claims
Match each statement of purpose with the reference/resource listed below.
Conditions of Participation and Conditions for Coverage
CPT Assistant and HCPCS Assistant
National Correct Coding Initiative
Outpatient Code Editor with APCs
e.
Coding Clinic for HCPCS Level II
83. Medicare regulations (Centers for Medicare and Medicaid Services)
84. Software used by hospitals to help identify CPT/HCPCS coding errors
85. Monthly newsletter published by AMA as an official coding resource
86. Quarterly newsletter published by AHA as an official coding resource
e
87. Code edits pairs” that cannot be reported on the same claim for payment
Match each illegal coding practice with the correct term listed below.
Downcoding
Jamming
Overcoding
Unbundling
Upcoding
88. Reporting multiple CPT codes to increase reimbursement when a combination code should be reported
89. Reporting codes for associated signs and symptoms in addition to an established diagnosis
90. Routinely assigning lower-level CPT codes as a convenience instead of reviewing documentation and the coding manual to determine the proper code to be reported
91. Routinely assigning an unspecified ICD-10-CM disease code instead of reviewing the coding manual to select the appropriate code number
92. Reporting codes that are not supported by documentation in the patient record for the purpose of increasing reimbursement
Match each credential with the corresponding credentialing organization listed below.
AAMA
AAPC
AHIMA
AMBA
NEBA
93. CCS
94. CHRS
95. CMA
96. CPC
97. CMRS
Match each description with the type of code set listed below.
large code set
small code set
98. Actions related to disease impairment management, prevention, and treatment
99. Causes of injury, disease, impairment, or other health-related problems
100. Diseases, injuries, impairments, other health-related problems and their manifestations
101. Race, ethnicity, type of facility, and type of unit
102. Substances, equipment, supplies, or other items
103. Which provides normalized names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software?
NDC
NLM
NTF-RT
RxNorm
104. Which classifies health and health-related domains that describe body functions and structures, activities, and participation and complements ICD-10, looking beyond mortality and disease?
DSM
HIPPS
ICD-O-3
ICF
105. Which was implemented in 2001 to classify a tumor according to primary site (topography) and morphology (histology, behavior, and aggression of tumor)?
ICD-9-CM
106. Which is published by the American Psychiatric Association and contains diagnostic assessment criteria used as tools to identify psychiatric disorders?
HCPCS
ICD
107. Which provides a new standardized framework and a unique coding structure for assessing, documenting, and classifying home health and ambulatory care?
Alternative Billing Codes
ambulatory payment classifications
Clinical Care Classification System
diagnosis-related groups
108. Which is an electronic database and universal standard that is used to identify medical laboratory observations for the purpose of clinical care and management?
CCC
LOINC
SNOMED
UMLS
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