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What is the table that contains a classification of substances for identifying poisoning states and external causes of adverse effects?

Table of drugs and Chemicals

E codes are used

to show external cause of injury

The term "malignant" in relationship to blood pressure means

Life threatening

CPT publication is updated and revised

annually

Largest section of the CPT book is the

Surgery section

What is the name of the book used in the physician's office to code procedures?

Current Procedural Terminology CPT

Carcinoma in situ is used to describe

cancer that is confined to the site of origin

A working knowledge of ______________ and a course i anatomy and physiology are essential to becoming a topnotch coder of diagnoses

Medical Terminology

Diagnostic codes have from _______ to ______digits

3 to 5

CPT uses a basic ______ digit system for coding services PLUS a _______digit add on modifier

5 and 2

Insurance companies go by the rule "if it is not documented, then it was not

done or performed

Coding and billing numerous CPT codes to identify procedures that are usually described by a single code is called

Unbundling

Deliberate manipulation of CPT codes for increased payment is called

upcoding

A term used as the name of a disease, structure, operation, or procedure usually derived from the name of a place or person who discovered or described it first is called a/an

eponym

Name 6 basic location methods to locate main terms in the index CPT

Service, procedure, anatomic site, disease, synonym, eponym, abbreviation

Medical etiquette refers to

consideration for others

Reporting incorrect information to private insurance carriers is considered

unethical

AHIMA publishes

Diagnostic and procedure training code books and diagnostic coding and reporting requirements

Why are multi-skilled health practitioners MSHP in demand

They are cross trained to provide more than one function
They are often competent in more than one discipline
They offer more flexibility to their employer

Medical ethics include

Standard of conduct

A self employed medical insurance biller that does independent contracting is responsible for

advertising
billing
accounting

When an insurance billing specialist bills for a physician and completes a medicare claim form with information that does not reflect the true situation

he/she may be subject to fines and imprisonment

Billing for services or supplies not provided is

Fraud, illegal

A billing practice such as excessive referrals to other providers for unnecessary services is considered

Medical billing abuse

Stealing money that has be entrusted to one's care is know as

embezzlement

Coined term by AHIMA's eHealth Task Force to describe transactions in which health care information is accessed, processed, stored, and transferred using electronic technologies is usually abbreviated as

eHIM (electronic health information management)

Individual designated to help a provider remain in compliance by setting policies and procedures in place, train staff regarding HIPAA, and act as the contact person for questions and complaints

Privacy officer, privacy official

A health care coverage carrier, clearinghouse, or physician who transmits health information in electronic for in connection with transaction covered by HIPAA is called

Covered entity

Who renders medical services, furnishes bills, or is paid for health care in the normal course of business?

Health care provider

3rd Party administrator who receives insurance claims from physician's office, performs edits, and redistributes the claims electronically to various insurance carriers?

Clearinghouse

Who is hired by medical practice to process claims to 3rd party payer?

Business associate

List 5 disciplinary standards resulting from misconduct

verbal warning, written warning, written reprimand, suspension or probation, demotion, termination

Security rule that addresses electronic protected health information is divided into what 3 main sections?

1. Administrative safeguards
2. Technical safeguards
3. Physical safeguards

PHI

Protected Health Information

CMS

Centers for Medicare/Medicaid Services

CAP

Claims Assistance Professional

AHIMA

American Health Information Management Association

AMA

American Medical Association

E codes are used

to show external causes of injury

In locating a diagnosis, look up the main term, which is the

Condition or disease

Reasons for documentation are

Defense of a professional liability claim.
Insurance carriers require accurate documentation that supports procedure and diagnostic codes.

SOAP is

Subjective
Objective
Assessment
Plan

A diseased condition or state is known as

morbidity

According to birth law, if both parents have the same birthday

The hour of birth determines who pays first

What is the correct term to determine if a procedure is covered and medically necessary

Preauthorization

Obtaining and recording patient data before the person's first visit is known as

Preregistration

Discovering the maximum $ amount that the carrier will pay for a procedure is called

predetermination

Criteria used by insurance companies when making decisions to limit or deny payment of medical services or procedures must be justified by the patient's symptoms and diagnosis are called

medical necessity

If husband & wife both have insurance through their employers, and each has added the spouse to their primary insurance plans for coverage. If the wife is seen for treatment then her plan is considered

primary

The Health Insurance Claim Form , also know as universal claim form is often called

CMS-1500

If a professional liability claim is filed by a patient, good____________helps establish a strong defense

documentation

Insurance claim submitted on paper

Paper claim

Insurance claim held in suspense due to review or other reason

Pending claim

Insurance claim that is submitted via a dial-up modem or direct data entry

Electronic claim

Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring

Multi skilled health care practitioners

Claims assistance professional

CAP- works for the consumer, helps patients file insurance claims

In medical practice what is "cash flow"

actual money available to a medical practice

Front office medical duties have become increasingly important because

diagnostic and procedural coding must be review for its correctness and completeness

What level of education is generally required for one who seeks employment as an insurance coder?

Completion of an accredited program for coding certification

What organization published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirement for physician billing

AHIMA American Health Information Management Association

Amount of money an insurance billing specialist earns is dependent on what

knowledge
experience
size of employing institution

billing specialist is entrusted with

holding patients medical information in confidence
collecting monies
being a reliable resource for co-workers

Confidentiality between the physician and the patient is automatically waived when the patient is being dreated in a workers' compensation case

True

A patient has the right to obtain a copy of his/her confidential health information

True

Confidential information includes

Everything that is heard about a patient
everything that is read about a patient
everything that is seen regarding a patient

Non-privileged information about a patient consists of the patient's

City of residence

Confidentiality is automatically waived in cases of

gunshot wound, child abuse, extremely contagious diseases

To bill medicare beneficiaries at a higher rate than other patients is considered

abuse

Electronic media refers to

Leased phone or dial-up phone lines
the internet
transmissions that are physically moved from one location to another

MSHP

Multi skilled health practitioner

What year was CPT first developed and published

1966

CMS-1500

Universal claims form

CMS-1500 is divided into what 2 sections

Patient and physician information

What does bundling mean

Grouping codes that are related to a procedure

When is principal diagnosis applicable

Inpatient Hospital coding

It is advisable to process insurance claims

In batches, grouping claims of patients who have the same type of insurance

An insurance claim register facilitates

follow-up of insurance claims

What does co-morbidity mean?

Underlying diseases or other conditions presnet at the time of the visit

The diagnosis listed first in submitting insurance claims for patients seen in a physician's office is the

Primary diagnosis

The International Classification of Diseases, Ninth Revision Clinical Modification was published by the Department of Health Services in what year

1979

The term "malignant" in relation to blood pressure means

Life threatening

When does the physician/patient contract begin?

When the physician accepts the patient and agrees to treat the patient

Most physician/patient contracts are

Implied

When a patient carries private medical insurance, the contract for treatment exists between

the physician and the patient

An emancipated minor is

a person younger than 18 who lives independently

Who does the contract exist between in a workers compensation case?

The physician and the insurance company

In health insurance the insured is also known as

subscriber
member
policyholder

Assignment of benefits (AOB) is

the transfer of one's legal right to collect an amount payable under an insurance contract

Provider who sends the patient for tests or treatment

Referring physician

provider whose opinion is requested by another physician about evaluation and management of a specific problem

Consulting physician

provider who is the medical staff member legally responsible for the care and treatment given to a patient

Attending physician

Services rendered by a physician whose opinion is requested by another physician for evaluating a patient's illness

Consultation

providing similar services to the same patient by more than one physician on the same day

Concurrent care

Intensive care provided during an acute life-threatening condition that requires constant bedside attention by the provider

Critical care

The Healthcare Common Procedure Coding System HCPCS consists of two levels of codes

True

An E code may never be sequenced in the first position

True

When is the principal diagnosis applicable?

Inpatient Hospital coding

Why was diagnostic coding developed?

For medical research
for evaluation of hospital service use
for tracking of disease processes

PPO

Preferred Provider Organization

What volumes of ICD-9-CM are used in a physicians office

Volumes 1 and 2

Terms enclosed in parentheses following the main term are referred to as

nonessential modifiers

An insurance policy is a legally enforceable agreement called a/an

Contract

The amount that must be paid each year by the insured before policy benefits begin is known as the

deductible

When the insured is required to pay a percentage of the covered services cost, this is referred to as

Co-insurance

Discovering the maximum DOLLAR amount that the carrier will pay for a procedure is called

predetermination

It is the responsibility of the _____or______ to hand write or dictate the documentation for medical transcription

Physician or provider

Most insurance companies perform routine_____on practices with unusual billing patterns or excessive payment amounts

audits

A reference list of all staff members names, job titles, signatures, and their initials is know as the

signature log

CC

Chief complaint

ROS

review of system

What term describes a disease that persists over a long period of time

Chronic

PFSH

Past Family Social History

Concise statement describing the symptoms, problems, conditions, diagnosis, physician-recommended return, or other factors that is the reason for the encounter is abbreviated as

CC

What is "new patient"

one who has not received any professional services fro the physician within the past 3 years

Medical report is

permanent legal document
part of the health record

When patient fails to return for need treatment, documentation should be made

in the patient's medical record
in the appointment book
on the financial record or ledger card

What is "established patient"

one who has previously received professional services from a physician or another physician of the same specialty who belongs to the group practice within the past 3 years

A health record is considered

medical information
a medical record

A large % of reimbursement in the physician's office is generated from 3 party payers

True

You should not give patients the option of asking if they would like to pay now or have a bill sent

True

All accounts older than 120 days should go to a collection agency

False

Insurance claim register provides

follow up procedure for insurance claims

What is the best way to file pending insurance claims for timely follow up

file by service date

Follow up effort made to an insurance company to locate the status of a insurance claim is called

inquiry or
tracer

An insurance claim with an invalid procedure code would be

denied

What should you do if insurance carrier requests information about another insurance carrier

Provide the information

What should be done to inform a new patient of office fees and payment policies

Send a patient information brochure
send a confirmation letter
discuss fees and policies at the time of the initial contact

Professional courtesy means

Making no charge to anyone, patient or insurance company, for medical care

When collecting fees, your goal should always be

collect the full amount

Most common method of payment in the medical office is

personal check

Accounts receivable are aged in what time periods

30-60-90-120 days

Messages included on statements to promote payment are called

Dun messages

Outsourcing means

Employment of a billing service

Collection calls should be placed

after 8 AM and before 9 PM

Which group of accounts would a collector target when they made telephone calls

Accounts older than 120 days

Documentation from private insurance carriers sent to participating providers that accompanies payment and describes the response to a claim is referred to by the acronym

RA-remittance advice

EOB

Explanation of benefits

Delinquent insurance claim may be easily located by reviewing the

Insurance claim registrar

A suspense or follow up file for pending insurance claims is also called

tickler file

overdue payment on an insurance claim is referred to as

Delinquent claims

If medical practice receives more than contracted rate from an insurance claim that is called

overpayment

Credit comes from a Latin word meaning

to believe or to trust

unpaid balance due from patients for services rendered is called

accounts receivable

relationship of amount of $ owed and the amount of $ collected on the accounts receivable is called

Collection ratio

Patients information sheet is also called

Patients registration form

Assets or debts that have been deemed noncollectable are taken off account books as a loss are called

write offs or courtesy adjustment

An amount due listed on patients financial accounting record is referred to as the account

balance

If endorsement on back of check does not match the name on the front this could be a case of

Check forgery

The procedure of systematically arranging the accounts receivable by age from the date of service is called

aging reports

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