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107 Cards in this Set

  • Front
  • Back
The creation of an opening of a portion of the colon through the abdominal wall to an outside surface is called a(n):

A physician suspects that his patient , Mr. Jones, may have bladder cancer. He wants to visually examine Mr. Jones' bladder. This procedure is called a(n):

Three year old Alyssa Walker was referred to an endocrinologist by her pediatrician with symptoms of chronic respiratory infections, pancreatic insufficiency, and a growing intolerance to heat. The endocrinologist plans to order a series of tests including a sweat test, hoping to rule out a hereditary disorder called:

Cystic Fibrosis
When a thrombus travels through the vascular system, it is called a(n):

A leiomyoma is a tumor of the:

Smooth Muscle
A patient is prescribed albuterol. The patient has been experiencing SOB during times of stress and during exercise. When this occurs, audible wheezing is another sign. Which of the disorders listed below could be the medical term to describe this patient's medical condition?


Karen Davis presents to the ED with severe abdominal pain. It is determined after laboratory and ultrasound testing that she has an abdominal pregnancy. This type of pregnancy could also be termed as:


An allergic reaction of the skin that is manifested by the presence of hives is called:

The removal of foreign material, dead tissue, or damaged tissue is called:


SPECT, PET, MRI, and CT scan are all types of:

Radiology Procedures

Which group of organs listed below is associated with the lymph system?

Spleen, Thymus Gland, and Tonsils

The formed elements of plasma include:

Thrombocytes, Erythrocytes and


Which organ listed below is known as the "master gland"?


Which of the following is the first part of the small intestine?


Melanin is produced by the skin epithelial cells called melanocytes. Where are melanocytes located?

Stratum Basale

Which of the following structures is part of the lower respiratory tract?

The large arteries of the human cardiovascular system have three layers. What is the function of arteries?

Carry blood from the heart to the body cells

The axial skeleton is composed of:

Skull, Rib Cage and

Vertebral Column

Nephrons are present in kidney tissue. What is the function of nephrons?

Maintaining homeostasis by regulating water, salts and glucose
Which of the following is an internal structure of the female reproductive system?


What is the name used to identify medical coding software? The software assists in the assignment of ICD-10-CM and/or HCPCS codes.


What is the definition of the acronym LAN?
Local Area Network
Which group listed below are input devices?
Keyboards, Scanners, Pointing Devices, and Light Pen

What is the acronym used to define a health record that is stored in a digital format and is accessible to providers and health care professionals via computer software? This format is able to record and have medical data entered into it for updating medical events and as a record of care.


What is the term given to a computerized information station that allows facility visitors and patients to access information on health-related topics or a map of the facility?

Information Kiosk

What federal legislation details provision for the transmission of health data electronically?

What is the acronym given to a group or network in a community or region that is sharing clinical information? This group may not be within the same health care facility or hospital.

Virus protection software and data recovery software are considered what type of computer programs?

Utility Programs

Which of the following is a secondary storage device?

All of the above

Which of the following is correct for defining an intranet?

An intranet is a network that works like the Internet but is limited to certain people (e.g., company employees)

What is the definition of the acronym ISP?
Internet Service Provider

Which website address below is the correct onr for the Centers for Medicare and Medicaid Services?
What is the definition of the acronym FTP?
File Transfer Protocol
What is the definition of the acronym ASCII?

American Standard Code Information Interchange
Which of the following codes is from the E/M section of CPT?

CPT code 47550 has a plus sign (+) in front of it; this means that:
This procedure is an add-on code

If a patient has CPT code 99205 circled on his encounter form, that means that the patient was seen:

In the Office
What level of exam is required for a 99215 E/M code to be assigned?


Code 4013F is what type of CPT code?

Category II
What is a clearinghouse?

A company that processes paper claims into electronic claims
What is an advantage of a value-added network (VAN)?
Efficiency and less cost to the provider

What agency can providers check with to see if a clearinghouse is accredited?

What is the third stage of a claim's life cycle?


What federal legislation mandated national standards for electronic data?
A CMS-1500 claim must be converted into what type of file for electronic processing?

Electronic Flat File
Which of the following would be performed during the claim adjudication process?
The claim is screened to ensure that it is not a duplicate claim

Which item would result in the denial of a claim?

Noncovered benefit

Which definition best describes a claim attachment?

An authorization letter from the insurance company

What is the difference between an extranet claims submission and internet claims submission?

If using an extranet, the provider can access information about payers and various data elements on a claim.

Which statement could be listed in Box 12 of the CMS-1500 claim?

Signature on File

If a procedure is done multiple times during an office visit, how is this reflected on the CMS-1500 claim?
Number of units is completed in Box 24G

CMS-1500 claims are designed for

Optical Scanning

What is the unique 10-digit number that identifies a provider and is placed on a CMS-1500 CLAIM?

Where are ICD-10-CM diagnosis(es) code(s) entered on a CMS-1500 claim?

Box 21
The abbreviation for POS
Place of Service

The legal business name of the practice that is entered in Box 33 is called?

Billing entity

What is the maximum number of procedures that can be reported on one CMS-1500 claim?

Which of the following is the correct date pattern to be used in Block 24A on a CMS-1500 claim?

When entering information on a CMS-1500 claim, which of the following statements is true?

When entering a nine-digit zip code, enter the hyphen.
The rule stating that a policyholder whose birth day and month occur earlier in the year is the primary policyholder for dependent children is called the ______ rule.

Which Medicare program is designed to pay for prescription drugs?

Part D

What form is important for Mr. Martin to complete for workers' compensation coverage?

First Report of Injury

To which part of Medicare should the billing specialists submit the claims for Mrs. Wilson's care in this facility?

Part A
For hospital billing, what form is used to file medical claims?
What was the impact of TEFRA on medical billing?

TEFRA required the implantation of PPS systems in the US health care reimbursement arena

What situation may be covered by liability insurance

claim for $100,000 in lost wages

Medicare provides health care coverage to Americans over the age of 65. Medicare is a type of _____________ health plan.

What legislation impacted managed care plans by requiring them to follow reporting and disclosure requirements?


What was the impact of HIPAA on medical billing?

HIPAA has established national code sets, which include ICD-10-CM and CPT
Which of the following is a feature unique to a BCBS plan?

In their negotiated contract with providers, they agree to provide educational seminars on health topics to providers and enrollees.

What is a QMBP? What services does it provide for an individual?

QMBP is a program that provides funds to pay for individuals' Medicare Part A & Part B premiums.

What has replaced the EOMB form from Medicare?

What are the four factors of medical necessity?
purpose, scope, evidence, and value

Which of the following is a managed care option health plan for military officers and their dependents?

Tricare Prime

What is the term used for updated medical information on a patient who is receiving workers' compensation coverage and/or workers' disability coverage?

Progress Report
Which of the following is the insurance program administered by states that expands health care coverage for children?

Which of the following is a typically covered service under Medicare Part B?
DME, ambulatory hospital care and physician services

Which patient could be a Medicare eligible recipient?
A 35-year-old diagnosed with end-stage renal disease

What is the focus of PACE?

To provide community-base services for individuals who require nursing care

Which of the governmental agencies or departments provides compliance program guidelines?

Office of Inspector General

Per the OIG, what is the first step of compliance plan?

Establishment of an audit program for claims review

Which of the following is an important component of a compliance plan?

Establishment of a reporting method for employees to report alleged compliance violations
Which of the following was established to provide CPT coding information, especially on the issue of unbundling?

What is meant by the term upcoding?

Submitting a claim for a level of reimbursement that is not documented in the health record
Accreditation by The Joint Commission or another health care agency is


Per OIG compliance guidelines for small group physician practices, which statement is true?

Conduction of audits internally is recommended

What is a focus of the OIG work plan?

Duplicate patient claims

What is meant by the term unbundling?

Separating the components of a surgical procedure into multiple CPT codes when it should have been billed under one CPT code
What federal legislation governs improper billing practices?


Peer Review Organizations, which are contracted by CMS to perform claim audits, are now known as:

Which of the following could be considered abuse under the False Claims Act?
E/M documentation in patient record that agrees with CPT code level billed to CMS only 2.5 percent of the time
Which of the following could be considered fraud under the False Claims Act?

Submission of claims for office visits that were not rendered

Which health care provider system or employer has the largest settlement to date under the False Claims Act?


Which website address is correct to report suspected Medicare fraud?

The simplified ____________ billing process was developed to enable Medicare beneficiaries to participate in mass PPV and influenza virus vaccination programs offered by public heath clinics and other entities that bill Medicare payers.
What is a Medicare Ombudsman?

an individual who works with Medicare beneficiaries to provide them with information on their options under the Medicare system
Qui tam is a legal phrase that relates to:

the Federal False Claims Act

What is the definition of UCR?
Uncovered, Costly and Reasonable

There are three major types of managed care plans; one of them is a point-of-service plan. What are the other two major types?
Which of the following is a component of an HMO?
PCP as gatekeeper

What is an actuarial calculation?

Calculation used to determine the managed care companies' rates and premiums

How can relative value units be used by physician practice management?
To compare physician performance within a group practice

What is a Management Service Organization?
A company owned by a hospital or physician practice that provides administrative and managerial services

Which of the following is a component of a health risk appraisal?

Personal and family health history of an enrollee

When employees have the opportunity to choose which benefit(s) they want under an employer sponsored plan, this is called a(n):
Cafeteria plan

What is the purpose of underwriting?

Assumption of risk

What best describes the role of a case manager?

to coordinate care for a patient by working with doctors and insurance for a plan that meets the patient's needs based on medical necessity