A Guided Approach to Intermediate and Advanced Coding (Lame, Young) - Chapter 1.docx

A GUIDED APPROACH TO INTERMEDIATE AND ADVANCED CODING TEST BANK CHAPTER 1: THE ROLE OF THE MEDICAL CODER IN HEALTHCARE MATCHING Directions: Select the word or phrase that best completes each sentence. QUESTION ANSWER ____ is a comprehensive list of eligible charges for an individual provider or healthcare facility. N ____ is software that finds and reports errors in the coding of claims data. G ____ is the degree to which different coding professionals consistently assign the same codes to the same health record. H ____ is the United Nations coordinating authority on international public health. F ____ is the average relative weight of all cases treated at a given healthcare facility that reflects the intensity of the resources utilized. L ____ is the Medicare payment system that reimburses physicians treating Medicare patients. Q ____ is a set of terms used in a particular discipline. B ____ is the term used for a health record for a patient record in a long-term care setting. I ____ is a document created to record a patient’s health and the services received during healthcare visits. T ____ is a series of code edits which identify incorrect CPT-4 code combinations on Medicare Part B claims. M ____ is the mechanism by which a facility or provider ensures that they are providing and billing for services according to the laws, regulations, and guidelines that govern billing and coding practices to prevent fraud and abuse. O ____ is a set of standardized terminology used for a nomenclature. A ____ is a national organization that provides education and professional certification to medical coders in the specialty areas of physician office, hospital outpatient, interventional radiology, and cardiology. R ____ is the cabinet-level federal agency that oversees all of the health and human services activities of the federal government and administers federal regulations. P ____ is the amount of time it takes for the health record to be coded. S ____ is the degree to which a professional coder captures all of the diagnoses and procedures documented by the physician in the health record. E ____ is a software system that assists in providing structure to the data in order to improve outcomes in decision-making tasks associated with nonroutine and nonrepetitive healthcare issues. K ____ is a national organization that focuses on the management of personal health information. J ____ is the degree to which the codes assigned accurately reflect the physician documentation for diagnoses and procedures in an episode of care. C ____ is the health record for patients in a hospital setting. D LIST OF CHOICES Clinical terminology Nomenclature Validity Patient record Completeness World Health Organization Medicare Code Edits Reliability Resident record American Health Information Management Association Decision support system Case-mix index National Correct Coding Initiative Charge description master Compliance plan Department of Health and Human Services Resource-based relative value scale American Academy of Professional Coders (AAPC) Timeliness Health record MULTIPLE CHOICE Directions: Select the word or phrase that best completes each sentence or best answers the question. QUESTION ANSWER The entire healthcare system in the United States is mandated to utilize _______________ exclusively, as of October 1, 2015. EHR ICD-10 HIPAA NCCI A Which of the following is NOT a classification system? CPT NCCI ICD-19-CM ICD-10-PCS B ICD-10-PCS replaced: ICD-9-CM, Volumes 1 and 2. ICD-9-CM, Volume 3. CPT. HCPCS. B Which of the following are examples of PPS? MCE and NCCI RBRVS and CMI MS-DRG and APC CDM and CDT C Two coding professionals who each assign the same codes to the same patient record is an example of: completeness. reliability. timeliness. validity. B The Standards of Ethical Coding are published by: DHHS. WHO. AAPC. AHIMA. D In which healthcare setting do patients receive short-term treatment for severe injuries, acute episodes of illness, and surgical intervention? Hospital acute care inpatient Emergency department Physician office Behavioral healthcare A In which healthcare setting do coders review claims, conduct medical coding accuracy review, and quality review on claims? Ambulatory care Home health Long-term care Insurance companies D Which level of HCPCS codes are copyrighted by the American Medical Association? Level I Level II Level III All levels A Under PPS, ________ is computer software that will assign patients to a specific classification scheme based on the codes the coder assigns. decision support an encoder hard coding a grouper D 3M and QuadraMed are examples of: decision support software. fiscal intermediaries. encoder software. insurance companies. C The official, primary authority reference publication for official ICD-10-CM coding guidelines is: AMA CPT Assistant. National Correct Coding Initiative edits. AHA Coding Clinic. CMS Medicare Code Edits. C An example of a(n) _____ is external cause of morbidity codes wrongfully being utilized as principal diagnosis. MS-DRG MCE NCCI OGCR B The mechanism by which a facility or provider ensures that they are providing and billing for services according to the laws, regulations, and guidelines that govern billing and coding practices to prevent fraud and abuse is: Standards of Ethical Coding. HIPAA. Office of the Inspector General. Corporate Compliance Plan. D Which code set reports physician and nonphysician services such as durable medical goods, drugs, and supplies? CPT HCPCS Level II HCPCS Level III ICD-10-PCS B What entity defines HCPCS Level III codes? CMS AMA FI DHHS C A patient’s inpatient hospital bill for ancillary charged is based on data generated by the: CDM. DRG. MCE. grouper. A What entity maintains the ICD-10-CM Official Guidelines for Coding and Reporting? Coordination and Maintenance Committee Department of Health and Human Services World Health Organization American Hospital Association A NCCI edits apply to: ICD-10-PCS CPT and APC. ICD-10-CM and MS-DRG. ICD-10-PCS and CPT. B What organization is the authority for the United States regarding rules and application of the ICD-10-CM coding system? Coordination and Maintenance Committee AMA CMS WHO C What software detects and flags potential errors in either codes assigned or the billing form prior to the claim being submitted to Medicare? Encoders Groupers APC MCE D What organization approves formal coding programs that may be available online or through traditional educational settings? AAPC AHIMA CAHIIM DHHS B The Certified Coding Specialist (CCS) credential is offered by: AHIMA. AAPC. BMSC. NCRA. A The CTR credential stands for: Certified Therapy Registrar. Certified Tumor Registrar. Coding Technician for Radiology. Cancer Tumor Registrar. B The Certified Professional Coder (CPC) credential is offered by: AHIMA. AAPC. BMSC. NCRA. B Which of the following credentials requires an associate’s degree? CCA CPC CCS-P RHIT D Which of the following organizations is NOT a likely source of employment for a coding professional? Same-day surgery Long-term care Prison Freestanding urgent care C The health record is: the principal repository or storage medium for patient health information. the platform for the electronic collection, storage, and analysis of private patient health information. a clinical database with a patient-specific financial information. the mechanism to which an organization is able to store and retrieve diagnoses and procedure information from databanks. A A coder who fully captures all of the diagnoses and procedures documented by the physician for a particular encounter has met the quality criteria of: reliability. validity. completeness. timeliness. C Ethical standards for coding are: different for inpatient vs. outpatient settings. different for research vs. patient care. different for apprentice vs. fully certified coders. the same for all healthcare settings. D The length of stay of patients in an acute inpatient setting is generally _____ days. 1 - 3 3 - 6 5 - 10 7 - 12 B ______ payment is based on a formula that takes into account the physician’s geographic region, work done, supplies, equipment, overhead, and malpractice insurance. RBRVS APC MS-DRG PPS A Which setting does NOT use PPS? Inpatient hospital Long-term care Physician office Emergency department C A patient with a chronic or debilitating medical problem that makes it impossible for the patient to care for himself/herself in the traditional home setting may be admitted to a(n): ambulatory care facility. home health service. behavioral health facility. long-term care facility. D Which setting does NOT use CPT codes? Acute inpatient hospital Home healthcare Ambulatory care Emergency department A Information is: raw facts and measurements. a set of terms used in a particular discipline. a database of clinical procedures. data in a useful, meaningful form. D Administrative applications for clinical vocabularies include: public health. disease prevention. clinical research. physician credentialing. D The use of specific code sets is required by: CMS. WHO. HIPAA. AMA. C The_____ provides the average relative weight of all cases treated at a given healthcare facility. CMI MS-DRG APC MCE A Which code set is used in inpatient settings ONLY? ICD-10-CM, ICD-10-PCS CPT HCPCS B