INSURANCE CODING FINAL

Question 1

ICD-9-CM is updated how often?

Answer 1

every year on October

Question 2

Worker’s compensation cases are kept open for how long from the last date of service?

Answer 2

2 years from the last date of treatment

Question 3

Is the data bank that lists all active and retired military service members called Manage Care? Why?

Answer 3

No, it is called DEERS ( defense enrollment eligibility reporting system)

Question 4

When parents are divorced or separated, whose insurance is usually considered the primary plan?

Answer 4

Whoever has legal custody

Question 5

An insurance card proves that a patient has insurance coverage?

Answer 5

No, eligibility need to be verified through the automated system using point of service or online in California

Question 6

The statute of limitations for minors is extended until what age?

Answer 6

Legal age in all states

Question 7

A V-code describes what?

Answer 7

A condition other than illness

Question 8

An E-code is used to identify what?

Answer 8

Identifies an accident

Question 9

What volume of ICD-9-CM would you use to code inpatient services?

Answer 9

Volume 3

Question 10

Medicare Part A is for inpatient services, would the patient have to pay premiums for this coverage?

Answer 10

Usually they do not pay a premium

Question 11

What is indemnity insurance? Can patients chose their own doctors?

Answer 11

A fee-for-service with annual deductible and copay; yes patients can choose their own doctor and pay portion of the fees

Question 12

Where would you find the rules and regulations governing health insurance and coding?

Answer 12

Federal register

Question 13

Which claim form would be submitted to the insurance company using ICD and CPT codes?

Answer 13

CMS 1500

Question 14

What are the methods for sending electronic claim to the insurance company or clearinghouse?

Answer 14

Dial up modem, over the internet, and direct data entry

Question 15

The Department of Veterans Affairs manages which healthcare program?

Answer 15

CHAMP VA

Question 16

What is an explanation of benefits?

Answer 16

a statement receive from the insurance check and explained how payment was made

Question 17

give four examples of Medical fraud

Answer 17

Dispensing generic drugs and billing for brand name drugs, bribery, false cost reports, and giving or accepting something in return for medical services (kickback)

Question 18

list four services a state must provide to receive federal matching funds for Medicaid.

Answer 18

inpatient care, outpatient care, hospital care, and physical therapy

Question 19

what is COBRA?

Answer 19

it provides possible continuation of health insurance coverage’s through a previous employer when a worker leaves a job

Question 20

what is commercial insurance?

Answer 20

any kind of insurance not paid by the government

Question 21

what is a waiver?

Answer 21

form that the doctor has the patient sign to acknowledge financial responsibility when the patient insist on receive treatment not covered by their insurance

Question 22

what federal act protects civil rights of disabled individuals?

Answer 22

Federal act of 1990 of ADA

Question 23

who issues a NPI number for physicians?

Answer 23

center of medicare and Medicaid (CMS)

Question 24

which agency handles the claims and payments for self-funded insurance plans?

Answer 24

third party administrator

Question 25

which volume of ICD-9-CM contains the alphabetic index?

Answer 25

volume 2

Question 26

Medicaid is insurance that covers what category of patients?

Answer 26

Medically needy

Question 27

what do the OCR guidelines consist of?

Answer 27

Month, day, year, upper case, no punctuation, cannot send a copy of the claim

Question 28

when using multiple modifiers in coding, which modifier would you use first?

Answer 28

-99

Question 29

Which HMO model allows patient's to go outside and see any provider they choose?

Answer 29

point of service

Question 30

worker's compensation benefits would include what type of coverage for patient's?

Answer 30

Disability payments, medical cost, and vocational rehabilitation

Question 31

after finding a code in the alphabetic index of the ICD-9-CM, you should cross-reference the coding by checking what?

Answer 31

tabular list

Question 32

who pays the premiums for worker's compensation?

Answer 32

the patients employer

Question 33

which insurance is more expensive, individual or group insurance?

Answer 33

individual

Question 34

can providers balance bill Medicaid patients for any cost of treatment after their insurance pays for services?

Answer 34

no

Question 35

what is one of the advantages of having group insurance through your employer, union, etc?

Answer 35

everyone is eligible for coverage no matter what their health status is

Question 36

does the date of service refer to the date the charges are posted to the patients account?

Answer 36

no the date of service is when the patient was provided the services

Question 37

are the usual, customary and reasonable fees of physician the same or different from the healthcare provider' actual charges?

Answer 37

they may be different from the health care providers charges

Question 38

an allowable charge is the maximum that who will pay for the particular procedure or service?

Answer 38

third party payers

Question 39

what does ICD-9-CM stand for?

Answer 39

international classification of diseases, ninth revision, clinical modification

Question 40

what does HCPCS stand for?

Answer 40

health care common procedure coding system

Question 41

what does CPT stand for?

Answer 41

current procedural terminology

Question 42

how many sections are in the CPT?

Answer 42

6

Question 43

the codes most frequently used in the CPT manual are?

Answer 43

evaluation and management

Question 44

define outpatient:

Answer 44

not officially admitted, staying less than 24 hours

Question 45

do you only need to code from the alphabetic index in the ICD-9? Why?

Answer 45

no, confirm your code in the tabular list

Question 46

can V codes be used as the primary diagnosis?

Answer 46

yes

Question 47

can E codes be used as the primary diagnosis?

Answer 47

no

Question 48

how many digits are ICD-9 codes?

Answer 48

5th digit used whenever possible

Question 49

how many digits are CPT codes?

Answer 49

5

Question 50

when coding an unlisted procedure, what must be attached to the claim?

Answer 50

special report

Question 51

managed care insurance plans usually require what before a patient can be referred to a specialist?

Answer 51

referral report

Question 52

define deductible:

Answer 52

a specific amount of money that must be paid each year before the policy benefits begin

Question 53

define crossover claim:

Answer 53

claim that automatically forwards from one plan to another

Question 54

define an eligible patient:

Answer 54

a patient that has current coverage with an insurance claim

Question 55

define a dependent under an insurance plan:

Answer 55

person covered under the subscribers plan

Question 56

define pre-existing condition:

Answer 56

a condition test that existed and treated before the insurance policy is issued

Question 57

define exclusion:

Answer 57

injury or illness that is excluded from the policy

Question 58

is Medicare only for retired person age 65 and older? Why?

Answer 58

No, also for certain individuals who are disabled at any age with end stage renal disease, permanent kidney disorders, and required dialysis or transplant

Question 59

when coding from the ICD-9-CM in a doctor's office, which volumes should you use?

Answer 59

Volumes 1 & 2

Question 60

what is another name for the CMS-1500 claim for?

Answer 60

universal claim form

Question 61

what is the birthday rule?

Answer 61

when both parents have insurance, it determines that a parent whose bday falls first in the calendar year is the primary insurance

Question 62

ICD-9 identifies:

Answer 62

diagnosis

Question 63

CPT identifies:

Answer 63

procedures

Question 64

which codes have a modifier?

Answer 64

CPT

Question 65

why do we use standard coding systems to report diagnosis and procedures?

Answer 65

to facilitate payment from third party payers

Question 66

is the secondary insurance billed first?

Answer 66

no, the primary is billed first

Question 67

which claim form is used to bill medicare?

Answer 67

CMS-1500