Missed Practice Questions

Question 1

What organization is responsible for updating procedure classification of ICD-10-PCS?

Answer 1

Centers for Medicare and Medicaid Services (CMS)

Question 2

In ICD-10-CM, a condition that is produced by another illness or an injury and remains after the acute phase of the illness or injury is called?

Answer 2

Sequela

Question 3

What does the forth character of an ICD-10-CM diagnosis code capture?

Answer 3

Etiology

Question 4

If a procedure is performed on a body part that does not have a specific value in ICD-10-PCS, what two resources can be used to identify the correct body part character to assign?

Answer 4

ICD-10-PCS alphabetic index and ICD-10-PCS body part key

Question 5

What are the purposes and goals of ICD-10-PCS?

Answer 5

Improve accuracy and efficiency of coding; Reduce training efforts; and Improve communication with physicians

Question 6

The assignment of a diagnosis code is based on what?

Answer 6

The providers statement that the patient has a particular condition

Question 7

What does Medicare require to identify a wound closed with tissue adhesives?

Answer 7

A Level II HCPCS code

Question 8

What type of hospital is excluded from Medicare inpatient prospective payment system?

Answer 8

Children’s hospitals

Question 9

What hospital is not reimbursed according to the Medicare outpatient prospective payment system?

Answer 9

Critical access hospitals

Question 10

What form would a health record technician use to perform the billing function for a physician’s office?

Answer 10

CMS-1500

Question 11

When a provider accepts assignment, this means the ….?

Answer 11

Provider agrees to accept as payment in full the allowed charge from the fee schedule

Question 12

What is the goal of coding compliance?

Answer 12

To reduce liability in regards to fraud and abuse

Question 13

What are NCCI automated prepayment edits based on?

Answer 13

Coding conventions defined in CPT book; National and local policies and coding edits; and analysis of standard medical and surgical practice

Question 14

What is the NCCI editing system used in processing OPPS claims called?

Answer 14

Outpatient code editor (OCE)

Question 15

Denials of outpatient claims are often generated from what edits?

Answer 15

National Correct Coding Initiative (NCCI); Outpatient code editor (OCE); and national and local policies

Question 16

What are essential data elements for healthcare insurance claims?

Answer 16

Revenue code; Procedure name; and Provider name

Question 17

CMS has made significant advances to link quality to reimbursement using …… programs, which provide accountability by healthcare providers?

Answer 17

Value-based purchasing (VBP)

Question 18

What is the pre-MDC assignment based on?

Answer 18

A defined set of ICD-10-PCS procedures

Question 19

What is the government sponsored program that provides expanded coverage of many healthcare services including HMO plans, PPO plans, special needs plans, and Medical Savings accounts?

Answer 19

Medicare Advantage

Question 20

What system reimburses hospitals a predetermined amount for each Medicare inpatient admission?

Answer 20

MS-DRG

Question 21

What did CMS implement in 2004 to provide fair and accurate payments while rewarding efficiency and high-quality care for Medicare’s chronically ill population?

Answer 21

Hierarchical condition categories (CMS-HCCs)

Question 22

Reviewing the health record for missing signatures, missing medical reports, and ensuring that all documents belong in the health record is an example of what type of review?

Answer 22

Quantitative

Question 23

What is a defining characteristic of an integrated health record format?

Answer 23

Components are arranged in strict chronological order

Question 24

What is a goal of a CDI program?

Answer 24

Identify and clarify missing, conflicting, or nonspecific physician documentation related to diagnoses and procedures

Question 25

What doe using uniform terminology improve?

Answer 25

Data reliability

Question 26

What is a record of all transactions in the computer system that is maintained and reviewed for unauthorized access called?

Answer 26

Audit trail

Question 27

Who issues compliance program guidance?

Answer 27

OIG (Office of the Inspector General)

Question 28

The charge description master coordinator's tasks include planning for a review of payment system rules and ....?

Answer 28

Incorporation of CMS rule changes into the CDM

Question 29

What was created in 2009 to prevent waste, fraud and abuse, reduce healthcare costs, and improve the quality of care provided to Medicare patient?

Answer 29

The Health Care Fraud Prevention Team (HEAT)

Question 30

What are the two types of queries used in clinical documentation integrity?

Answer 30

Paper and electronic

Question 31

What is a misrepresentation that an individual knows to be false and knows could result in an unauthorized benefit to some other person an example of?

Answer 31

Fraud

Question 32

What is used by some healthcare organizations to extract information for research and reimbursement purposes from an electronic health record?

Answer 32

Computer-assisted coding

Question 33

What is the legal term used to define the protection of health information in a patient-provider relationship?

Answer 33

Confidentiality

Question 34

Where are online transactions processed?

Answer 34

Clinical data repositories

Question 35

What law was issued by the Office of National Coordinator for health information technology to be a resource to the nation as a vision and reference?

Answer 35

Federal Health Information Technology Strategic Plan 2015-2020

Question 36

What system requires the author to sign into the system using a user ID and password to complete the entries made?

Answer 36

Electronic signature authentication

Question 37

When a patient is seen by a new or different provider over the course of treatment for a pathological fracture, assignment of the seventh character is based on what?

Answer 37

Whether there is a complication in the healing process (malunion, nonunion, sequelae, etc)

Question 38

What is each HCPCS code assigned that establishes how a service, procedure, or item is paid in the outpatient prospective payment system (OPPS)?

Answer 38

Payment status indicator (SI)

Question 39

What is the basic formula for calculating each MS-DRG hospital payment?

Answer 39

Hospital payment= MS-DRG relative weight x hospital base rate

Question 40

What are the possible add-on payments that a hospital could receive in addition to the basic Medicare DRG payment?

Answer 40

Additional payments may be made to disproportionate share hospitals for indirect medical education, new technologies, and cost outlier cases

Question 41

What is the name of the national program to detect and correct improper payments in the Medicare fee-for-service (FFS) program?

Answer 41

Recovery audit contractors (RACs)

Question 42

What should a hospital refer to if they need to know how much Medicare paid on a claim so they can bill the secondary insurance?

Answer 42

Remittance advice

Question 43

A fee schedule is ....?

Answer 43

Developed by third-party payers and includes a list of healthcare services, procedures, and changes associated with each

Question 44

If a provider believes a service may be denied by Medicare because it could be considered unnecessary, the provider must notify the patient before the treatment begins using what form?

Answer 44

Advance beneficiary notice (ABN)

Question 45

What is the name of the criteria potential organ donors must meet?

Answer 45

United Network of Organ Sharing (UNOS)

Question 46

Statements that define the performance expectations and structures or processes that must be in place are called what?

Answer 46

Standards

Question 47

What organization is not an accrediting body for behavioral healthcare?

Answer 47

American Psychological Association

Question 48

What type of organization works under contract with CMS to conduct Medicare and Medicaid certification surveys for hospitals?

Answer 48

State licensure agencies

Question 49

What component of the revenue cycle is responsible for determining the appropriate financial class for the patient?

Answer 49

Pre-claims submission

Question 50

Who are the government inspectors whose mission is to reduce Medicare improper payments through the detection and collection of overpayments, identification of underpayments, and implementation of activities to prevent future improper payments?

Answer 50

Recovery audit contractors (RACs)

Question 51

Computer assisted coding can help prevent fraudulent coding and ensure complete, consistent coding due to what?

Answer 51

Natural language processing

Question 52

What is the biggest threat to data security?

Answer 52

People

Question 53

Each state has ...... that may include specific requirements for content, format, retention, and use of patient records.

Answer 53

Licensure regulations

Question 54

What is the best reference tool to determine how CPT codes should be assigned?

Answer 54

American Medical Association's CPT Assistant newsletter

Question 55

The Office of Inspector General's (OIG) Compliance Program for Hospitals recommends that hospitals appoint a cheif compliance officer and .....?

Answer 55

Establish a compliance committee

Question 56

What is the best reference tool for ICD-10-CM and ICD-10-PCS coding advice?

Answer 56

AHA's Coding Clinic for ICD-10-CM/PCS

Question 57

Two Medicare patients were hospitalized with pneumonia. One patient was hospitalized for three days, the other for 30 days. Both cases result in the same MS-DRG with different lengths of stay. How will the hospital be reimbursed?

Answer 57

The hospital will receive the same reimbursement for the same MS-DRG regardless of the length of stay

Question 58

What condition fails to meet the CMS classification of a hospital-acquired condition?

Answer 58

Gram-negative pneumonia

Question 59

What is the maximum number of ambulatory payment classifications (APCs) that may be reported per outpatient encounter?

Answer 59

There is no maximum number. It's unlimited

Question 60

The physician has signed a statement that all of her dictated reports should be automatically considered approved and signed unless she makes corrections within 72 hours of dictating. What is this called?

Answer 60

Auto-authentication

Question 61

What type of data is exemplified by the insured party's member identification number?

Answer 61

Financial data (includes details about patient's occupation, employer, and insurance coverage)

Question 62

What is the type of master patient index (MPI) matching algorithm that assigns weights to specific data elements and uses the weights to compare one record to another?

Answer 62

Rules-based

Question 63

Two patients were assigned the same health record number. What is this an example of?

Answer 63

Overlay

Question 64

Reviewing the health record for missing signatures, missing medical reports, and ensuring that all documents belong in the health record is an example of what type of analysis?

Answer 64

Quantitative (looks for the presence of documents and signatures)

Question 65

What federal fraud and abuse law prohibits a physician's referral of designated health services for Medicare and Medicaid patients if the physician has a financial relationship with the entity?

Answer 65

Stark Law (Physician Self-Referral Law; prohibits physicians from referring patients to a business in which they are a member)

Question 66

What program has been in place in hospitals for years and has been required by the Medicare and Medicaid programs and accreditation standards?

Answer 66

Quality improvement

Question 67

Charge description master (CDM) software is primarily designed to continuously apply edits to point out compliance issues, check validity of CPT and revenue codes and .....?

Answer 67

Identify item pricing

Question 68

Dr. Smith dictated his report and then immediately edited it. What type of speech recognition is being used?

Answer 68

Front-end

Question 69

A valid authorization for disclosure of information requires what?

Answer 69

An expiration date or event; Must have enough information to identify the patient

Question 70

The right of an individual to keep his or her personal information from being disclosed to anyone is a definition of what?

Answer 70

Privacy; the right of an individual to be left alone; includes freedom from observation or intrusion into one's private affairs and the right to maintain control over certain personal and health information

Question 71

According to the Joint Commission Accreditation Standards, which document must be placed in the patient's record before a surgical procedure may be performed?

Answer 71

Report of history and physical examination

Question 72

External clinical validation audits are typically conducted on Medicare patients' health records by who?

Answer 72

Recovery audit contractors (RACs)

Question 73

What are the two types of physician queries?

Answer 73

Open-ended and multiple-choice

Question 74

The inpatient clinical documentation integrity process can be divided into three main functions; query for documentation clarification, physician education and what?

Answer 74

Record review