Learning Goal: I’m working on a health & medical test / quiz prep and need suppo

Learning Goal: I’m working on a health & medical test / quiz prep and need support to help me learn.ReimbursementName: _____________________________ Chapter 06: ICD-10-CM Coding1. The International Classification of Diseases, published by the World Health Organization, is used to classify __________ data from death certificates.a. moratoryb. morbidityc. morphologyd. mortality2. ICD-10-CM was developed in the United States and is used to classify __________ data from inpatient and outpatient records, including provider-based office records.a. moratoryb. morbidityc. morphologyd. mortality3. ICD-9-CM is a(n) __________ classification system because of ICD-10-CM and ICD-10-PCS implementation.a. contemporaryb. legacyc. optionald. updated4. Physician office __________ codes are submitted for reimbursement purposes.a. ICD-10-CM, CPT, and HCPCS level IIb. ICD-10-PCS, CPT, and HCPCS level II5. Hospital inpatient __________ codes are submitted for reimbursement purposes.a. CPT, and HCPCS level IIb. ICD-10-CM, CPT, and HCPCS level IIc. ICD-10-CM and ICD-10-PCSd. ICD-10-CM, ICD-10-PCS, CPT, and HCPCS level II6. Hospital outpatient __________ codes are submitted for reimbursement purposes.a. CPT and HCPCS level IIb. ICD-10-CM, CPT, and HCPCS level IIc. ICD-10-CM and ICD-10-PCSd. ICD-10-PCS, CPT, and HCPCS level II7. General equivalency mappings are __________ of codes that can be used to roughly identify ICD-10-CM codes for their ICD-9-CM equivalent codes (and vice versa).a. crosswalksb. detailsc. indexesd. registers8. ICD-10-CM codes require up to __________ characters, are entirely alphanumeric, and have unique coding conventions, such as Excludes1 and Excludes2.a. fiveb. sixc. sevend. eight9. ICD-10-CM and ICD-10-PCS incorporate much greater specificity and clinical information, which results in __________.a. decreased sensitivity when refining grouping and reimbursement methodologies.b. enhanced ability to conduct public health surveillancec. increased need to include supporting documentation with claimsd. reduced ability to measure health care services10. The ICD-10-CM and ICD-10-PCS classifications include updated medical terminology and classification of diseases, provide codes to allow for the comparison of mortality and morbidity data, and provide __________ for the purpose of conducting research, designing payment systems, identifying fraud and abuse, and more.a. clinical decisionsb. improved datac. measurement of cared. public health tracing11. Which of the following will best assist medical coding staff as ICD-10-CM and ICD-10-PCS classifications are implemented?a. ability to document information in patient recordsb. basic knowledge of anatomy and physiologyc. effective communication with medical staffd. reporting ICD-10-CM/PCS codes from indexes12. When coders have questions about documented diagnoses or procedures/services, they should use a __________ process to contact the responsible physician to request clarification about documentation and the code(s) to be assigned.a. medical coordinationb. physician queryc. quality assuranced. utilization management13. ICD-10-CM far exceeds ICD-9-CM in the number of codes provided, having been expanded to __________.a. delete fifth digits for some codesb. include health-related conditionsc. mandate assignment of just three charactersd. reduce specificity at the sixth-digit level14. The ICD-10-CM/PCS Coordination and Maintenance Committee is responsible for overseeing all changes and modifications to ICD-10-CM and ICD-10-PCS codes, including the creation and update of general equivalency mappings. ICD-10-CM codes are reported for __________, while ICD-10-PCS codes are reported for __________.a. diagnoses; proceduresb. diagnoses; conditionsc. procedures; diagnosesd. services; procedures15. Matching ICD-10-CM diagnosis codes to CPT and HCPCS level II procedure and service codes on a claim submitted for a patient encounter ensures that services and procedures are reasonable and necessary for the diagnosis or treatment of an illness or injury. This concept is called __________.a. advance beneficiary notice of nonpaymentb. medical necessityc. quality assuranced. utilization management16. According to Medicare, if it is possible that scheduled tests, services, or procedures may be found medically unnecessary, the patient must sign an advance beneficiary notice, which __________.a. acknowledges the patient’s responsibility for payment if Medicare denies the claimb. ensures that the provider will receive reimbursement from another third-party payerc. guarantees that Medicare will deny payment for the claim, and the patient must payd. improves the chances that Medicare will approve the submitted claim for payment17. Which is the face-to-face contact between a patient and a health care provider who assesses and treats the patient’s condition?a. benefit periodb. encounterc. episode of cared. spell of illness18. Which of the following criteria is used to determine medical necessity?a. Costly treatment is provided when compared with alternative methods.b. Least expensive service is provided to patient, regardless of outcome.c. Procedure or service is performed to treat a health care condition.d. Treatment has a 50 percent chance of being effective for health outcome.19. Which is a condition that occurs as the result of another condition and for which the codes are always reported as secondary codes?a. manifestationb. signc. symptomd. syndrome20. The subterm due to is located in the ICD-10-CM index in alphabetical order below a main term to indicate the presence of a __________ relationship between two conditions.a. cause-and-effectb. either/orc. inclusionaryd. mutually exclusive21. A code listed next to a main term in the ICD-10-CM index is referred to as a(n) __________ code..a. categoryb. defaultc. etiologyd. unspecified22. The ICD-10-CM Diagnostic Coding and Reporting Guidelines for Outpatient Services — Hospital-Based Outpatient Services and Provider-Based Office Visits were developed by the federal government and approved for use by hospitals and providers for coding and reporting __________ services and provider-based office visits.a. ambulatory surgical centerb. home health care/hospicec. hospital-based outpatientd. skilled nursing facility23. The Uniform Hospital Discharge Data Set definition of principal diagnosis applies to __________.a. clinicsb. inpatientsc. outpatientsd. skilled nursing care24. An outpatient is treated in which of the following settings?a. acute inpatient admissionb. domiciliary care facilityc. hospital observation unitd. nursing home25. Which is a concurrent condition that coexists with the first-listed diagnosis, has the potential to affect treatment of the first-listed diagnosis, and is an active condition for which the patient is treated and/or monitored?a. comorbidityb. complicationc. qualified diagnosisd. sign/symptomChapter 07: CPT Coding1. Procedures and services submitted on a claim must be linked to the __________ that justifies the need for the service or procedure.a. CPT codeb. HCPCS codec. ICD-10-CM coded. HCPCS level I code2 The Evaluation and Management section is located at the beginning of CPT because these codes describe __________.a. encounters that have unusual circumstancesb. health care rendered by nonphysicians onlyc. procedures performed by anesthesiologistsd. services most frequently provided by physicians3. The Evaluation and Management __________ of service reflects the amount of work involved in providing health care to a patient.a. complexityb. levelc. placed. type4. The __________ of service refers to the physical location where health care is provided to patients.a. complexityb. levelc. placed. type5. The __________ of service refers to the kind of health care services provided to patients.a. complexityb. levelc. placed. type6. A new patient is one who has not received any professional services from the physician, or from another physician of the same specialty who belongs to the same group practice, within the past __________ year(s).a. oneb. twoc. threed. four7. An established patient is one who has received professional services from the physician, or from another physician of the same specialty who belongs to the same group practice, within the past __________ years.a. oneb. twoc. threed. four8. Concurrent care is the provision of similar services, such as hospital inpatient visits, to __________ on the same day.a. different patients by more than one providerb. different patients by the same providerc. the same patient by more than one providerd. the same patient by the same provider9. Transfer of care occurs when a physician who is managing some or all of a patient’s problems releases the patient to the care of another physician who is __________.a. consulting on the case in the officeb. not providing consultative servicesc. providing consultative servicesd. terminating all care provided10. CMS developed Evaluation and Management Documentation Guidelines, which explain how CPT evaluation and management codes are assigned according to __________ associated with comprehensive multisystem and single-system examinations.a. documentationb. elementsc. office visitsd. reimbursement11. The __________ components of history, examination, and medical decision making are required when selecting an evaluation and management level of service code.a. collaborativeb. key12. The __________ components include counseling, coordination of care, nature of presenting problem, and time.a. collaborativeb. key13. A history is an interview of the patient that includes which of the following elements?a. chief complaint, history of present illness, past/family/social historyb. chief complaint, history of present illness, past/family/social history, physical examinationc. chief complaint, history of present illness, past/family/social history, review of systemsd. chief complaint, past/family/social history, physical examination, review of systems14. The CPT __________ of history is categorized according to four levels.a. extentb. levelc. ranged. type15. The CPT problem-focused history includes the __________.a. chief complaint and brief history of present illness or problemb. chief complaint, brief history of present illness or problem, and problem-pertinent system reviewc. chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient’s problemd. chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH16. The CPT expanded problem-focused history includes the __________.a. chief complaint and brief history of present illness or problemb. chief complaint, brief history of present illness or problem, and problem-pertinent system reviewc. chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient’s problemd. chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH17. The CPT detailed history includes the __________.a. chief complaint and brief history of present illness or problemb. chief complaint, brief history of present illness or problem, and problem-pertinent system reviewc. chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient’s problemd. chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH18. The CPT comprehensive history includes the __________.a. chief complaint and brief history of present illness or problemb. chief complaint, brief history of present illness or problem, and problem-pertinent system reviewc. chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient’s problemd. chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a view of all additional body systems, and complete PFSH19. Which is an assessment of the patient’s body areas and organ systems?a. physical examinationb. review of systems20. The CPT problem-focused examination includes a(n) __________.a. extended examination of the affected body areas and other symptomatic or related organ systemsb. general multisystem examination or a complete examination of a single organ systemc. limited examination of the affected body area or organ systemd. limited examination of the affected body areas or organ systems and other symptomatic or related organ systems21. The CPT expanded problem-focused examination includes a(n) __________.a. extended examination of the affected body areas and other symptomatic or related organ systemsb. general multisystem examination or a complete examination of a single organ systemc. limited examination of the affected body area or organ systemd. limited examination of the affected body areas or organ systems and other symptomatic or related organ systems22. The CPT detailed examination includes a(n) __________.a. extended examination of the affected body areas and other symptomatic or related organ systemsb. general multisystem examination or a complete examination of a single organ systemc. limited examination of the affected body area or organ systemd. limited examination of the affected body areas or organ systems and other symptomatic or related organ systems23. The CPT comprehensive examination includes a(n) __________.a. extended examination of the affected body areas and other symptomatic or related organ systemsb. general multisystem examination or a complete examination of a single organ systemc. limited examination of the affected body area or organ systemd. limited examination of the affected body areas or organ systems and other symptomatic or related organ systems24. CPT medical decision making refers to the complexity of __________ as measured by the number of diagnoses or management options, amount and/or complexity of data to be reviewed, and risk of complications and/or morbidity or mortality.a. assessing patient data in a group or single practiceb. completing a comprehensive history and physical examinationc. establishing a diagnosis and/or selecting a management optiond. ordering ancillary tests and interpreting their results25. CPT defines counseling as it relates to evaluation and management coding as a(n) __________ concerning areas that involve diagnostic results, impressions, recommended diagnostic studies, and so on.a. assessment that impacts patient careb. discussion with a patient and/or familyc. order for further ancillary testingd. way to guarantee quality patient careChapter 08: HCPCS Level II Coding1. Medicare defines __________ as equipment that can withstand repeated use in the patient’s home and not in the absence of illness or injury.a. durable medical equipmentb. durable medical equipment and suppliesc. durable medical equipment, prosthetics, and orthoticsd. durable medical equipment, prosthetics, orthotics, and supplies2. Which includes artificial limbs, braces, medications, surgical dressings, and wheelchairs?a. durable medical equipmentb. durable medical equipment and suppliesc. durable medical equipment, prosthetics, and orthoticsd. durable medical equipment, prosthetics, orthotics, and supplies3. Which supply patients with durable medical equipment?a. carriersb. fiscal intermediariesc. DMEPOS dealersd. Medicare administrative contractors4. The CMS HCPCS Workgroup maintains __________, permanent national codes, miscellaneous codes, temporary codes, and modifiers.a. HCPCS level I codesb. HCPCS level II codesc. HCPCS level III codesd. HCPCS level IV codes5. HCPCS level II __________ codes are reported when a DMEPOS dealer submits a claim fora product or service for which there is no existing HCPCS level II code.a. miscellaneousb. permanentc. temporaryd. unlistedChapter 09: CMS Reimbursement Methodologies1. Reimbursement according to a __________ means that hospitals reported actual charges for inpatient care to payers after discharge of the patients from the hospital.a. prospective cost-based rateb. prospective price-based ratec. retrospective reasonable cost systemd. site-of-service differential2. Which is established in advance and based on reported health care charges from which a predetermined per diem rate is determined?a. prospective cost-based rateb. prospective price-based ratec. retrospective reasonable cost systemd. site-of-service differential3. Which is associated with a particular category of patient and is established by the payer prior to the provision of health care services?a. prospective cost-based rateb. prospective price-based ratec. retrospective reasonable cost systemd. site-of-service differential4. The federal government administers several health care programs, some of which require services to be reimbursed according to predetermined reimbursement methodologies, which are established as __________.a. cost-based ratesb. price-based ratesc. payment systemsd. reasonable cost systems5. Which is a facility’s measure of the types of patients treated and reflects patient utilization of varying levels of health care resources?a. case mixb. cost basisc. discharge statusd. resource utilizationChapter 10: Coding for Medical Necessity1. A provider often considers diagnoses that do not receive direct treatment during an encounter because they impact treatment of other conditions. It is appropriate to report codes for such diagnoses on the CMS-1500 claim because they have been __________.a. discounted by the payerb. included in coveragec. medically managedd. treated during the visit2. The procedure or service provided is linked with the _________ that provided medical necessity for performing the procedure or service.a. diagnosisb. procedurec. serviced. supply3. Which is a form required by Medicare for all outpatient and physician office procedures/services that are not covered by the Medicare program?a. advance beneficiary noticeb. assignment of benefitsc. fee-rendered scheduled. patient waiver form4. The Medicare coverage database (MCD) is used by Medicare administrative contractors,providers, and other health care industry professionals to determine whether a procedure or service is __________ for the diagnosis or treatment of an illness or injury.a. billed at the appropriate levelb. preauthorized by the contractorc. reasonable and necessaryd. usual, customary, and reasonable5. Local coverage determinations specify under which __________ a service is covered and coded correctly.a. clinical circumstancesb. health care settingsc. medical necessityd. service conditionsPage 3
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