Medical Billing and Coding

The difference between the provider's actual charge and the allowable charge is called _______________.

Which defines unbundling correctly?

Providers and facilities out of the net work is described as:

Organization other than a patient which pays for services, such as insurance companies, Medicare and Medicaid are called_____________.

Mr. Allis is admitted at Sentara Northern Virginia Hospital and is being monitored by Dr. Gory. Dr Gory is Mr. Allis' __________

The procedure used to visualize the uterus is termed as:

The IXth (ninth) cranial nerve is termed as:

Which is the positive urine protein for Multiple Myeloma?

Which defines utilization review (UR)?

Using multiple codes that describe different components of a treatment instead of using a single code that describes all steps of the procedure is__________________

Timely filing requirement is defined as ________________

Which is the correct Tier related to its definition?

Ms Elizabeth is under the monitoring of Dr. Carl's care. Dr. Carl is Elizabeth's _____________

Physicians are not allowed to refer patients to a particular with whom they have a financial relationship. This law is _________________

A model of HMO that provides hospitalization and physician services through its own staff is named as ______________.

Code that explains the reason for a payment adjustment is called________________.

Codes that are not related to a specifc claim are termed as ______________

A HIPAA rule that establishes protections for the privacy of individual's health information is ______________

A review that looks at whether the procedure could be performed safely but less expensively in an outpatient setting is termed ________________

The amount the patient owes is called:

Which is used when no other code applies to the adjustment?

A unique 10-digit code for providers required by HIPAA is which of the following?

A modifier can be defined as which of the following?

Plans that provides focused, specialized health care for specific groups of people, such as those who have both Medicare and Medicaid, live in a long-term care facility, or have chronic medical conditions is termed as _________________.

The organ that receives a hormone is classfied as the

A patient is admitted to the hospital for surgical removal of a neoplasm with adjunct chemotherapy. While in the hospital, the patient's COPD and hypertension were also monitored. Which diagnosis should be coded as the principal diagnosis?

ICD-10-CM, which one of the following choices is a code placeholder that has no meaning?

Which one of the following choices is the correct code for osteochondropathy of the elbow and ankle?

What degree is a burn if it completely damages the epidermis and then part of the dermis?

Symptoms that most patients experience with a given condition are known as

A patient overdoses on a prescription drug because he was acidentally following the incorrect doses set by the physician. This incident would be classified as a(n)

A negative physical reaction is coded as a(n)

Which term means "to spread and invade organs"?

If a physician documents "metastatic cancer in lung, liver, and bone," what's the primary cancer site?

Nausea and pain are both examples of

A living patient is donating a kidney. Which one of the following diagnosis codes indicates a kidney donor?

A patient previously smoked for 14 years, but no longer smokes. Which one of the following choices is the correct ICD-10-CM code for history of tobacco use?

When coding burns for multiple sites, it's important to remember to assign

Which of the following choices is a tissue replacement using from another person?

Which one of the following choices is defined as "the condition established after study to be chiefly responsible for occasioning the admision of the patient to the hospital"?

Which of the following choices is a result of using external cause codes?

Which of the following episodes of care indicates the patient that the patient received active treatment for an injury during the current encounter?

A patient was admitted to the hospital with slurred speech, facial drooping, and left arm weakness. On discharge, the physician documents "possible stroke." What should be listed as the principal diagnosis?

A patient sees a doctor for diabetic cataracts. He also has diabetic neuropathic arthropathy. How many codes will be assigned for this encounter?

An undetermined type of poisoning due to Trimeton would be coded to which one of an undetermined type of poisoning due to Trimeton would be coded to which one of the following groups?

If a physician documents "personal history of breast cancer," which one of the following choices indicates the correct way to search the coding manual index for the code assignment?

Jone Doe visits a physician office for a required pre-employment examination for a new job. Which diagnosis code should be assigned?

A patient with type 1 diabetes comes into the office for wound care of a diabetic foot ulcer with muscle necrosis on the heel of the foot. Which diagnosis code is sequenced first?

On May 15 the physician documents, "Hypertension based on multiple elevated blood pressure readings from March, April and May. The coder should assign code(s) for

The extraction of specific data from a medical record, often for use in an external database, such as a cancer registry is called ___________________

Practices that directly or indirectly result in unnecessary costs to the Medicare program is termed as _____________

ICD Coding is used to assign codes to:

An EOB is sent by the:

To ensure the patients' information is protected, the government enacted:

An outstanding payment from a patient is ocnsidered delinquent after:

Which ICD-10 category would you use to code "tachycardia"?

COB stands for:

Inorder to accept payment from the carrier, the provider must:

Modifiers are attached to:

What is the name of the procedure that involves the passage of an endoscope down through the tube leading from the pharynx to the stomach?

Which of the following is a valid ICD 10 code?

What is the difference between co-pay and co-insurance?

What does the prefix "onco" mean?

TRICARE was implemented for what type of individuals?

Which organ produces bile?

Which of the following is a HIPAA violation?

Which procedure is most likely to need a Prior Authorization?

The proper CPT range for anesthesia is:

The member's ID number must appear on the CMS 1500.

Insurance for the elderly is:

The CPT codebook would be used to code:

Add-on codes are part of ICD coding?

Which is not a type of diabetes?

Which of these procedures requires a modifier?

When might a health care proxy be used?

Which of the following overrides HIPAA?

Which of the following insurances is not government-based?

Which scenario requires part of box 10 on CMS 1500 to be checked "yes"?

When does the medical biller get an EOB?

Where might you find cartilage?

Which box on a claim form indicates special permission to do a procedure?

Medicare's 80/20 policy is known as:

Which medical specialists would treat impetigo in an adult?

To code cancers, you use this:

Which type of diabetes involves the kidneys?

All anesthesia codes require a physical status modifier

Who receives a payment when box 27 on CMS 1500 is checked "no"?

Which type of medical care would carry the highest copayments?

Which body part might be involved when being treated by a gastroenterologist?

When is "X" used in an ICD-10 code?

Which ICD-10 code category would be used to code asthma?

The amount a member pays monthly for their insurance is called :

Which insurance is never primary?

ICD-10 coding become mandatory in 2011?

What would you do first if a claim was rejected for an invalid ID number?

Which diagnosis would be coded in the B category using ICD-10?

In which body system would you find the trachea?

Which part of Medicare covers medication?

In what category would you find the ICD-10 code for obesity?

What type of doctor is often referred to as a "gatekeeper"?

In what CPT code range would you find an MRI?

Which one of the following choices is defined as "the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital?

Patient comes into an office to have allergens applied to his skin to see if reactoins occur. This is called

What is the correct code for crohn's disease of the large intestine with abscess?

A patient is seen for synovium rupture in teh right shoulder and right elbow. Which of the following choices is the correct code and sequencing for this scenario?

Patient is admitted for treatment of malignant neoplasm of the bladder that has metastasized to the uterus, ovaries, and rectum. What should be sequenced first?

You cannot have both Medicare and Medicaid.

Mr. Jones is disabled, 62 years old and works for a company that has 80 employees. He has both Original Medicare and insurance from his employer. Mr. Jones needs medical care. Generally,

A process used to determine the medical necessity of a particular procedure or service, designed to ensure that the procedure or service is appropriate and is being in the most cost-effective way.

Three-digit code that describes a classification of a product or service provided to the patient.

Payment for services rendered from a third-party payer.

Four digit code that identifies specific accomodation, ancillary service, or billing calculation related to services on a bill.

Physcians are not allowed to refer patients to a practitioner with whom they have a financial relationship.

Individually identifiable health information

17b locator on CMS1500

A private health insurance that pays for most of th charges not covered by Parts A and B

Which part of Medicare plan provides hospitalization insurance to eligible individuals:

Coding and Classification system that captures diseases and health-related conditions.

Coding and classification system developed for use in the U.S. only. Specific to inpatient hospital procedures.

Abstracted information is which of the following?

Abstracting involves which of the following?

CPT codes are used to describe which of the following?

The term reconciliation means which of the following?

Which of the following is NOT a charge the patient is expected to pay?

The allowable charge is which of the following?

An RA (Remittance Advice) is sent to the patients

An RA is sent to the providers

An aging report refers to which of the following?

A copay is the patient's share of the insurance premium.

Which of the following accurately defines preauthorization?