Lesson 13-18

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For Knowledge Assessment 3
Habiba A.
Flashcards by Habiba A., updated more than 1 year ago
Habiba A.
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When conducting research on the internet, which of these may not be a reliable source of information? A: NIH B: AMA C: TMZ D: CMS C: TMZ When conducting research on the internet, it is important for the Medical Administrative Assistant to use trusted and reliable websites. Sources are reliable because they are written by experts in the field. Websites are trusted because they do not pose a security threat to the facility.
Which of these is used to prevent unauthorized users from reading data sent over the internet? A: Encryption B: Access Restriction C: Authentication D: Verification A: Encryption Encryption is used to encode information into a non-readable form to be sent securely over the network or internet. Encryption prevents unauthorized users from reading the data. On the other side, an authorized user must use an encryption key to make the text readable again.
The IT department can use _______ to track user activity in various programs used in the facility. A: Verification B: Authentication C: Audit Trails D: Access Restriction C: Audit Trails Through audit trails, the Cyber Security office, Network Administrator, or IT department can see what each user is doing on each computer, which patient records and files a person looked at, as well as other tasks done while using the computer.
Lotus 1-2-3, iWork Numbers and Microsoft Excel are examples of which of the following types of software? A: Word Processing B: Database management C: Systems Software D: Spreadsheet D: Spreadsheet Commonly used spreadsheet programs are Microsoft Excel, Lotus 1-2-3, Google sheets, and Apple iWork Numbers. Spreadsheets are used to track financials, for inventory purposes, and many other reporting needs.
Limiting access to specific levels of information to only certain staff members is: A: Authentication B: Verification C: Access Restriction D: Encryption C: Access Restriction Access restrictions allow only certain staff members to have access to specific levels of information. The HIPAA Privacy Rule generally requires covered entities to take reasonable steps to limit use, disclosure, and access to PHI to the minimum necessary level to accomplish an activity.
What is typically used to prevent unauthorized access to a private network? A: Invasion Detection B: Magnetic Disk Drive C: Network systems D: Firewall D: Firewall A Firewall is used as a barrier between the information on the internet and a private network or computer. Under HIPAA and HITECH law, it is crucial to safeguard electronic PHI through installation of strong firewalls, encrypting data, and keeping malware protection programs up to date.
Which of these is not a computer peripheral? A: Printer B: Speakers C: Scanner D: Central Processing Unit D: Central Processing Unit Computer Peripherals (or peripheral devices) are external machines that are connected to the computer to add functionality. In addition to a keyboard, monitor, and mouse, typical peripherals are speakers, microphones, web cameras, printers, and scanners.
In the healthcare facility, which of these tasks would Microsoft Access be used for? A: Creating a business letter B: Encrypting documents C: Creating an inventory spreadsheet D: Creating a Database D: Creating a Database Microsoft Access is a Database Management System (DBMS). This is software that allows users to create and access data in a database. Some other common database management systems are: Open Source, Oracle, MySQL, and SQL server. Encrypting documents is done through EHR encryption software.
Application Software is a program designed to: A: Provide the computer with basic instructions for controlling the computer, laptop, or tablet B: A set of instructions written in a programming language C: Perform a variety of tasks, such as word processing, database functions, and patient billing D: All of the above C: Perform a variety of tasks, such as word processing, database functions, and patient billing Software is made up of many programs that allow the user to perform coordinated functions, tasks, and activities on the computer. Examples of software are your web browser, patient billing software, spreadsheet, database and word processing programs. Applications (Apps) can be thought of as a sub-grouping of Software with a graphical user interface.
Which means that each employee has a unique username and password that they use to log in to the network? A: Verification B: Access Restriction C: Authentication D: Encryption C: Authentication Authentication verifies the identity of the user through a unique log in name and password. It is important to have a strong password and use different passwords for different logins with frequent password changes. Remember to log out when you step away from your workstation.
Files for patients who have died, moved away, or otherwise are terminated from service will have which file status? A: Active B: Purged C: Inactive D: Closed D: Closed Files can have three different statuses: Active, Inactive and Closed. An inactive patient is someone who has not received services in six months or more. For patients who move away, terminates service with your office, or who have died, the record should be closed. Closed records are archived for the appropriate length of time before being destroyed.
Which of these filing methods assigns patients consecutive numbers with digits separated into groups of two’s or three’s, which are then filed in reverse order? A: Terminal Digit B: Numeric Color-Code C: Straight Numeric D: Middle Digit A: Terminal Digit The terminal digit is the last or ending number in the record number. This filing system is sometimes known as “reverse numeric filing” because the numbers are read in groups from right-to-left instead of left-to-right. The records are then filed backward in groups of two or three digits.
Who is the legal owner of a patient’s physical medical record? A: The patient B: The provider or medical facility C: The U.S. government D: None of the above B: The provider or medical facility Legally, the medical record (whether paper or electronic) belongs to the provider or facility, but the patient owns the information and has a right to access it. The provider who creates the record is called the “maker”.
Tickler files are commonly used in the medical office to: A: Train new employees B: Organize medical documents by type C: Remind staff of date-specific tasks D: Alphabetize records C: Remind staff of date-specific tasks Tickler files are date-driven reminders to follow up on an activity or task. Tickler files can be used to remind you of recurring events like payments, meetings, or to call a patient back about rescheduling, and can be printed as needed.
Which of these approaches organizes the medical record by dividing it into four categories: database, problem list, treatment plan, and progress notes? A: EMR B: POMR C: SOAP D: CHEDDAR B: POMR The Problem-Oriented Medical Record (POMR) approach organizes notes, results, and reports by Problem Number and divides the medical record into four categories: database, problem list, treatment plan and progress notes.
In a paper record, which is not an acceptable method for the Medical Front Office Assistant to correct a handwritten entry? A: Write initials or signature below the correction and date B: Insert the correction above or immediately after the error C: Erase or use correction fluid D: Draw a line through the error C: Erase or use correction fluid The are several steps are used in correcting paper chart errors but erasing, using correcting fluid, or any other type of obliteration is never acceptable!
Which of these methods organizes the medical record chronologically based on the department where the information originated? A: SOMR B: CHEDDAR C: POMR D: SOAP A: SOMR A Source Oriented Medical Record (SOMR) organizes information in the medical record chronologically by the source of information. This would be the department that provided the care (such as from the physician’s office, laboratory, radiology department, etc.)
The information gained by questioning the patient or by having them complete a form is called: A: Objective data D: Progress notes C: Subjective impressions D: Confidential information C: Subjective impressions Subjective impressions refers to information obtained directly from the patient. This would include things like demographics, chief complaint (CC), and medical history. The Patient’s chief complaint is a record of the patient’s symptoms as explained by the patient.
The medical record should only be released with a: A: Written approval from the office manager B: Written authorization from the patient C: Written order from the insurance D: Written order from the physician B: Written authorization from the patient When releasing medical record information, extreme care must be taken to ensure that patient privacy is maintained. Patient’s must give authorization before any information is released to a third party by signing a HIPAA-compliant Release of Information form.
The proper way for the Medical Front Office Assistant to index the name “Suzanne C. Carter-Crosby” is: A: Carter, Suzanne C. Crosby B: CarterCrosby, Suzanne C. C: Crosby, Suzanne C. Carter D: Crosby Carter, Suzanne C. B: CarterCrosby, Suzanne C. With hyphenated personal names, ignore the hyphen and alphabetize as usual. Index with last name first, then first name, and then by middle name or initial.
Which of the following does not monitor healthcare data and the public healthcare experience? A: HITECH B: HIPAA C: NCHS D: HIMSS D: HIMSS Monitoring of healthcare data and the public healthcare experience is performed by organizations like the NCHS as well as through compliance with HIPAA and HITECH.
Which of the following organizations collects data for birth and death records, medical records, interview surveys, and through direct physical exams and lab testing? A: NCQA B: JCAHO C: NCHS D: HIMSS C: NCHS The National Center for Health Statistics (NCHS) is a division of the CDC and is the main agency in the U.S. providing health information statistics. The information they collect is implemented in public health improvements. The NCHS guides policies that improve our nation’s health.
Which of these is not considered Health Information? A: Treatment Plans B: Symptoms and Diagnoses C: Medical History D: Health Insurance policies D: Health Insurance policies Health information is health and medical data about a patient. The medical record contains this health information: the patient’s medical history (including symptoms and diagnoses), results of any exams performed, diagnostic tests, and treatment plans developed.
Data in the medical record is used to ensure Continuity of Care. This means: A: A formal examination of an organization's or individual accounts B: Medical care that continues smoothly from one provider to another for the patient's greatest benefit C: Granted or endowed with a particular authority D: An aggregate of activities designed to ensure adequate quality, in product and service industries B: Medical care that continues smoothly from one provider to another for the patient's greatest benefit Data collected in the patient’s medical record contains a complete health history which the provider incorporates into their plan of care. It is also used to ensure that patients receive Continuity of Care when accessing services across all providers.
Which of these is a system that enables the sharing of health-related information among providers nationally? A: HITECH B: HIT C: HIE D: HIMSS C: HIE A Health Information Exchange (HIE) is a system that enables the sharing of health-related information among providers according to nationally recognized standards. This allows providers to exchange clinical information to improve quality care for patients.
Which of these eliminates pre-existing condition and gender discrimination so that patients cannot be charged more based on their health status or gender? A: EOB B: AOB C: ABN D: ACA D: ACA The Patient Protection and Affordable Care Act (ACA) increased the quality, availability, and affordability of private and public health insurance for those who would not otherwise qualify for coverage. It prohibits dropping health coverage, it eliminates pre-existing condition and gender discrimination, allows young adults to remain on their parent's insurance until age 26, expands Medicaid coverage to 15.9 million Americans, and creates Health Insurance Marketplaces where low-to-middle-income Americans can purchase healthcare coverage.
What is the difference between Medicare and Medicaid? A: Medicaid serves the medically and financially needy, and Medicare serves those over 65 years old B: Medicaid is funded by the federal government, and medicare is both state and federally funded C: Medicare provides health insurance, but medicaid only provides public assistance and food vouchers D: Medicare patients do not pay a monthly premium, but Medicaid patients do A: Medicaid serves the medically and financially needy, and Medicare serves those over 65 years old Medicare is a federally-funded government plan that provides health insurance to patients 65 years or older, to those with certain disabilities or those with End-Stage Renal Disease (ESRD). Medicaid or Medical Assistance (MA) is partially-funded by the Federal government, and partially by the Medicaid patient’s home state. MA provides healthcare coverage to those that are medically needy and financially indigent.
Which part of Medicare covers both inpatient and outpatient benefits as a package? A: Part A B: Part B C: Part C D: Part D C: Part C Part C (Medicare Advantage) is a combined package of benefits encompassing both Part A and Part B coverage. Part A covers inpatient hospital services, and Part B covers outpatient medical. Medicare Advantage plans are purchased through Medicare-approved private insurance companies, and patients pay a deductible and premium in addition to the Part B premium.
At check out, the patient is asked to pay 30% of the $100 charge for today’s procedure. Which of these is the Medical Administrative Assistant asking the patient to pay? A: Coinsurance B: Premium C: Copay D: Deductible A: Coinsurance Coinsurance is a percentage of the allowable amount that the insured is responsible to pay, as determined by their health plan. For example: the plan pays 70% of the allowable and the patient must pay the remaining 30% coinsurance balance. (This is known as an 70/30 plan).
When a Utilization Review committee analyzes individual patient cases, what is medical necessity based on? A: The provider's time, expertise, and services B: The patient's diagnosis or condition C: Malpractice insurance D: Whether the provider is PAR or Non-PAR B: The patient's diagnosis or condition Medical necessity for services is based on the patient’s diagnosis or condition. A proper level of service in an appropriate setting is essential to meet Medical Necessity requirements. Insurance companies use Medical Necessity to make decisions about whether a claim will be paid or denied. The Encounter Form lists the patient’s diagnosis for this purpose.
When a third-party payer uses a weighted scale to determine an allowable amount, which type of fee schedule is used? A: RBRVS B: Fee-for-service C: UCR D: Capitation A: RBRVS Resource Based Relative Value Scale (RBRVS) is a weighted scale payment system used to determine how much a provider should be paid for various procedures. The system is based on the idea that payments for medical services should vary depending on resource costs for providing those services.
Which of these payers is not a government plan? A: Medicare Advantage B: SCHIP C: Medicaid D: BCBS D: BCBS Blue Cross/Blue Shield (BCBS) is a commercial or private insurance. The other carriers are Government health plans, paid by either the federal government, or a combination of federal and state government.
Which mechanism determines which health insurance plan is primary, secondary, and tertiary? A: Coordination of Benefits B: Payer of last resort C: Continuity of Care D: Birthday Rule A: Coordination of Benefits Coordination of Benefits (COB) is the mechanism used when a patient has two or more health insurance plans. The purpose is to limit the total amount of payment to no more than 100% of the allowable amount. Certain rules apply to determine which health insurance plan pays primary (first), secondary (second) or tertiary (third). Typically, Medicaid is the last payor for patients with more than one health plan.
Which type of referral is used for a life-threatening emergency? A: Regular B: STAT C: Urgent D: Self-Referral B: STAT STAT referrals are for immediate, life threatening and emergency situations. Typically, the approval is provided over the phone from Utilization Review department.
Of the following, which represents the Birthday Rule? A: The health plan of the parent whose birth month and year comes last is primary B: The health plan of the parent whose birthday comes first on the calendar is primary C: The health plan of the parent whose birth month and year comes first is primary D: The health plan of the parent whose birthday comes last on the calendar is primary B: The health plan of the parent whose birthday comes first on the calendar is primary The Birthday Rule is applied when a minor or child is covered by more than one insurance to determine which health plan is primary. Under the birthday rule, the health plan of the parent whose birthdate comes first on the calendar (by month and day) will be designated as the primary insurance for claims submitted for their dependents. The parents birth year is not part of determining which health plan is primary.
On the Encounter Form, which of these establishes medical necessity? A: Utillization Review Committe B: The provider's time, expertise, and services C: Procedures or services rendered D: Diagnosis D: Diagnosis The diagnosis and ICD code explain Why a procedure is performed or a service is provided, thus justifying the medical necessity or the need for the encounter. The Utilization Review Committee analyzes patient cases for the proper level of service in an appropriate setting, which is essential to meet Medical Necessity requirements.
When is the letter “X” needed in ICD-10? A: As a placeholder B: For the NOS Codes C: For the 7th character extensions D: To indicate sequela A: As a placeholder If the appropriate ICD-10-CM code chosen for a patient’s condition only has five characters but the coding guidelines require a 7th character extension, a placeholder is used for the sixth character. The letter “X” is always used for a placeholder. Example: S64.11XA.
In ICD-10, which volume is used for facility coding? A: PCS B: Volume III C: Volume I D: Volume II A: PCS ICD-10-CM has a Tabular List of Diseases and Injuries (like Volume I of ICD-9), and an Index to Diseases and Injuries which is the alphabetic listing of main terms (like Volume II in ICD-9). However, with ICD-10, there is no Volume III. Facility codes are contained in their own separate publication called ICD-10-PCS (PCS stands for “Procedure Coding System”).
Which of the following is not a use for ICD codes? A: Create hospital budgets B: Clinical research C: Disease statistics D: Reimbursement A: Create hospital budgets ICD codes are used on insurance claim forms for reimbursement, to gather data morbidity and mortality statistics, for clinical research, to analyze payments for health services, and to serve as a basis for diagnosis-related groups (DRGs) used for hospital billing. They are not used for budgets.
Medical Coders are required to be as specific as possible when selecting codes or the claim may be rejected. True/False True Coding to the highest level of specificity (based on documentation) is a requirement of Medical Coders.
Which of these ICD codes represents a category code? A: S62.024A B: 814.09 C: 491.8 D: Z21 D: Z21 The first 3 characters of either ICD-9-CM or ICD-10-CM codes represent the Category code. Each additional character provides more specificity about the patient’s diagnosis.
The condition of being ill or having disease is: A: Etiology B: Mortality C: Morbidity D: Diagnosis C: Morbidity Morbidity is the condition of being ill or having disease. Morbidity is often referenced in terms of the number of cases of a disease within a group of people. Mortality is death from a disease, illness or injury. Typically, mortality rates indicate the number of deaths in a population due to a specific cause. Etiology is the cause or manner of the condition.
Which of the following is not used in determining the diagnosis and assigning an ICD code? A: Progress Notes B: Operative Reports C: Discharge Summary D: Daily Journal D: Daily Journal Besides the Encounter form, additional documentation may be needed to properly select a diagnosis code. These documents may include an H & P report, progress notes, a discharge summary, operative reports, and/or radiology, laboratory, or pathology reporting.
When would the Medical Administrative Assistant or Medical Coder use the GEMs tool? A: For new patient encounters after October 2015 B: For existing patient returns prior to September 30, 2015 C: For new patient encounters prior to October 2015 D: For existing patient returns after September 30, 2015 D: For existing patient returns after September 30, 2015 ICD-10-CM became effective October 2015. The General Equivalence Mapping (GEMs) tool takes the previously-used ICD-9 codes and converts them to ICD-10-CM codes. Therefore, if a patient was seen before October 2015, and now returns for a visit after the transition, the GEMs tool can provide a list of ICD-10-CM choices to select from.
Which of these is the first step in correctly assigning a diagnosis code? A: Abstract the diagnostic statement B: Locate the diagnosis code in the Tabular List C: Code to the highest level of specificity D: Locate the terms in the Alphabetic Index A: Abstract the diagnostic statement The very first step is to Abstract the Diagnostic Statement. This means to identify the reason for the visit or encounter by reviewing the documentation. This might include a sign, symptom, diagnosis, or condition.
When assigning a procedure code, it is appropriate to code directly to the Alphabetic Index. True/False False After abstracting the procedure or service information from the medical documentation, locate the main and modifying terms in the Alphabetic Index first, and then proceed to the Tabular List of the procedure code book.
What organization developed and updates the CPT manual each year? A: AMA B: CMS C: HCPCS D: WHO A: AMA The CPT manual was developed by the American Medical Association (AMA), and is updated annually. The HCPCS codebook is updated annually by the Centers for Medicare and Medicaid Services (CMS).
The Medical Administrative Assistant is helping in the billing department and notices that a patient’s chart has a copy of a claim that is billed for services that do not appear to have been provided to the patient. This is an example of: A: Abuse B: Downcoding C: Upcoding D: Fraud D: Fraud Fraud is defined as an intentional deception or misrepresentation. It refers to purposely billing for items or services that were never given; or billing for a service that has a higher reimbursement (or payment) rate than what was actually provided. Upcoding is an example of fraud where a code is selected that has a higher reimbursement then the service documented.
Which of these are used for supplemental tracking and performance measurements? A: E/M B: ICD-10-PCS C: HCPCS D: Category II CPT D: Category II CPT Category II CPT codes are used for supplemental tracking and performance measurements. These are optional codes meant to facilitate data collection and quality of rendered care. Evaluation and Management (E/M) codes are a section of CPT codes used for patient encounters.
Downcoding and Upcoding are both illegal practices and the Medical Administrative Assistant could be prosecuted for either. True/False True Upcoding or Downcoding fall into the Fraud and Abuse category and are not consistent with sound business or fiscal practices. Both of these actions can also expose providers and their staff to civil and criminal penalties.
Which of these are considered Level II procedure codes? A: HCPCS B: CPT-4 C: ICD-10-PCS D: Category II CPT A: HCPCS The Healthcare Common Procedure Coding System is divided into Level I and Level II codes. CPT codes are considered Level I HCPCS codes, and Level II HCPCS codes represent equipment, supplies, and other health care services not found in CPT.
Which of these statements best defines the use of Modifiers? A: Indicating that a procedure or service was performed more than once B: Indicating that a procedure was altered by a circumstance but does not change the code's definition C: Indicating that the level of a service was increased or reduced D: Indicating that a procedure was altered by a circumstance which changes the CPT code's definition B: Indicating that a procedure was altered by a circumstance but does not change the code's definition Modifiers provide Medical Coders the means to indicate that a service, procedure or supply has been altered by some specific circumstance but has not changed in the definition of the CPT or HCPCS code. Examples are when more than one provider performs a procedure, when a service or procedure is performed more than once, and when the level of a service or procedure is increased or reduced.
Which procedure codes are most often used by physicians when billing for services rendered? A: CPT-4 B: HCPCS C: ICD-9 D: ICD-10-CM A: CPT-4 CPT codes (4th edition) are developed by the American Medical Association (AMA) to identify services most often provided by physicians in the medical office. The most frequently used CPT procedure codes are in the Evaluation and Management (E/M) category (e.g. 99203, 99213, 99241).
Which of following is a HCPCS Level II code? A: L24.81 B: 496 C: B4162 D: 80202 C: B4162 HCPCS codes are 5 characters in length, starting with a letter followed by 4 numbers (B4162). CPT codes are 5-digit codes made up of all numbers (80202). HCPCS and CPT codes do not have any decimals, only ICD codes do.
Which of the following modifiers indicates that a procedure or service was performed bilaterally? A: -50 B: LR C: -22 D: -F8 A: -50 Modifier -50 means the service was performed bilaterally (meaning on both right and left sides).
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