Question 1

Of the following, which is not a reason that the United States did not implement ICD-10 at the time other countries did?

Accepted Answer

The decision between ICD-10 and CPT was not a reason for delay; CPT is used for procedures, not diagnoses, and is separate from ICD coding.

Question 2

Nick Malone underwent an appendectomy by Dr. Lopez on September 5. Dr. Lopez documented appendicitis as Mr. Malone's diagnosis. The diagnosis was documented

Accepted Answer

The diagnosis of appendicitis was documented to show medical necessity for the appendectomy procedure.

Question 3

Converting narrative diagnoses and procedures into numeric form is known as

Accepted Answer

Coding is the process of converting narrative diagnoses and procedures into numeric form.

Question 4

In many managed care plans, patients are responsible for paying a portion of the charges (fixed amount) at the time services are rendered. This is known as the

Accepted Answer

A co-pay is a fixed amount that patients pay at the time of service in many managed care plans.

Question 5

Groups of doctors and other healthcare providers and facilities who voluntarily form a partnership that results in high-quality, coordinated healthcare is known as a/an

Accepted Answer

An Accountable Care Organization (ACO) is a group of healthcare providers who come together voluntarily to provide coordinated high-quality care to their patients, aiming to improve health outcomes and reduce costs.

Question 6

The amount charged for each service provided in a medical practice is known as a

Accepted Answer

A fee schedule is a list of charges or established allowances for specific medical services and procedures provided by a healthcare provider.

Question 7

The actual claim process begins when the patient

Accepted Answer

The answer of The actual claim process begins when the...

Question 8

Which is true of ACOs?

Accepted Answer

The answer of Which is true of ACOs?
...

Question 9

The type of insurance plan that promotes quality, cost-effective healthcare by monitoring patients, encouraging preventive care, and requiring performance measures of physicians is known as

Accepted Answer

Managed care plans emphasize preventive care, monitor patients, and require performance measures of physicians to promote quality and cost-effective healthcare.

Question 10

The term used to describe the relationship between ICD-10 and CPT codes, demonstrating medical necessity, is

Accepted Answer

Code linkage refers to the connection between ICD-10 diagnosis codes and CPT procedure codes to demonstrate the medical necessity of a service or procedure for billing purposes.

Question 11

Which of the following is a true statement about ICD-10-CM/PCS?

Accepted Answer

Current coders will need to relearn how to code because ICD-10-CM/PCS is significantly different from ICD-9-CM, with more codes and a different structure.

Question 12

ICD-10-CM/PCS was implemented because

Accepted Answer

ICD-9-CM was outdated and did not provide the necessary detail for modern healthcare data needs, prompting the implementation of ICD-10-CM/PCS.

Question 13

Knowingly billing for services that are not medically necessary or that did not happen at all is

Accepted Answer

Knowingly billing for services that are not medically necessary or did not happen is considered fraud, as it involves intentional deception for financial gain.

Question 14

The coding system used in illustrating the tangible items such as supplies is

Accepted Answer

HCPCS Level 2 codes are used to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies.

Question 15

Which of the following is a true statement about using practice management (PM) software for an office's claims management process?

Accepted Answer

It allows for more efficient tracking and reporting of daily transactions.

Question 16

The source document for completing the actual insurance claim form is the

Accepted Answer

The encounter form, also known as a superbill, is used by healthcare providers to record the services provided to a patient, which is then used to complete the insurance claim form.

Question 17

As a result of which piece of legislation are hospitals and providers reimbursed based on proof that they are rendering high-quality, coordinated care to their patients?

Accepted Answer

The Affordable Care Act (ACA) introduced value-based care models, which reimburse providers based on the quality and coordination of care, rather than the volume of services provided.

Question 18

In a physician's office, procedures and services are converted into numeric form using which coding system?

Accepted Answer

CPT (Current Procedural Terminology) is the coding system used to convert procedures and services into numeric form in a physician's office.

Question 19

As of October 1, 2015, the coding system used to code diagnoses in any healthcare setting is

Accepted Answer

As of October 1, 2015, the United States transitioned from ICD-9-CM to ICD-10-CM for coding diagnoses in healthcare settings.

Question 20

Which of the following is not part of a paper encounter form (Superbill)?

Accepted Answer

The medical history is not typically included in a paper encounter form or Superbill, which primarily lists the medical practice's name, CPT codes for procedures, and ICD-10-CM diagnosis codes.

Quiz 6: Financial Management: Insurance and Billing Functions