Review Test Submission: 01 Chapter Review Exam Content User Leeann McGrier Course 2013 Physician Coding for CPC Certification (L-P) Test 01 Chapter Review Started 7/10/13 2:00 PM Submitted 7/10/13 2:36 PM Status Completed Attempt Score 100 out of 100 points Time Elapsed 36 minutes out of 2 hours. Instructions  Question 1 4 out of 4 points What is the value of a remittance advice? Selected Answer: b. It tells you what you will be paid and why any changes to charges were made. Correct Answer: b. It tells you what you will be paid and why any changes to charges were made. Response Feedback : Rationale: The determination of the payer is then sent to the provider in the form of a remittance advice. The remittance advice explains the detail of outcome of the insurance adjudication on the claim, including the payment amount, denial, and/or reason for denial.  Question 2 4 out of 4 points The minimum necessary rule applies to Selected Answer: d. Covered entities taking reasonable steps Correct Answer: d. Covered entities taking reasonable steps Response Rationale: The Privacy Rule generally requires covered entities to take false Feedback : reasonable steps to limit the use or disclosure of, and requests for, protected health information to the minimum necessary to accomplish the intended purpose. The minimum necessary standard does not apply to the following: Disclosures to or requests by a health care provider for treatment purposes. Disclosures to the individual who is the subject of the information. Uses or disclosures made pursuant to an individual’s authorization. Uses or disclosures required for compliance with the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Rules. Disclosures to the Department of Health and Human Services (HHS) when disclosure of information is required under the Privacy Rule for enforcement purposes. Uses or disclosures that are required by other law.  Question 3 4 out of 4 points HHS / OCR has investigated and resolved over ____ cases by requiring changes in privacy practices and other corrective actions by the covered entities since its inception in 2003. Selected Answer: c. 14,309 Correct Answer: c. 14,309 Response Feedback: Rationale: HHS / OCR has investigated and resolved over 14,309 cases by requiring changes in privacy practices and other corrective actions by the covered entities since its inception in 2003  Question 4 4 out of 4 points When coding an operative report, what action would NOT be recommended? Selected Answer: c. Coding from the header without reading the body of the report. Correct Answer: c. Coding from the header without reading the body of the report. Response Feedback: Rationale: Operative report coding tips include reviewing the documentation in the detail of the procedure to further clarify or define both procedures and diagnoses.  Question 5 4 out of 4 points Technicians who specialize in coding are called: Selected Answer: a. Coding specialists Correct Answer: a. Coding specialists Response Feedback: Rationale: Technicians who specialize in coding are called medical coders or coding specialists.  Question 6 4 out of 4 points What type of health insurance provides coverage for low-income families? Selected Answer: a. Medicai d Correct Answer: a. Medicai d Response Feedback: Rationale: Medicaid is a health insurance assistance program for some low-income people (especially children and pregnant women) sponsored by federal and state governments.  Question 7 4 out of 4 points When are providers responsible for obtaining an ABN for a service not considered medically necessary? Selected Answer: b. Prior to providing a service or item to a beneficiary Correct Answer: b. Prior to providing a service or item to a beneficiary Response Feedback: Rationale: Providers are responsible for obtaining an ABN prior to providing the service or item to a beneficiary.  Question 8 4 out of 4 points Many coding professionals go on to find work as: Selected Answer: b. Consultan t Correct Answer: b. Consultan t Response Feedback : Rationale: The coding profession has evolved significantly over the past several decades into a career path with unlimited possibilities. Many professionals who have learned coding have also gone on to roles as consultants, educators, or medical auditors. There are endless possibilities in an ever changing field.  Question 9 4 out of 4 points Which of the following is a BENEFIT of electronic transactions? Selected Answer: c. Timely submission of claims Correct Answer: c. Timely submission of claims Response Feedback: Rationale: Electronic claims benefit the provider office by allowing timely submissions to the insurance carrier and proof of transmissions of the claims.  Question 10 4 out of 4 points A covered entity does NOT include Selected Answer: b. Patient Correct Answer: b. Patient Respon se Feedba ck: Rationale:  Question 11 4 out of 4 points What is PHI? Selected Answer: b. Protected health information Correct Answer: b. Protected health information Response Feedback : Rationale: Protected health information under the Health Information Portability and Accountability Act (HIPAA) is any information, whether oral or recorded, in any form or medium that is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse relating to the past, present, or future physical or mental health or condition of an individual, the provision of health services to that individual, or payment around those services. Only health information at the individual level is covered; health information of groups is not.  Question 12 4 out of 4 points Medicare Part D is what type of insurance? Selected Answer: c. Prescription drug coverage available to all Medicare Beneficiaries Correct Answer: c. Prescription drug coverage available to all Medicare Beneficiaries Response Feedback: Rationale: Medicare Part D is a prescription drug coverage program available to all Medicare beneficiaries. Private companies approved by Medicare provide the coverage.  Question 13 4 out of 4 points A covered entity may obtain consent of the individual to use or disclose protected health information to carry out all but what of the following? Selected Answer: a. for public use Correct Answer: a. for public use Response Feedback: Rationale: A covered entity may obtain consent of the individual to use or disclose protected health information to carry out treatment, payment, or health care operations.  Question 14 4 out of 4 points Voluntary compliance programs also provide benefits by not only helping to prevent erroneous or ____, but also by showing that the physician practice is making additional good faith efforts to submit claims appropriately. Selected Answer: b. Fraudulent claims Correct Answer: b. Fraudulent claims Response Feedback: Rationale: Voluntary compliance programs also provide benefits by not only helping to prevent erroneous or fraudulent claims, but also by showing that the physician practice is making additional good faith efforts to submit claims appropriately.  Question 15 4 out of 4 points The OIG recommends that the physician’s practice enforcement and disciplinary mechanisms be Selected Answer: c. Consisten t Correct Answer: c. Consisten t Response Rationale: The OIG recommends that a physician practice’s enforcement Feedback : and disciplinary mechanisms ensure that violations of the practice’s compliance policies will result in consistent and appropriate sanctions, including the possibility of termination, against the offending individual.