AMCA BILLING & CODING TEST QUESTIONS WITH ANSWERS, Exams of Medical Records

Download AMCA BILLING & CODING TEST QUESTIONS WITH ANSWERS and more Exams Medical Records in PDF only on Docsity! 1 / 15 AMCA BILLING & CODING TEST QUESTIONS WITH ANSWERS 1. What type of insurance allows treatment virtually anywhere with a high deductible that policy holders are willing to pay? a. COBRA b. EPO c. PPO d. HMO: C 2. Veterans with service related disabilities are eligible for case under which of the following programs: a. CHAMPUS b. Medicare c. CHAMPVA d.TRICARE: C 3. is usually sponsored and partially paid by an employer. a.TRICARE b. Private Insurance c. Group Health Insurance d. Worker's Aide: C 4. are used to report encounters for circumstances other than a disease or injury in the ICD-10-CM. a. A codes b. V codes c. Z codes d. E codes: D 5. The abbreviation PMPM stands for: a. Per member per month b. Provider membership per management c. Provider management provider manual d. Pre menstrual after midnight: A 6. Schedule of benefits means: a. Coordination of benefits b. HMO c. Medical service covered under the insured's policy d. Managed care organization: C 7. Medicare is funded by: a. State Funds 2 / 15 b. Federal Funds c. Employers d.The patient: B 8. Physicians establish a list of their usual fees for: a.The charges they have written off b.The procedures and services they frequently perform c. Workers' Compensation patients d.Their Medicare patients: B 9. The insurance carrier is allowed to use nay method to determine the amount for a service, also known as the: a. Allowed amount b. Fee schedule c. Deductible d. Insurance premium: B 10.Which of the following statements is true under the doctrine of respondeat superior? a.The billing and coding specialist is superior to other members of the medical staff b. The billing and coding specialist is responsible for any errors made by the medical staff c.The physician is responsible for any errors made by the medical staff d. The person who has been employed for the longest period of time is responsible for any errors made by the medical staff: C 11.HIPAA, stands for which of the following? a. Health Insurance Portability and Accountability Act b. Health Insurance Privacy Assessment and Agreement c. Health Insurance Privacy and Agreements d. Health Insurance Practices and Agreements: A 12. Information given by a patient to medical personnel that cannot be dis- closed without consent constitutes: a. Judgment b. Duty of care c. Privileged communication d. Negligence: C 13.Why is a superbill/encounter form an important document in the office? a. It is used when considering purchasing medical billing software b. It has information needed for vendors c. It ensures the correct spelling of the patient's name d. It ensures the correct patient data information and procedure codes: D 5 / 15 27.An unintentional, harmful reaction to the correct dosage of a drug is called: a. A manifestation b. A co-existing condition c. A late effect d. An adverse effect: D 28.Which of the following CPT conventions indicates the code description is revised? a. Red dot b. Plus sign c. Blue triangle d. Lightning bolt: C 29.What is meant by the term "Code to the Highest Level of Specificity"? a. Using the most specific code possible b. Using the code the doctor annotates, even if the physician notes do not coincide c. Code using the four-digit subcategory code, even when a five-digit code is available. d. Code using inconclusive and rule out diagnoses: A 30.A medical term that contains the root word meaning "uterus": a. Oophrectomy b. Colporrhaphy c. Hysterectomy d. Salpingectomy: C 31. If the patient is treated for both an acute and chronic condition, each of which has a separate code, how should the codes be listed? a. Acute code, chronic code b. Chronic code, acute code c. V code, condition code d. Acute code, V code: A 32.A new patient is one who has not received services from the physician or any other physician in that group for: a. 3 years b. 1 year c. 2 years d. 90 days: A 33.The abbreviation for PFSH is: a. Present, family and social history b. Past, family and/or social history 6 / 15 c. Patient, family and/or systems history d. Past, family and systems history: B 34.The three key factors in selecting E/M codes are: a.Time, severity of presenting problem and history b. History, examination and time c. History, examination and medical decision making d. Past history, history of present illness and chief complaint: C 35.When a panel code from the Pathology and Laboratory section is reported: a. 50% of the listed tests must have been performed b. 90% of the listed tests must have been performed c. All the listed tests must have been performed d. All of the listed tests must have been performed on the same day: C 36.What is the Medicare Coverage Gap also know as the "donut hole"? a. The amount of out of pocket costs after a certain amount of money has been spent from Medicare on prescription drugs b. It is the gap in coverage from month to month c. It is out of pocket costs associated with a hospital stay d. It is a specific part of Medicare coverage that can be subscribed to: A 37.CPT is what level of Healthcare Common and Procedure coding system? a. Level IV b. Level III c. Level I d. Level II: C 38. M ost individuals receiving TANF payments are limited to a - year benefit period. a. 1 b. 7 c. 10 d. 5: A 39.Which of the following is not a commonly used transmission method for HIPAA claims? a. Direct transmission b. Fax c. Clearinghouse d. Direct data entry: D 40.Medicare Part A covers: a. Physician services 7 / 15 b. MACs c. Hospital services d. Prescription drugs: A 41.A payer's initial processing of a claim screens for: a. Utilization guidelines b. Medical edits 10 / 49.The word used in medical terminology to mean "toward the midline of the body" is: a. Dorsal b. Medial c. Lateral d. Ventral: B 50.To indicate that something lies nearer the surface, use the term: a. Distal b. Superficial c. Deep d. Proximal: B 51.The definition of fraud would be: a. submitting a claim with incorrect patient information b. Unintentionally making a coding error c. Providing poor quality care to the patient d. Intentionally upcoding in order to increase payment: D 52. In order to find a code using the ICD-10-CM manual, the first step is to look up in the index? a. main term b. nonessential modifier c. manifestation d. sub term: A 53.A lab report cannot be used for coding purposes because: a. they are not reviewed by a physician before inclusion in the record b. Pathologists are not physicians c.They are not part of the health record d.They are diagnostic tests: A 54.Which one of the following instructional notes suggests that a second code may be required? a. Code also b. Includes c. See also d. See: A 55.Which CPT modifier should the billing and coding specialist attach to a consultation code when the service performed is required by a third party- pay- er r governmental regulatory body? a. -59 (Distinct Procedural Services) b. -32 (Mandated Services) 11 / c. -22 (Unusual Procedural Services) d. -26 (Professional Component): B 56.What do the letters NOS (not otherwise specified) indicate? a. Equals unspecified b. Encloses synonyms, alternative words or explanatory phrases c. Indicated terns that are to be codes elsewhere d. Appears under a code to further define or explain the content: A 57.What do the letters NEC (not elsewhere classified) indicate? a. Encloses synonyms, alternative words, or explanatory phrases b. Appears under a code to further define or explain the content c. Indicates the use of code assignment for "other" when a more specific code does not exist d. Indicates terms that are to be coded elsewhere: C 58.An established patient presents to the clinic complaining of a sore throat, cough, and a stuffy nose. This is a patient with known diabetes and hyperten- sion. The physician documents diabetes, hypertension, and upper respiratory infection. Which of the following is the first listed diagnosis. a. Hypertension b. Sore throat c. Diabetes d. Upper respiratory infection: D 59.A new patient presents to the office complaining of shortness of breath, cough, and pain in the chest. The physician performs a history and medical exam. The patient has a history of diabetes and hypertension. She suspects the patient is suffering from pneumonia and performs a sputum culture. The physician asks the patient to return in three days to discuss the results. Which of the following diagnosis would be coded if there were no further documentation? a. Diabetes, hypertension b. Shortness of breath, cough, pain, diabetes, hypertension c. Pneumonia, diabetes, hypertension d. Pneumonia, diabetes, hypertension shortness of breath cough, pain: B 60. In the following question, identify the term for the first-listed diagnosis in the following encounter or visit. Established patient presented to clinic with exacerbation of Crohn's disease. Patient's rheumatoid arthritis stable. a. Arthritis b. Crohn's disease 12 / c. Rheumatoid arthritis d. Established patient: B 61. Identify the term for first-listed diagnosis in the following encounter or visit. Initial office visit fir patient requiring management of COPD and CHF. a. Established patient b. Initial visit c. COPD and CHF d. Pain management: C 62.The UB-04 is used for primarily what type of patient visit? a. Clinic b. Hospital inpatient c. Urgent care d. Emergency room: B 63.The term malignant refers to: a. Site of origin or where the tumor originated b. Site to which a malignant tumor has spread c. Used to describe a cancerous tumor that grows worse over time d. Malignancy that is located within the original site if development: C 64.Which of the following terms refers to a cancerous neoplasm in its original location? a. Ca in situ b. Benign c. Malignant primary d. Malignant secondary: A 65. In accordance to the Health Insurance Portability and Accountability Act (HIPAA), which of the following organizations considers health plans, health care providers and clearinghouses as covered entities? a. American Heart Association (AHA) b. American Medical Association (AMA) c. Centers for Medicare and Medicaid Services (CMS) d. Utilization Review Accreditation Commission (URAC): C 66.Which of the following forms notifies a patient, in writing, that they will be required to cover the costs for services provided if the payment is denied by Medicare and deemed medically unnecessary? a. Release of Information b. Advanced Beneficiary Notice (ABN) c. Assignment of Benefits d. Arbitration Agreement: B 15 / a.TRICARE 16 / b. CHAMPVA c. Medicaid d. Medicare: A 81.Which of the following is not a correct format for ICD-10-CM? a.The second character is always a numeric character b.The first character used is always alphabetic character c. ICD-10 consists of three to five characters d. All letters are used in the ICD-10-CM, except the letter U: C 82.Medical Necessity is defined as: a. Acceptable treatment b. Coverage for any illness c. Coverage or any service d. Services that are reasonable and necessary for the related diagnosis or treatment: D 83.During collections, most practices use: a. Audit reports and tax returns b. E-mail messages and faxes c. Local police and state police d. Letters and calls: D 84.The first three factors a coder must consider when coding are patient status, place of service, and: a.Type of co-pay b.Type of service c.Type of billing d.Type of insurance: B 85.The four types of examinations, in order of difficulty (from least difficult to most difficult) are problem focused expanded problem focused, detailed and: a. Comprehensive b. Reactive c. Serious d. Diagnostic: A 86.Coding is the: a. Way healthcare facilities receive reimbursement b. Number that is entered to open lock box c.Transformation of verbal description into numbers d. Assignment of appropriate codes on medical claim forms: D 87.A code that reports more than one diagnosis with one code is a . 17 / a. Complex code