Certified Billing & Coding Specialist Exam Review With Complete Solutions Latest Update, Exams of Nursing

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Certified Billing & Coding Specialist Exam

Review With Complete Solutions Latest

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What are Medical Ethics? - correct answers Standards of conduct based on moral principle. they are generally accepted as a guide for behavior towards pt's, dr's, coworkers, the gov, and ins co's What does acting within ethical behavior boundaries mean? - correct answers Carrying out one's responsibilities with integrity, dignity, respect, honesty, competence, fairness, and trust Compliance regulations - correct answers Most billing- related cases are based on HIPAA and False Claims Act Health Insurance Portability & Accountability Act (HIPAA) - correct answers Enacted in 1996, created by the Health Care Fraud & Abuse Control Program- enacted to check for fraud and abuse in the Medicare/ Medicaid Programs and private payers What are 2 provisions of HIPAA? - correct answers Title 1: Insurance Reform Title 2: Administrative Simplification

What is Title 1 of HIPAA? - correct answers Insurance Reform-primary purpose is to provide continuous coverage for workers & their dependents when they change or lose jobs. Also Limits the use of pre-existing conditions exclusions Prohibits discrimination from past or present poor health Guarantees certain employees/ individual the right to purchase new health insurance coverage after losing job Allows renewal of health insurance coverage regardless of an individuals health condition that is covered under the particular policy What is Title 2 of HIPAA? - correct answers Administrative Simplification- goal is to focus on the health care practice setting to reduce administrative cost & burdens. Has 2 parts

1. development and implementation of standardized health related financial & administrative activities electronically
2. implementation of privacy & security procedures to prevent the misuse of health info by ensuring confidentiality What is the False Claims Act (FCA)? - correct answers Federal law that prohibits submitting a fraudulent claim or

making a false statement or representation in connection with a claim. Also protects & rewards whistle-blowers What is the National Correct Coding Initiative (NCCI)? - correct answers Developed by CMS to promote the national correct coding methodologies & to control improper coding that lead to inappropriate payment of Part B health insurance claims How many edits does NCCI include? - correct answers 2: 1.Column 1/ Column 2 (previously called Comprehensive/ Component) Edits 2.Mutually Exclusive Edits Column 1/ Column 2 edits (NCCI) - correct answers Identifies code pairs that should not be billed together because 1 code (Column 1) includes all the services described by another code (Column 2) Mutually Exclusive Edits (NCCI) - correct answers ID's code pairs that, for clinical reasons, are unlikely to be preformed on the same patient on the same day What are the possible consequences of inaccurate coding and incorrect billing? - correct answers delayed processing & payment of claims, reduced payments, denied claims fine and or imprisonment, exclusion from

payer's programs, loss of Dr.'s license to practice medicine Who has the task of investigate and prosecuting health care fraud & abuse? - correct answers The Office of Inspector General (OIG) Fraud - correct answers knowingly & intentionally deceiving or misrepresenting info that may result in unauthorized benefits. it is a felony and can result in fines and or prison Who audits claims? - correct answers State & Federal agencies as well as private insurance companies What are common forms of fraud? - correct answers billing for services not furnished, unbundling, and misrepresenting diagnosis to justify payment Abuse - correct answers incidences or practices, not usually considered fraudulent, that are inconsistent with the accepted medical business or fiscal practices in the industry What are examples of Abuse? - correct answers submitting a claim for services/ procedures performed

that is not medically necessary, and excessive charges for services, equipment or supplies What is a method use to minimize danger, hazards and liabilities associated with abuse? - correct answers Risk Management Patient Confidentiality - correct answers All patient's have right to privacy and all info should remain privileged. Only discuss patient info when necessary to do job. Obtain a signed consent form to release medical info to insurance company or other individual When may a provider use PHI (Protected Health Information) without specific authorization under the HIPAA Privacy Rule? - correct answers When using TPO, Treatment (primarily for the purpose of discussion of patient's case with other Dr's) Payment (providers submit claims on behalf of patients) Operations (for purposes such as training staff and quality improvement) What is Employer Liability? - correct answers Means physicians are legally responsible for their own conduct and any actions of their employees (designee) performed within the context of their employment. Referred to as "vicarious liability" A.K.A " respondent superior"- "let the

master answer". Means employee can be sued & brought to trial What is Employee Liability? - correct answers "Errors & Omissions Insurance"- protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the claim. Some Dr.'s contract with a billing service (clearinghouse) to handle claims submission and some agreements contain a clause stating that the Dr. will hold the co harmless from "liability resulting from claims submitted by the service for any account", means Dr. is responsible for mistakes made by billing service, errors and omissions is not needed in the instance. However, if the Dr. ever asks the insurance biller to do the least bit questionable, such as write off patients balances for certain patients automatically, make sure you have a legal document or signed waiver of liability relieving you of responsibility for such actions. What is a Medical Record & what is it comprised of? - correct answers Documentation of the patients social and medical history, family history, physical exam findings, progress notes, radiology and lab results, consultation reports and correspondence to patients Is the foremost tool of clinical care and communication What is a medical report? - correct answers part of the medical record & is a permanent legal document that

formally states the consequences of the patients exam or treatment in letter or report form IT IS THIS RECORD THAT PROVIDES INFO NEEDED TO COMPLETE THE INSURANCE CLAIM FORM Reasons for Documentation - correct answers Important that every patient seen by Dr. has comprehensive legible documentation about patients illness, treatment and plans for following reasons:

• Avoidance of denied or delayed payment by insurance company investigating the medical necessity of service
• Enforcement of medical record-keeping rules by insurance company's requiring accurate documentation that supports procedure & diagnosis codes
• Subpoena of medical records by state investigators or the court for review
• Defense of professional liability claim Retention of Medical Records - correct answers Is governed by state & local laws & may vary from state-to- state. Most Dr. are required to retain records indefinitely, deceased patient records should be kept for at least 5 years -algia - correct answers pain -emia - correct answers blood condition

-itis - correct answers inflammation -megaly - correct answers enlargement -meter - correct answers measure -oma - correct answers tumor, mass -osis - correct answers abnormal condition -pathy - correct answers disease condition -rrhagia - correct answers bursting forth of blood -rrhea - correct answers discharge, flow -sclerosis - correct answers hardening -scopy - correct answers to view/ visual examination -centesis - correct answers surgical puncture

-ectomy - correct answers removal, resection, excision -gram - correct answers record -graphy - correct answers process of recording -lysis - correct answers separation, breakdown, destruction -pexy - correct answers surgical fixation -plasty - correct answers surgical repair -rrhapy - correct answers suture -stomy - correct answers opening -therapy - correct answers treatment -tomy - correct answers incision, to cut into a, an- - correct answers without

ante- - correct answers before anti- - correct answers against brady- - correct answers slow dys- - correct answers painful, difficult endo- - correct answers inside, within epi- - correct answers upon, above ex- - correct answers out, out of hemi- - correct answers half, partial hypo- - correct answers below, deficient infra- - correct answers below inter- - correct answers between neo- - correct answers new

oligo- - correct answers scanty, little pan- - correct answers all para- - correct answers beside per- - correct answers through poly- - correct answers many pre- - correct answers before, in front of pseudo- - correct answers false sub- - correct answers under supra- - correct answers above, beyond tetra- - correct answers four arth/o - correct answers cartilage

cephal/o - correct answers head cardi/o - correct answers heart cholecyst/o - correct answers gall bladder chondro/o - correct answers cartilage colp/o - correct answers vagina derm/o - correct answers skin enter/o - correct answers intestine episi/o - correct answers vulva gastr/o - correct answers stomache gloss/o - correct answers tongue hepat/o - correct answers liver hyster/o - correct answers uterus

lapar/o - correct answers abdomen lact/o - correct answers milk lith/o - correct answers stone mast/o - correct answers breast my/o - correct answers muscle nat/o - correct answers birth oophor/o - correct answers ovary oste/o - correct answers bone pneum/o - correct answers lung rhin/o - correct answers nose salping/o - correct answers fallopian tubes

stomat/o - correct answers mouth Anterior, Ventral - correct answers front surface of the body Posterior, Dorsal - correct answers back side of the body Superior - correct answers above another structure Inferior - correct answers below another structure Anterior, Ventral - correct answers front surface of the body Proximal - correct answers near the point of attachment Distal - correct answers far from point of attachment to the trunk Medial - correct answers pertaining to the side Lateral - correct answers pertaining to the side

Frontal, Coronal - correct answers vertical plane dividing the body into anterior and posterior portions Sagittal - correct answers vertical plane dividing the body into right and left sides Transverse, Cross-sectional - correct answers horizontal plane dividing the body into upper and lower portions Anatomy & Physiology - correct answers a professional medical coder must have knowledge of anatomy and physiology so that coding assignment is quick and accurate What is the 1st body system for which medical procedures are described in the CPT manual? - correct answers the integumentary system (the skin and it's accessory organs) integument means covering. it is a complex system of specialized tissues containing glands, nerves and blood vessels. How much area does the skin cover? - correct answers an area of 22 sq ft (an average adult) it is the largest organ of the body What is the main function of the skin? - correct answers to protect the deeper tissues from excessive loss of

minerals, heat and water. it also provides protection from diseases by providing a barrier. it accomplishes its diverse functions with assistance from the hair, nails and glands Sebaceous (oil) glands & Suddoriferious (sweat) glands - correct answers produce secretions that allow the body to be moisturized or cooled How many layers to the skin? - correct answers 3: Epidermis, Dermis, Subcutaneous Epidermis - correct answers thin, cellular membrane layer that contains keratin Dermis - correct answers dense, fibrous, connective tissue that contains collagen Subcutaneous - correct answers thicker and fatter tissue Hair - correct answers composed of tight fused meshwork of cells filled with hard protein called karatin. has its roots in the dermis and together with their coverings, is called HAIR FOLLICLES. main function is to assist in regulating body temp. holds heat when body is cold by standing on end and holding a layer of air as insulation

Nails - correct answers covers and protects dorsal surface of the distal bones of the fingers and toes. part that is visible is nail body, nail root is under skin at the base of the nail and nail bed is the vascular tissue under the nail that appears pink when the blood is oxygenated or blue/purple when it is oxygen deficient What is the moon like white area of the nail called? - correct answers lunula What is the eponychium? - correct answers the cuticle at the lower part of the nail sometimes referred to as such Sebaceous Glands - correct answers located in the dermal layer of the skin over the entire body, except for palm of hands and soles of feet. Secrete oily substance called Sebum. Sebum contains lipids that help lubricate the skin and minimize water loss. it is the overproduction of sebum during puberty that contributes to acne in some people Suddoriferous Glands - correct answers sweat glands that are tiny, coiled glands found on almost all body surfaces. they are most numerous in the palms and soles of feet. coiled sweat glands originate in the dermis and straighten out to extend up through the epidermis. tiny opening at surface is called a pore

How many types of sweat glands? - correct answers 2: eccrine & apocrine Eccrine sweat glands - correct answers most common Apocrine sweat glands - correct answers secrete odorless sweat What organ secretes hormones? - correct answers the adrenal glands, they secrete epinephrine and steriods Albino - correct answers deficient in pigment (melanin) Collagen - correct answers structural protein found in the skin and connective tissue Melanin - correct answers major skin pigment Lipocyte - correct answers a fat cell Macule - correct answers discolored, flat lesion (freckles) Polyp - correct answers benign growth extending from the surface of the mucous membrane

Fissure - correct answers groove or crack like sore Nodule - correct answers solid, round or oval elevated lesion (more than 1 cm in diameter) Ulcer - correct answers open sore on the skin or mucous membrane Vesicle - correct answers small collection of clear fluid (blister) Wheal - correct answers smooth, slightly elevated, edematous (swollen) area that is redder or paler than the surrounding skin Alopecia - correct answers absence of hair from areas where it normally grows (baldness) Gangrene - correct answers death of tissue associated with the loss of blood supply Impetigo - correct answers bacterial inflammatory skin disease characterized by lesion, pustules, and vesicles

Multigravida - correct answers a pregnant woman who has had at least one previous pregnancy The Musculoskeletal System - correct answers includes bones, muscles and joints. acts as a framework for the organs, protects many of those organs, and also provides the body with the ability to move What are bones connected to one another by? - correct answers by fibrous bands of tissues called Ligaments What are muscles attached to the bone by? - correct answers tendons What is the fibrous covering of muscles called? - correct answers the fascia and the articular cartilage, covers the end of many bones and serves as a protective function Bones - correct answers complete organs made up of connective tissue called Osseous. inner core of bones is comprised of Hematopoietic tissue. this is where the red bone marrow manufactures blood cells. Other parts of the bones are storage areas for minerals necessary for growth (calcium and phosphorous)

How are bones categorized? - correct answers as belonging to either the Axial Skeleton or the Appendicular Skeleton Axial Skeleton - correct answers consist of the skull, rib cage and spine Appendicular Skeleton - correct answers made up of the shoulder, collar, pelvic, arm and legs Long Bones - correct answers typically very strong, are broad at the ends and have large surfaces for muscle attachment. (humerus and femur) Short Bones - correct answers are small with irregular shapes, they are found in wrist and ankle Flat Bones - correct answers are found covering the soft body parts (shoulder blades, ribs and pelvic bones) Sesamoid Bones - correct answers small, rounded bones that resemble a sesame seed. they are founf near joints and increase the efficiency of muscles near a joint (knee cap)

Skull - correct answers made up of 2 parts: the cranium and the facial bone Cranium - correct answers includes: Frontal Bone, Parietal Bone, Occipital Bone, Temporal Bone, Ethmoid Bone, Sphenoid Bone Frontal Bone - correct answers forms the anterior [art of the skull and forhead Parietal Bone - correct answers forms the sides of the cranium Occipital Bone - correct answers forms the back of the skull, there is a large hole at the ventral surface in this bone called the foramen magnum, which allows the brain to communicate with the spinal cord Temporal Bone - correct answers forms the 2 lower sides of the cranium Ethmoid Bone - correct answers forms the roof of the nasal cavity Sphenoid Bone - correct answers anterior to the temporal bone

Zygoma - correct answers cheekbone Lacrimal Bones - correct answers paired bones at the corner of each eye that cradle the tear ducts Maxilla - correct answers upper jaw bone Mandible - correct answers lower jaw bone Vomer - correct answers bone that forms posterior/ inferior part of the nasal septal wall between the nostrils Palatine Bones - correct answers make up part of the roof of the mouth Spinal/ Vertebral Column - correct answers is divided into 5 regiions from the neck to the tailbone. there are 26 bones in the spine and are referred to as the Vertabrae Cervical - correct answers neck bone Thoracle - correct answers upper back

Lumbar - correct answers lower back Sacral - correct answers sacrum Coccygeal - correct answers coccyx (tailbone) Rib Cage - correct answers there are 12 pairs of ribs. the 1st 7 pairs join the sternum anteriorly through the cartilaginous attachments called Costal Cartilage. the True Ribs #'s 1-7 attach directly to the sternum in the front of the body. the False Ribs #'s 8-10 are attached to the sternum by cartilage. ribs 11 & 12 are Floating Ribs, because they are not attached at all Upper Appendicular Skeleton - correct answers includes the shoulder girdle which is made up of the Scapula, Clavicle and Upper Extremities Scapula - correct answers shoulder blades are flat bones that help support the arms Clavicle - correct answers collarbone is curved horizontal bones that attach to the upper sternum at one end, these bones help stabilize the shoulder

Upper Extremities - correct answers consist of : Humerue, Ulna, Radius, Carpals, Metacarples, phalanges Humerus - correct answers upper arm bone Ulna - correct answers lower medial arm bone Radius - correct answers lateral lower arm bone(in line with the thumb) Carpals - correct answers wrist bones, there are 2 rows of 4 bones in the wrist Metacarpals - correct answers the 5 radiating bones in the fingers. these are the bones in the palm of the hand Phalanges - correct answers finger bones, each finger has 3 phalanges, except for the thumb. the 3 phalanges are the proximal, middle and a distal phalanx. the thumb has a proximal and distal Lower Appendicular - correct answers can be divided into the pelvis and the lower extremities Pelvis - correct answers superior and widest bone