Lesson 10
What is another name for health insurance that is delivered by private insurance companies?
A. Policy holder
B. Primary health insurance
C. Government-sponsored health-care programs
D. Commercial insurance
D. Commercial insurance
What originated in the 1800s in England as a way to classify the most frequent causes of death?
A. Coding of fraud
B. Coding of procedures
C. Coding of services
D. Coding of diagnoses
D. Coding of diagnoses
What is defined as “…an intentional misrepresentation that a coder makes in order to obtain an unauthorized payment”?
A. Code set
B. Mortality
C. Abuse
D. Fraud
D. Fraud
Which of the following would be coded using the CPT code book?
A. Anemia
B. Bedside commode
C. Congestive heart failure
D. Mastectomy
D. Mastectomy
What is another name for a third-party carrier?
A. Third-party premium
B. Insurance carrier
C. Deductible
D. Primary insurance
B. Insurance carrier
What is the term for people who are covered under the insurance policy but are not the policy holder?
A. Dependents
B. Self-pay
C. Enrollee
D. Uninsured
A. Dependents
How many main sections is the bulk of the ICD-10-CM code book divided into?
A. 8
B. 6
C. 4
D. 2
D. 2
What is the main term in the diagnosis: Metastatic renal cell carcinoma of the right kidney?
A. Carcinoma
B. Metastatic
C. Kidney
D. Renal cell
A. Carcinoma
ICD-10-CM codes selected in the Alphabetic Index should always be verified where?
A. HCPCS Level II
B. HCPCS Level I
C. Tabular List
D. Evaluation and Management Section
C. Tabular List
Which of the following would use the HCPCS Level II code set?
A. Colonoscopy
B. Synthetic sheepskin pad
C. MRI
D. Achlorhydria
B. Synthetic sheepskin pad
What did the Affordable Care Act create when it was signed into federal law in 2010?
A. Medicare
B. Medicaid
C. Indian Health Service
D. Health Insurance Marketplace
D. Health Insurance Marketplace
Which type of codes answer the question: What did the provider do for the patient’s problem?
A. E/M codes
B. CPT codes
C. HCPCS Level II codes
D. ICD-10-CM codes
B. CPT codes
Which section of CPT is used by almost every provider specialty?
A. Medicine
B. Radiology
C. Pathology and Laboratory
D. Evaluation and Management
D. Evaluation and Management
What does “unbundling” mean in medical coding?
A. Assigning multiple ICD-10-CM codes when only one code is required.
B. Assigning multiple CPT codes for a procedure that is fully explained by one code.
C. The failure to append a modifier to a CPT code.
D. Selecting a higher-level medical code to increase the reimbursement.
B. Assigning multiple CPT codes for a procedure that is fully explained by one code.
Which Medicare part offers prescription drug coverage to Medicare patients?
A. Part A
B. Part B
C. Part C
D. Part D
D. Part D
What is the largest single health-care program in the United States?
A. Children’s Health Insurance Program (CHIP)
B. Commercial insurance
C. Military Health Care
D. Medicare
D. Medicare
Which of the following statements is true about coordination of benefits?
A. The combined benefits from all plans cannot exceed 100% of the allowable fee.
B. When a child has coverage under both parents, the older parent has the primary coverage.
C. Coordination of benefits is not applicable to inpatient hospital services.
D. The patient only pays one premium.
A. The combined benefits from all plans cannot exceed 100% of the allowable fee.
Which of the following is a standardized code set that is used to identify services and supplies not included in CPT, such as durable medical equipment and prosthetic devices?
A. ICD-10-CM
B. HCPCS Level II codes
C. ICD-10-PCS
D. CPT modifiers
B. HCPCS Level II codes
Which of the following terms is the concept that all services and procedures provided to a patient must be reasonable, necessary, or justified by the diagnosis?
A. Medical necessity
B. Managed care
C. Participating provider
D. Birthday rule
A. Medical necessity
Which aspect of utilization review involves a process of assessing the appropriateness of health care services after care has been provided?
A. Retrospective review
B. Medical record review
C. Concurrent review
D. Prospective review
A. Retrospective review
What has become the predominant form of health care delivery in most parts of the United States?
A. Managed care
B. Home health care
C. Medicare
D. Skilled nursing facility care
A. Managed care
What is another term for policyholder?
A. Subscriber
B. Third-party payer
C. Participating provider
D. Uninsured
A. Subscriber
ICD-10-CM codes selected in the Alphabetic Index should always be verified where?
A. HCPCS Level II
B. HCPCS Level I
C. Tabular List
D. Evaluation and Management Section
C. Tabular List
What is the federally funded health program for people over the age of 65?
A. TRICARE
B. Medicare
C. Worker’s Compensation
D. Medicaid
B. Medicare
What code set is commonly used for procedures and services provided by physicians and outpatient facilities?
A. CDT (Current Dental Terminology)
B. CPT (Current Procedural Terminology)
C. HCPCS Level II (Healthcare Common Procedure Coding System)
D. ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification)
B. CPT (Current Procedural Terminology)