A patient is admitted to the hospital with shortness of breath and congestive heart
failure. The patient undergoes intubation with mechanical ventilation. The final
diagnoses documented by the attending physician are: Congestive heart failure,
mechanical ventilation, and intubation. Which of the...
A patient is admitted to the hospital with shortness of breath and congestive heart
failure. The patient undergoes intubation with mechanical ventilation. The final
diagnoses documented by the attending physician are: Congestive heart failure,
mechanical ventilation, and intubation. Which of the following actions should the coder
take in this case?
a. Code congestive heart failure, respiratory failure, mechanical ventilation, and
intubation
b. Query the attending physician as to the reason for the intubation and mechanical
ventilation to add as a secondary diagnosis
c. Query the attending physician about the adding the symptom of shortness of breath
as a secondary diagnosis
d. Code shortness of breath, congestive heart failure, mechanical ventilation, and
intubation - Answer B
Which of the following requires financial institutions to develop written medical identity
theft programs?
a. HIPAA Security Rule
b. HITECH Act
c. Fair and Accurate Credit Transactions Act
d. HIPAA Privacy and Security Rule - Answer C
Reviewing claims to ensure appropriate coding for deserved payments is one method of:
a. Achieving legitimate optimization
b. Improving documentation
c. Ensuring compliance
,d. Using data monitors - Answer A
The following table is an example of an:
Patient/ Service (A) Total (B) Not Payable Plan
Service Date(s) Charge by Plan Paid Amount
White, Jane
Office Visit 02/17/201X $56.00 $10.00 CP* $46.00 100%
X-Ray 02/17/201X $268.00 $250.00
$3.60 DD* CI* $14.40 80%
Lab 02/17/201X $20.00 $15.00 CP* $5.00 100%
Total
*CI: Coinsurance; CP: Copayment; DD: Deductible
a. Insurance coverage advanced notice service waiver
b. Explanation of benefits
c. Insurance claim form
d. Encounter form - Answer B
Which of the following terms is used to describe the requirement of the healthcare
provider to obtain permission from the health insurer prior to providing service to the
patient?
a. Preauthorization
b. Advance beneficiary notification
c. Point of care collection
d. Local coverage determination - Answer A
,The practice of using a code that results in a higher payment to the provider than the
code that actually reflects the service or item provided is known as:
a. Unbundling
b. Billing for services not provided
c. Medically unnecessary services
d. Upcoding - Answer D
Which of the following terms does not describe the requirement for a healthcare
provider to obtain permission from the health insurer in order to provide predefined
services to the patient?
a. Preauthorization
b. Prior approval
c. Precertification
d. Preassessment - Answer D
All of the following are examples of identity theft red flags categories except:
a. Alerts or notification from a consumer reporting agency
b. Suspicious documents
c. Alerts or notification from AHIMA
d. Suspicious personally identifying information - Answer C
A patient has HIV with disseminated candidiasis. What is the correct code assignment?
B20 Human immunodeficiency virus [HIV] disease
B37.0 Candidal stomatitis, Oral thrush
B37.7 Candidal sepsis Disseminated candidiasis Systemic candidiasis
B37.89 Other sites of candidiasis Candidal osteomyelitis
, a. B20, B37.0
b. B37.7, B20
c. B20, B37.7
d. B20, B37.89, B37.7 - Answer C
In a typical acute-care setting, the explanation of benefits, Medicare summary notice,
and remittance advice documents (provided by the payer) are monitored in which
revenue cycle area?
a. Preclaims submission
b. Claims processing
c. Accounts receivable
d. Claims reconciliation and collections - Answer D
With what agency may patients file a complaint if they suspect medical identity theft
violations?
a. Internal Revenue Service
b. Office of Civil Rights
c. Centers for Medicare and Medicaid Services
d. Federal Trade Commission - Answer D
What is the payment reduction for facilities that fail to successfully meet the
requirements of Medicare's quality reporting programs?
a. 1 percent reduction
b. 2 percent reduction
c. 3 percent reduction
d. 4 percent reduction - Answer B
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