QUESTIONS & ANSWERS WITH DETAILED RATIONALES |
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In a Private Pay agreement, when a capitation account is applied to the ledger it is also known
as a ? - correct answer -Monthly Prepayment amount
Which of the following are violations of the Stark Law? (2 correct answers) - correct answer -1)
Accepting gifts in place of payment from patient. 2) Referring patients to facilities where the
provider has a financial interest.
A new HIM director was recently hired at a hospital. She was advised her health insurance
benefits become available in 90 days. Which of the following is correct regarding her health
insurance? - correct answer -She will be able to keep her current medical insurance from her
previous job through COBRA.
A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To
which Medicare plan should the facility submit the claim? - correct answer -Part B
When following up on a denied claim, an insurance and coding specialist should have which of
the following pieces of information available when speaking with the insurance company? (3
correct answers) - correct answer -1) Patient's claim number, 2) Physician's NPI, 3) Patient's
insurance ID number
A patient has a home health aid come to his home to clean and dress a burn on his lower leg.
The aid uses a special absorptive, sterile dressing to cover 20 sq in area She also covers 15 sq in
area with self adhesive sterile gauze pad. What is the correct HCPCS code to be assigned? -
correct answer -A6262, A6219
Medical and Surgical Supplies:
- Wound filler, dry form, per gram, not otherwise specified.
, - Gauze, non-impregnated sterile, pad size - 16 sq in or less with any size adhesive boarder, each
dressing.
A patient presents to the Emergency Department with multiple stab wounds to the arms and
chest. On examination there are 3 deep lacerations to the arms measuring 1.2 cm, 1.4 cm and
2.1 cm requiring complex closure, and 2 superficial wounds measuring 1.3 cm and 2.4 cm
requiring intermediate closure. What is the correct CPT codes to be used? - correct answer -
13121, 12032-59
Wound Repair - complex - 2.6 cm to 7.5 cm (worst first)
Wound Repair - Intermediate - 2.6 cm to 7.5 cm
Which of the following modifiers is required for return to the operating room for an unplanned
related procedure or service by the same physician during the postoperative period? - correct
answer --78 - Unplanned return to operating room by same physician, following initial
procedure for a related procedure - during postoperative perior
A new patient comes to the window to find out what the abbreviation LMP on her form means.
The insurance and coding specialist blurts out the answer, and the office hears. Which of the
following standards has the specialist violated. - correct answer -HIPAA
A patient was seen in the office. Charges were recorded and submitted to the patient's
insurance, and and EOB was received by the office with a payment of $70.89. These
transactions should be recorded in the? - correct answer -Patient ledger
The patient suffers from atherosclerotic heart disease caused by plaque deposits in a grafted
internal mammary artery. The patient underwent arterial bypass graft four months ago. Which
of the following ICD-10-CM codes should be assigned? - correct answer -125.810 -
Atherosclerosis of coronary artery bypass graft(s) with out angina pectoris.
A patient has returned to the operating room to aspirate a seroma that has developed from a
surgical procedure that was performed two days ago. A 16 gague needle is used to aspirate 600