HCM 425 MIDTERM EXAM QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2026

HCM 425 MIDTERM EXAM QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2026 policyholder - Answers Which party signs a contract with a health insurance company and thus, owns the health insurance policy? universal health insurance - Answers Which has as its goal access to health coverage for every individual, regardless of the system implemented to achieve that goal? electronic health record - Answers The terms electronic health record (EHR) and electronic medical record (EMR) are often used interchangeably, but the _____ is a more global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient. patient registration - Answers Total practice management software (TPMS) is used to generate the EMR, automating which of the following medical practice functions? CHAMPVA - Answers If a veteran is rated as 100 percent permanently and totally disabled as a result of a service-connected condition, which program will provide benefits to the veteran's dependents? RBRVS - Answers A new fee schedule for Medicare services was implemented as part of OBRA in 1989 and 1990, replacing the regional "usual and reasonable" payment basis with a fixed fee schedule called: CLIA - Answers Quality standards for all laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the tests are performed were established specifically by __________ legislation. eliminate improper coding and promote national correct coding methodologies. - Answers CMS developed the National Correct Coding Initiative (NCCI) to: per diem - Answers The skilled nursing facility prospective payment system (SNFPPS) generates _____ payments for each skilled nursing facility admission. consumer-driven - Answers In 2000, which type of health plan was introduced as a way to encourage individuals to locate the best health care at the lowest price possible, with the goal of holding down health care costs? problem oriented record. - Answers The systematic method of documentation that consists of four components (database, problem list, initial plan, and progress notes) is called the: continuity of care - Answers The primary purpose of the record is to provide for ____, which involves documenting patient care services so that others who treat the patient have a source of information to assist with additional care and treatment. enrollees. - Answers Employees and dependents who join a managed care plan are called: make a profit. - Answers If a physician provides services that cost less than the managed care capitation amount, the physician will: supervising and coordinating health care services for enrollees. - Answers The primary care provider is responsible for: utilization management - Answers Which is the method of controlling health care costs and quality of care by reviewing the appropriateness and necessity of care provided to patients? security - Answers Assigning passwords to user who are authorized to access patient is a form of: ARRA - Answers Which act protects whistleblowers-individuals who make specified disclosures relating to funds covered by the act? perform periodic audits to internally monitor billing processes - Answers The first step a physician practice can take to identify areas in the practice that are vulnerable to fraud and abuse is to: duplicate processing of a claim. - Answers An example of an overpayment is: mortality - Answers The International Classification of Diseases, published by the World Health Organization, is used to classify __________ data from death certificates. morbidity - Answers ICD-10-CM was developed in the United States and is used to classify __________ data from inpatient and outpatient records, including provider-based office records. legacy - Answers ICD-9-CM is a(n) __________ classification system because of ICD-10-CM and ICD-10-PCS implementation. ICD-10-CM, CPT, and HCPCS level II - Answers Physician office __________ codes are submitted for reimbursement purposes. ICD-10-CM and ICD-10-PCS - Answers Hospital inpatient __________ codes are submitted for reimbursement purposes. ICD-10-CM, CPT, and HCPCS level II - Answers Hospital outpatient __________ codes are submitted for reimbursement purposes. crosswalks - Answers General equivalency mappings are __________ of codes that can be used to roughly identify ICD-10-CM codes for their ICD-9-CM equivalent codes (and vice versa). seven - Answers ICD-10-CM codes require up to __________ characters, are entirely alphanumeric, and have unique coding conventions, such as Excludes1 and Excludes2. enhanced ability to conduct public health surveillance - Answers ICD-10-CM and ICD-10-PCS incorporate much greater specificity and clinical information, which results in __________. physician query - Answers When coders have questions about documented diagnoses or procedures/services, they should use a __________ process to contact the responsible physician to request clarification about documentation and the code(s) to be assigned. inpatient hospital - Answers ICD-10-PCS is an entirely new procedure classification system that was developed by CMS for use in __________ settings only, replacing Volume 3 of ICD-9-CM. multiaxial - Answers ICD-10-PCS uses a __________ seven-character alphanumeric code structure (e.g., 047K04Z) that provides a unique code for all substantially different procedures, and it allows new procedures to be easily incorporated as new codes. encoders - Answers Private companies publish __________, which automate the coding process so that computerized or web-based software is used instead of coding manuals. diagnoses; procedures - Answers The ICD-10-CM/PCS Coordination and Maintenance Committee is responsible for overseeing all changes and modifications to ICD-10-CM and ICD-10-PCS codes, including the creation and update of general equivalency mappings. ICD-10-CM codes are reported for __________, while ICD-10-PCS codes are reported for __________. medical necessity - Answers Matching ICD-10-CM diagnosis codes to CPT and HCPCS level II procedure and service codes on a claim submitted for a patient encounter ensures that services and procedures are reasonable and necessary for the diagnosis or treatment of an illness or injury. This concept is called __________.