MIBC 101 - Intro to Medical Billing and Coding | Chapter
1 of 3-2-1 code it!
Demographic data is patient identification information that is collected according to
facility policy and includes information such as the _______.
a. Patient's date of birth
b. Insurance claim submitted
c. Quality of patient care
d. Medical codes reported *** a. Patient's date of birth
Which represents an online professional network about a variety of topics and issues?
a. Place-bound conference
b. Wide area network
c. Application service provider
d. Listserv *** d. Listserv
A third party administrator (TPA) is an entity that _____ and may contract with a health
care clearinghouse to standardize data for claims processing.
a. Combats waste, fraud, and abuse in the health insurance and health care delivery
b. Simplifies the administration of health insurance by creating unique identifiers
c. Processes health care claims and performs related business functions for a health
plan
d. Improves portability and continuity of health insurance coverage in a group/individual
markets *** c. Processes health care claims and performs related business functions
for a health plan
The Centers for Medicare and Medicaid services (CMS) is a(n) _______ in the federal
Department of Health and Human Services (DHHS).
a. Private organization
b. Third-party payer
c. Compliance section
d. Administrative agency *** d. Administrative agency
The UB-04 claim is submitted by _______ to health plans for reimbursement purposes.
a. Third-party payers
b. Physician offices
c. Hospitals
d. Departments of health *** c. Hospitals
, When coders have questions about documented diagnoses or procedures/services,
they use a physician query process to contact the responsible physician to
___________.
a. Eliminate the risk or fraud and abuse even though assumed by the facility or
physician
b. Confirm diagnoses, procedures, and services already documented in the record
c. Request clarification about documentation and the code(s) to be assigned
d. Document diagnoses, procedures, or services that will increase reimbursement ***
c. Request clarification about documentation and the code(s) to be assigned
Coders are prohibited from performing assumption coding, which is the assignment of
codes based on assuming, from a review of clinical evidence in the patient's record, that
the patient has certain diagnoses or received certain procedures/services even though
the __________.
a. Provider did not specifically document those diagnoses or procedures and services
b. Risk for health care fraud and abuse is assumed by the health care facility or
physician
c. Responsible physician was contacted to confirm diagnoses, procedures, and services
d. Physician query process was not implemented by the health care facility r physician
*** a. Provider did not specifically document those diagnoses or procedures and
services
Which contains a computer-generated list of procedures, services, and supplies and
corresponding revenue codes along with charges for each?
a. Insurance claim
b. Uniform bill
c. Chargemaster
d. Encounter form *** c. Chargemaster
The judgement, opinion, or evaluation made by the health care provider would be found
in the _________ portion of a problem-oriented SOAP note
a. Plan
b. Assessment
c. Objective
d. Subjective *** b. Assessment
A physician lists "viral pneumonia" as the final diagnosis. However, the coder notes that
the laboratory results state "gram-negative bacteria." There is also a documentation of
chest pain, fever, and dyspnea due to pneumonia. What should the coder do?
a. Code bacterial pneumonia, chest pain, fever, and dyspnea
b. Query the physician regarding the diagnosis of pneumonia
1 of 3-2-1 code it!
Demographic data is patient identification information that is collected according to
facility policy and includes information such as the _______.
a. Patient's date of birth
b. Insurance claim submitted
c. Quality of patient care
d. Medical codes reported *** a. Patient's date of birth
Which represents an online professional network about a variety of topics and issues?
a. Place-bound conference
b. Wide area network
c. Application service provider
d. Listserv *** d. Listserv
A third party administrator (TPA) is an entity that _____ and may contract with a health
care clearinghouse to standardize data for claims processing.
a. Combats waste, fraud, and abuse in the health insurance and health care delivery
b. Simplifies the administration of health insurance by creating unique identifiers
c. Processes health care claims and performs related business functions for a health
plan
d. Improves portability and continuity of health insurance coverage in a group/individual
markets *** c. Processes health care claims and performs related business functions
for a health plan
The Centers for Medicare and Medicaid services (CMS) is a(n) _______ in the federal
Department of Health and Human Services (DHHS).
a. Private organization
b. Third-party payer
c. Compliance section
d. Administrative agency *** d. Administrative agency
The UB-04 claim is submitted by _______ to health plans for reimbursement purposes.
a. Third-party payers
b. Physician offices
c. Hospitals
d. Departments of health *** c. Hospitals
, When coders have questions about documented diagnoses or procedures/services,
they use a physician query process to contact the responsible physician to
___________.
a. Eliminate the risk or fraud and abuse even though assumed by the facility or
physician
b. Confirm diagnoses, procedures, and services already documented in the record
c. Request clarification about documentation and the code(s) to be assigned
d. Document diagnoses, procedures, or services that will increase reimbursement ***
c. Request clarification about documentation and the code(s) to be assigned
Coders are prohibited from performing assumption coding, which is the assignment of
codes based on assuming, from a review of clinical evidence in the patient's record, that
the patient has certain diagnoses or received certain procedures/services even though
the __________.
a. Provider did not specifically document those diagnoses or procedures and services
b. Risk for health care fraud and abuse is assumed by the health care facility or
physician
c. Responsible physician was contacted to confirm diagnoses, procedures, and services
d. Physician query process was not implemented by the health care facility r physician
*** a. Provider did not specifically document those diagnoses or procedures and
services
Which contains a computer-generated list of procedures, services, and supplies and
corresponding revenue codes along with charges for each?
a. Insurance claim
b. Uniform bill
c. Chargemaster
d. Encounter form *** c. Chargemaster
The judgement, opinion, or evaluation made by the health care provider would be found
in the _________ portion of a problem-oriented SOAP note
a. Plan
b. Assessment
c. Objective
d. Subjective *** b. Assessment
A physician lists "viral pneumonia" as the final diagnosis. However, the coder notes that
the laboratory results state "gram-negative bacteria." There is also a documentation of
chest pain, fever, and dyspnea due to pneumonia. What should the coder do?
a. Code bacterial pneumonia, chest pain, fever, and dyspnea
b. Query the physician regarding the diagnosis of pneumonia
