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AMCA BILLING & CODING PRACTICE TEST EXAM QUESTIONS
WITH COMPLETE SOLUTIONS GUARANTEED PASS BRAND NEW
What type of insurance allows treatment virtually anywhere with a high deductible that policyholder are willing to pay? - ANSWER - >PPO Veterans with service related disabilities are eligible for care under which of the following programs: - ANSWER - >CHAMPVA ______________________ is usually sponsored and partially paid by an employer - ANSWER - >Group Health Insurance ______________________ are used to report encounter for circumstances other than a disease or injury in ICD- 10 - CM - ANSWER - >Z codes The abbreviation PMPM stand for - ANSWER - >Per member per month Schedule of benefits means: - ANSWER - >Medical service covered under the insured's policy Medicare is funded by - ANSWER - >Federal funds
Physician's establish a list of their usual fees for? - ANSWER -
The procedures and services they frequently perform The insurance carrier is allowed to use any method to determine the amount for a service, also known as th - ANSWER - >Allowed amount Which of the following statements is true under the doctrine of respondeat superior? - ANSWER - >The physician is responsible for any errors made by the medical staff HIPAA stands for which of the following? - ANSWER - >Health Insurance Portability and Accountability Act Information given by a patient to medical personnel that cannot be disclosed without consent constitutes - ANSWER - Privileged communication Why is a superbill/encounter form an important document in the office? - ANSWER - >It ensures the correct patient data information and procedure codes Which of the following facilities does not use CMS-1500 forms?
- ANSWER - >Acute care Physicians usually submit claims for patients and receive payments directly from the payers. The policy holder authorized this by signing and dating a: - ANSWER -
Assignment of benefits
Which of the following is one of the section in the CPT Coding Manual - ANSWER - >Pathology and Laboratory A late effect may be indicated in documentation by the use of the expression(s): - ANSWER - >Due to an old-due to a previous Multigravida is a term associated with - ANSWER - >pregnancy What insurance company is the payer of last resort? - ANSWER
Medicaid An unintentional, harmful reaction to the correct dosage of a drug is called - ANSWER - >An adverse effect Which of the following CPT conventions indicates the code description is revised? - ANSWER - >Blue triangle What is meant by the term "Code to the Highest Level of Specificity" - ANSWER - >Using the most specific code possible A medical term that contains the root word meaning "uterus" - ANSWER - >Hysterectomy f a patient is treated for both an acute and chronic condition, each of which has a separate code, how should the codes be listed? - ANSWER - >Acute code, chronic code
A new patient is one who has not received services from the physician or any other physician in that group for - ANSWER -
3 year The abbreviation for PFSH is: - ANSWER - >Past, family and/or social history The three key factors in selecting E/M codes are - ANSWER - History, examination and medical decision making When a panel code from the Pathology and Laboratory section is reported - ANSWER - >All of the listed tests must have been performed on the same day What is the Medicare Coverage Gap also known as the "donut hole"? - ANSWER - >The amount out of pocket cost after a certain amount of money has been spent from Medicare on prescription drugs CPT is what level of Healthcare Common and Procedure coding system? - ANSWER - >Level I Most individuals receiving TANF payments are limited to a ________________ year benefits period - ANSWER - > 5 Which of the following is not a commonly used transmission method for HIPAA claims? - ANSWER - >Fax Medicare Part A covers - ANSWER - >hospital services
To indicate that something lies neared the surface, use the term: - ANSWER - >Superficial The definition of fraud would be - ANSWER - >Intentionally upcoding in order to increase payment In order to find a code using the ICD- 10 - CM manual, the first step is to look up the _____________ in the index - ANSWER -
Main term A lab report cannot be used for coding purposes because: - ANSWER - >They are not reviewed by a physician before inclusion in the record Which of the following instructional notes suggests that a second code may be required - ANSWER - >Code also Which CPT modifier should the billing and coding specialist attach to a consultation code when the service performed is required by a third party payer or government regulatory body?
- ANSWER - >32 (Mandated Services) What does the letter NOS (not elsewhere specified) indicate? - ANSWER - >Equals unspecified What do the letters NEC (not elsewhere classified) indicate? - ANSWER - >Indicates the use of code assignment for 'other' when a more specific code does not exist
An established patient presents to the clinic complaining of a sore throat, cough, and a stuffy nose. This is a patient with known diabetes and hypertension. The physician documents diabetes, hypertension and upper respiratory infection. Which of the following is the first listed diagnosis? - ANSWER - >Upper respiratory infection A new patient presents to the office complaining of shortness of breath, cough, and pain in the chest. The physician performs a history and medical exam. The patient has a history of diabetes and hypertension. She suspects the patient is suffering from pneumonia and performs a sputum culture. The physician asks the patient to return in three days to discuss the results. Which of the following diagnoses would be coded if there were no further documentation? - ANSWER - >Pneumonia, diabetes, hypertension In the following equation, identify the term for the first listed diagnosis in the following encounter or visit. Established patient present to clinic with exacerbation of Crohn's disease. Patient's rheumatoid arthritis is stable. - ANSWER - >Crohn's disease Identify the term for first-listed diagnosis in the following encounter or visit. Initial office visit for patient requiring management of COPD and CHF - ANSWER - >Initial visit The UB-04 is used primarily for what type of patient visit? - ANSWER - >Hospital inpatient
the very first thing a coder does? - ANSWER - >Identify all main terms included in clinical diagnostic statement Bad debt is defined as - ANSWER - >uncollectible A/R The principal diagnosis when coding ICD- 10 - CM codes refers to which of the following? - ANSWER - >The condition or diagnosis that brought the patient into the facility The suffix - scopy means - ANSWER - >Visualize When working under a managed care plan, physicians agree to:
- ANSWER - >Accept fees that are predetermined by the plan Who should be billed for the treatment of an emancipated minor? - ANSWER - >The minor Which of the following statements best describes unbundling? - ANSWER - >Coding a procedure with multiple codes when a single code should be used A patient was suspected of having a myocardial infarction. After staying in the hospital as an outpatient in observation, the doctor found nothing wrong and sent the patient home. What code would you use in this scenario? - ANSWER - >Z03. Observation for suspected myocardial infarction Parentheses () are used in ICD- 10 - CM for which of the following purposes? - ANSWER - >
In reference to coding laterally and ICD- 10 - CM, which of the following statements is not true? - ANSWER - >A bilateral code is always provided Which insurance is provided only for active duty and retired military members and their families? - ANSWER - >TRICARE Which of the following is not a correct format for ICD- 10 - CM? - ANSWER - >ICD-10 consists of three to five characters Medical Necessity is defined as - ANSWER - >Service that are reasonable and necessary for the related diagnosis or treatmen During collections, most practices use - ANSWER - >letters and calls The first three factors a coder must consider when coding are patient status, place of service and - ANSWER - >Type of service The four types of examination in order of difficulty (from least difficult to most difficult) are problem focused, expanded problem focused, detailed and - ANSWER - >Comprehensive Coding is the - ANSWER - >Transformation of verbal description into numbers A code that reports more than one diagnosis with one code is a _______________ code - ANSWER - >Combination
digit would be used in this diagnosis? - ANSWER - >/3 Malignant neoplasm, stated or presumed to be primary Identify the first section character that would be assigned to the following procedure: INSERTION OF RADIUM INTO THE CERVIX (BRACHYTHERAPY) - ANSWER - >Radiation Oncology Identify the first section character that would be assigned to the following procedure: COMPUTERIZED TOMOGRAPHY OF THE SPINE - ANSWER - >Imaging Identify the first section character that would be assigned to the following procedure: GAIT TRAINING - ANSWER -
Chiropractic
