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Home  arrow Chapter Review Questions  arrow Chapter 8: Physician Medical Billing

Chapter 8: Physician Medical Billing



This activity contains 25 questions.

Question 1.
There are four types of audits.

   
 
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Question 2.
An accreditation audit is performed by the facility prior to claims submission.

   
 
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Question 3.
Code edits are conducted by the medical coder.

   
 
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Question 4.
When conducting an internal audit the three key elements reviewed are history, examination, and medical decision making.

   
 
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Question 5.
Code edits screen for improperly or incorrectly reported procedure codes.

   
 
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Question 6.
Compliance plans focus on training of physicians to use the AMA documentation guidelines for E/M services.

   
 
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Question 7.
Downcoding refers to a coding method in which lower level codes are selected to avoid government investigation.

   
 
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Question 8.
The term external audit may refer to an audit conducted by a consultant that the medical practice has hired.

   
 
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Question 9.
Both insurance carriers and agencies of the federal government may conduct external audits of medical practices' claims.

   
 
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Question 10.
An internal audit is conducted to verify that a medical practice is in compliance with reporting regulations.

   
 
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Question 11.
A prospective audit is also called an external audit.

   
 
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Question 12.
To comply with regulations, all codes that are reported must be current, correct, and complete.

   
 
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Question 13.
Retrospective internal audits permit the auditor to see which codes have been rejected or downcoded by the payer and set up ways to avoid making the same errors in the future.

   
 
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Question 14.
Evaluation and management (E/M) codes are an ongoing focus of external audits because they are reported by so many medical practices.

   
 
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Question 15.
Auditors may use an audit tool based on E/M documentation guidelines to determine whether a practice's selection of E/M codes complies with regulations.

   
 
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Question 16.
What type of audit is performed internally after claims are submitted?

 
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Question 17.
What type of external audit is performed by payers before claims are processed?

 
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Question 18.
The term downcode means that the procedure code stated is for a procedure that is ______.

 
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Question 19.
The AMA documentation guidelines set up the rules for the correct selection of:

 
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Question 20.
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Correct code linkage establishes the medical for a service or procedure. 

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Question 21.
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A retrospective is performed

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Question 22.
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Assigning a higher level of CPT code than is warranted by the documented service is called

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Question 23.
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Coding is part of a medical practice's overall effort to follow regulations in many areas. 

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Question 24.
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In addition to facilitating high-quality patient care, an appropriately medical record serves as a legal document to verify services provided. 

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Question 25.
Within the question text below, there is one text entry field where you can enter your answer.

An is performed to judge whether a medical practice complies with applicable regulations for correct coding and billing. 

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