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Exam 7: Insurance and Coding

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Question 31

Multiple Choice

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The ________________________ is made up of three characters in ICD-10-CM coding.

A) Category
B) Subcategory
C) Code
D) Classification

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Question 32

Multiple Choice

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A physician who joins an insurance plan is a(n) _____________________.

A) participating provider
B) nonparticipating provider
C) active provider
D) attending provider

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Question 33

Multiple Choice

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Michael last visited his physician, which is a single-physician office practice, in September 2006. He is at the office today for a sore throat and chest congestion. Since he was already a patient, the medical insurance coder submitted an established patient E/M code to Michael's insurance carrier for payment. The insurance carrier requested additional documentation regarding the visit. Which of the following may have been the reason?

A _______________________ is a certain amount of allowable or covered medical expense the insured must incur before the insurance carrier will begin paying benefits.

Medical insurance is a policy, or certificate of coverage, between a __________, called the "policyholder," and an insurance company, or ___________.

The Evaluation and Management section of procedure codes falls within which range of CPT codes?

What is the payment system Medicare uses for establishing payment for hospital stays?

What codes are used to include specified conditions that cannot be classified with any other code?

________________ is a federal health plan that provides insurance to citizens and permanent residents aged 65 and older; people with disabilities, including kidney failure; and spouses of entitled individuals.

Medicare Part ____, also known as hospital insurance, covers hospital, nursing facility, home health, hospice, and inpatient care.

During Michael's sick visit a CBC was performed. Which type of code(s) should be used for the service?

The letters "CM" in ICD-10-CM stand for ________________.

Which is the largest private-sector payer in the U.S.?

ICD-10-CM codes are the _______ revision of ICD.

PPOs _______ require referrals to specialists.

The Medicine (except Anesthesiology) section of procedure codes falls within which range of CPT codes?

Hope's insurance policy states she has a coinsurance of 90/10 of covered services. When she received her notice from the insurance carrier, it stated that the charges for her last office visit were not allowed. How much of the charges is Hope responsible for?

HMOs help control access to services by requiring the patient to select a ______________.

Updates to the diagnostic coding system are published ___________________.

Carol and her husband, Greg, just had a baby. Carol is laid off from her job and Greg works part-time at a gas station. They are without insurance coverage. The administrative medical assistant should supply Carol and Greg with information to contact: