EMR Chapter 6 Asessment

In many managed care plans, patients are responsible for paying a portion of the charges (fixed amount) at the time services are rendered. This is known as the

co-pay.

The out-of-pocket payment amount that a policyholder must meet before insurance coverage begins is called the

deductible

Which of the following is a true statement about using practice management (PM) software for an office's claims management process?

It allows for more efficient tracking and reporting of daily transactions.

Which of the following is not part of a paper encounter form (Superbill)?

the medical history

Nick Malone underwent an appendectomy by Dr. Lopez on September 5. Dr. Lopez documented appendicitis as Mr. Malone's diagnosis. The diagnosis was documented

to show medical necessity.

The actual claim process begins when the patient

makes the appointment.

Procedures, services, and tangible items such as durable medical equipment are converted to which numeric codes?

HCPCS and CPT

ICD-10-CM/PCS was implemented because

ICD-9-CM no longer meets the needs of healthcare organizations.

Which of the following is a true statement about ICD-10-CM/PCS?

There are more codes than in the ICD-9-CM version.

As of October 1, 2015, the coding system used to code diagnoses in any healthcare setting is

ICD-10-CM.

The coding system used in illustrating the tangible items such as supplies is

HCPCS level 2.

Knowingly billing for services that are not medically necessary or that did not happen at all is

fraud

Which is not true of ACOs?

Sharing of patient information through an EHR is necessary.

As a result of which piece of legislation are hospitals and providers reimbursed based on proof that they are rendering high-quality, coordinated care to their patients?

Affordable Care Act (ACA)

The process of reviewing claims to determine payment is called

adjudication

The primary person covered by an insurance plan is the

subscriber

The last step in the revenue cycle is

follow up payments and collections.

Which entity investigates suspected cases of fraud?

Office of Inspector General

Dr. Simmons' office has been notified that they are being audited due to a complaint that was filed by a Medicare patient regarding their billing practices. The audit will be conducted by the

Office of Inspector General.

A formal, written document that describes how a hospital or physician practice ensures that rules, regulations, and standards are being adhered to is called a/an

compliance plan.