Question 1

What are the three types of audits?

Accepted Answer

The three types are

Question 2

To consider time as the key factor in determining the level of E/M services, the counseling and/or coordination of care must make up more than:

Accepted Answer

A)  10% of the encounter. 
B)  25% of the encounter. 
C)  50% of the encounter. 
D)  75% of the encounter. 
A)  10% of the encounter. 
B)  25% of the encounter. 
C)  50% of the encounter. 
D)  75% of the encounter.

Question 3

If a patient complains of a dull ache in the left ear over the past 24 hours, he or she would be describing:

Accepted Answer

A)  one HPI element. 
B)  two HPI elements. 
C)  three HPI elements. 
D)  four HPI elements. 
A)  one HPI element. 
B)  two HPI elements. 
C)  three HPI elements. 
D)  four HPI elements.

Question 4

Elements of medical decision making include all of the following EXCEPT:

Accepted Answer

A)  number of diagnoses or management options. 
B)  number of procedures or services provided. 
C)  amount and/or complexity of data to be reviewed. 
D)  risk of significant complications, morbidity, and/or mortality. 
A)  number of diagnoses or management options. 
B)  number of procedures or services provided. 
C)  amount and/or complexity of data to be reviewed. 
D)  risk of significant complications, morbidity, and/or mortality.

Question 5

Match the following
-The term used when a code reports a procedure that is less involved than that documented in the patient chart.

Accepted Answer

A)  downcoded 
B)  retrospective 
C)  internal 
D)  prospective 
E)  complete review of systems
F) upcoded
G) external
H) code edits
I) extended review of systems
J) problem-pertinent review of systems 
A)  downcoded 
B)  retrospective 
C)  internal 
D)  prospective 
E)  complete review of systems
F) upcoded
G) external
H) code edits
I) extended review of systems
J) problem-pertinent review of systems

Question 6

Audits performed on a regular basis will confirm that documentation and coding were appropriate for the level of service provided or will identify problems.

Accepted Answer

A) True 
 B)False

Question 7

If documentation in the patient chart supports a lower level of service than that coded, the error would be called:

Accepted Answer

A)  upcoding. 
B)  downcoding. 
C)  bundling. 
D)  unbundling. 
A)  upcoding. 
B)  downcoding. 
C)  bundling. 
D)  unbundling.

Question 8

An independent medical record review completed after payment is received from an insurance carrier is a(n) ________ audit.

Accepted Answer

The answer of An independent medical record review completed after...

Question 9

The most extensive type of history is:

Accepted Answer

A)  problem focused. 
B)  expanded problem focused. 
C)  comprehensive. 
D)  detailed. 
A)  problem focused. 
B)  expanded problem focused. 
C)  comprehensive. 
D)  detailed.

Question 10

A medical chart that reports an exam involving at least nine organ systems or body areas would be documentation of a(n):

Accepted Answer

A)  problem-focused exam. 
B)  expanded problem-focused exam. 
C)  detailed exam. 
D)  comprehensive exam. 
A)  problem-focused exam. 
B)  expanded problem-focused exam. 
C)  detailed exam. 
D)  comprehensive exam.

Question 11

In general, medical decision making with respect to a diagnosed problem is harder than that for an identified but undiagnosed problem.

Accepted Answer

A) True 
 B)False

Question 12

Physician services that are more intense than the work of other E/M services and that involve frequent personal assessment by the physician would be coded as:

Accepted Answer

A)  consultation. 
B)  critical care. 
C)  subsequent care. 
D)  initial hospital care. 
A)  consultation. 
B)  critical care. 
C)  subsequent care. 
D)  initial hospital care.

Question 13

In a patient's chart, a diagnosis:

Accepted Answer

A)  must be explicitly stated. 
B)  can be stated or implied. 
C)  must be part of the HPI. 
D)  must be coded. 
A)  must be explicitly stated. 
B)  can be stated or implied. 
C)  must be part of the HPI. 
D)  must be coded.

Question 14

An audit tool utilizes number counts in different categories to determine if the correct E/M code was used in billing an insurance carrier.

Accepted Answer

A) True 
 B)False

Question 15

A brief statement or notation indicating "negative" or "normal" is sufficient to document normal findings related to unaffected area(s) or asymptomatic organ system(s).

Accepted Answer

A) True 
 B)False

Question 16

If a physician documents that a patient's maternal grandmother died of breast cancer, he or she would be documenting the patient's ________ history.

Accepted Answer

The answer of If a physician documents that a patient's...

Question 17

An audit done by a practice before submitting a claim to an insurance company would be referred to as a(n) ________ audit.

Accepted Answer

The answer of An audit done by a practice before...

Question 18

Match the following
-The term used when a code reports a procedure that is more involved than that documented in the patient chart.

Accepted Answer

A)  downcoded 
B)  retrospective 
C)  internal 
D)  prospective 
E)  complete review of systems
F) upcoded
G) external
H) code edits
I) extended review of systems
J) problem-pertinent review of systems 
A)  downcoded 
B)  retrospective 
C)  internal 
D)  prospective 
E)  complete review of systems
F) upcoded
G) external
H) code edits
I) extended review of systems
J) problem-pertinent review of systems

Question 19

Time is considered the controlling factor for determining the level of E/M service if counseling with the patient or family members constitutes more than 50% of the encounter.

Accepted Answer

A) True 
 B)False

Question 20

What is the difference between a prospective and a retrospective audit?

Accepted Answer

A prospective audit is done be

What are the three types of audits?

To consider time as the key factor in determining the level of E/M services, the counseling and/or coordination of care must make up more than:

If a patient complains of a dull ache in the left ear over the past 24 hours, he or she would be describing:

Elements of medical decision making include all of the following EXCEPT:

Match the following -The term used when a code reports a procedure that is less involved than that documented in the patient chart.

Audits performed on a regular basis will confirm that documentation and coding were appropriate for the level of service provided or will identify problems.

If documentation in the patient chart supports a lower level of service than that coded, the error would be called:

An independent medical record review completed after payment is received from an insurance carrier is a(n) ________ audit.

The most extensive type of history is:

A medical chart that reports an exam involving at least nine organ systems or body areas would be documentation of a(n):

In general, medical decision making with respect to a diagnosed problem is harder than that for an identified but undiagnosed problem.

Physician services that are more intense than the work of other E/M services and that involve frequent personal assessment by the physician would be coded as:

In a patient's chart, a diagnosis:

An audit tool utilizes number counts in different categories to determine if the correct E/M code was used in billing an insurance carrier.

A brief statement or notation indicating "negative" or "normal" is sufficient to document normal findings related to unaffected area(s) or asymptomatic organ system(s).

If a physician documents that a patient's maternal grandmother died of breast cancer, he or she would be documenting the patient's ________ history.

An audit done by a practice before submitting a claim to an insurance company would be referred to as a(n) ________ audit.

Match the following -The term used when a code reports a procedure that is more involved than that documented in the patient chart.

Time is considered the controlling factor for determining the level of E/M service if counseling with the patient or family members constitutes more than 50% of the encounter.

What is the difference between a prospective and a retrospective audit?

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Understanding Managed Care: Medical Contracts and Ethics

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Explanation of Benefits and Payment Adjudication

Refunds and Appeals

Workers Compensation

Filters

Exam 9: Auditing

What are the three types of audits?

To consider time as the key factor in determining the level of E/M services, the counseling and/or coordination of care must make up more than:

If a patient complains of a dull ache in the left ear over the past 24 hours, he or she would be describing:

Elements of medical decision making include all of the following EXCEPT:

Match the following -The term used when a code reports a procedure that is less involved than that documented in the patient chart.

Audits performed on a regular basis will confirm that documentation and coding were appropriate for the level of service provided or will identify problems.

If documentation in the patient chart supports a lower level of service than that coded, the error would be called:

An independent medical record review completed after payment is received from an insurance carrier is a(n) ________ audit.

The most extensive type of history is:

A medical chart that reports an exam involving at least nine organ systems or body areas would be documentation of a(n):

In general, medical decision making with respect to a diagnosed problem is harder than that for an identified but undiagnosed problem.

Physician services that are more intense than the work of other E/M services and that involve frequent personal assessment by the physician would be coded as:

In a patient's chart, a diagnosis:

An audit tool utilizes number counts in different categories to determine if the correct E/M code was used in billing an insurance carrier.

A brief statement or notation indicating "negative" or "normal" is sufficient to document normal findings related to unaffected area(s) or asymptomatic organ system(s).

If a physician documents that a patient's maternal grandmother died of breast cancer, he or she would be documenting the patient's ________ history.

An audit done by a practice before submitting a claim to an insurance company would be referred to as a(n) ________ audit.

Match the following -The term used when a code reports a procedure that is more involved than that documented in the patient chart.

Time is considered the controlling factor for determining the level of E/M service if counseling with the patient or family members constitutes more than 50% of the encounter.

What is the difference between a prospective and a retrospective audit?

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Understanding Managed Care: Medical Contracts and Ethics

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Explanation of Benefits and Payment Adjudication

Refunds and Appeals

Workers Compensation

Filters