Exam 10: Auditing

If a medical office assistant is NOT sure about which evaluation and management (E/M) code to use, he or she should: A)not code the procedure. B)use the lowest possible code level. C)use an intermediate level code for the service. D)ask for help.

What is the purpose of an audit?

An expanded problem-focused history requires all of the following elements EXCEPT: A)chief complaint (CC). B)history of present illness (HPI). C)review of systems (ROS). D)past, family, and social history (PFSH).

A medical records audaA medical records audit conducted by a representative of a private or government payer is a(n)it conducted by a representative of a private or government payer is a(n) __________ audit.

When documentation does NOT support the level of service provided, and a lower-level code should have been selected, this practice is known as __________ .

Documentation of a review of systems (ROS) is required in all types of histories EXCEPT: A)problem focused. B)expanded problem focused. C)comprehensive. D)detailed.

All third-party payers follow the same rules and policies for submitting a clean claim.

A medical office specialist can find clinical examples for documenting medical necessity in the: A)CPT Index. B)CPT Appendix A. C)CPT Appendix C. D)CPT Guidelines.

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

Medical necessity of evaluation and management (E/M) services is based on all of the following factors EXCEPT the: A)acuity and severity of the problems addressed. B)complexity of documented comorbidities. C)physical scope encompassed by the problems. D)procedures performed to address the problem.

An extended history of present illness (HPI) will include one to three documented HPI elements.

If a chart note documents that the patient is status post-thyroid resection 10 years ago, this would be an example of the patient's: A)past history. B)family history. C)social history. D)history of present illness (HPI).

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

When auditing a medical chart, the auditor should verify that all documentation is initialed or signed by: A)the provider and the office manager. B)the provider. C)the office manager. D)all office staff.

An internal audit would determine: A)the coders' skill and knowledge. B)whether procedures were coded correctly. C)if additional training is needed for office staff. D)all of the above.

Documentation of an extended history of present illness (HPI) includes at least: A)one HPI element. B)two HPI elements. C)three HPI elements. D)four HPI elements.

Physician services that are more intense than the work of other evaluation and management (E/M) services and that involve frequent personal assessment by the physician would be coded as: A)consultation. B)critical care. C)subsequent care. D)initial hospital care.

A prepayment audit would verify: A)the date of service and the patient's insurance identification number. B)accurate coding and billing. C)appropriate documentation of the visit. D)completeness of progress reports.

The risk of significant complication, morbidity, and/or mortality is based on the risks of: A)the presenting problems. B)the diagnostic procedures. C)the possible management options. D)all of the above.

To consider time as the key factor in determining the level of evaluation and management (E/M) services, the counseling and/or coordination of care must make up: A)10% of the encounter. B)25% of the encounter. C)50% of the encounter. D)75% of the encounter.