INSURANCE & CODING CCMA 3.0

Before Aria comes in for her scheduled medical check-up, what should be ensured?

• That Aria is informed about the location of the clinic

• That proper paperwork is reviewed, completed, and signed by Aria

• That Aria is given a tour of the facility

• That Aria is immediately taken to the doctor

Answer explanation

Proper paperwork ensures legal consent and necessary information for medical services, making it a crucial step when patients come in for treatment.

What additional information do the registration forms at Dr. Smith's clinic provide for new patients?

• Directions to the nearest pharmacy

• Information about the patient's next of kin

• Expectations and office policies and procedures

• Details about the patient's dietary restrictions

Answer explanation

The correct answer is 'Expectations and office policies and procedures' as new patient forms typically provide information on what is expected of the patient and the policies and procedures of the office.

During Oliver's first visit to a new healthcare facility, which of the following documents is NOT typically required as part of the new patient documentation?

• Organization’s Notice of Privacy Practices (NPP)

• Patient’s Bill of Rights

• Assignment of Benefits

• Patient's dietary preferences

Answer explanation

The correct choice is 'Patient's dietary preferences' as it is not typically mentioned as part of the documentation for new patients, unlike the other options which are commonly included.

What is the purpose of a patient flow sheet in medical documentation?

• Records the diagnosis and procedures covered during the current visit

• Clinical notes that include history of present illness and current medications list

• Records and tracks patient health data, such as vitals or lab results

• Includes results from lab tests that were performed

Answer explanation

The purpose of a patient flow sheet is to record and track patient health data, such as vitals or lab results, making it the correct choice.

During Avery's visit to the clinic, what does the encounter form/Superbill document?

• Clinical notes that include history of present illness and current medications list

• Records and tracks patient health data, such as vitals or lab results

• Includes results and interpretation from radiology services provided

• Records the diagnosis and procedures covered during Avery's current visit

Answer explanation

The encounter form/Superbill document in a medical setting records the diagnosis and procedures covered during the current visit, making it the correct choice.

During Avery's routine check-up, what information is typically included in the encounter notes?

• Records and tracks patient health data, such as vitals or lab results

• Clinical notes that include history of present illness and current medications list

• Records the diagnosis and procedures covered during the current visit

• Includes results from lab tests that were performed

Answer explanation

Encounter notes typically include clinical notes with history of present illness and current medications list, making this the correct choice.

When Jackson submits a claim for his recent surgery, what must the diagnosis and procedure code link to in order to be considered valid by the insurance company?

• Medical necessity

• Patient's request

• Doctor's preference

• Insurance company's guidelines

Answer explanation

The diagnosis and procedure code must link to medical necessity in order to support a claim for medical services. This ensures that the services provided are justified and required for the patient's health.

During a visit to the clinic, James was given a document for his medical services. What is this document also referred to as?

• Superbill

• Invoice

• Prescription

• Medical record

Answer explanation

The encounter form is also referred to as a Superbill, making it the correct choice among the options provided.

Emma visited her doctor with a sore throat. What does the diagnosis code (ICD-10-CM) Emma's doctor used represent?

• The cost of Emma's medical services

• The reason for Emma's visit, such as tonsillitis or an annual exam

• The type of medication prescribed to Emma

• The duration of Emma's medical service

Answer explanation

The diagnosis code (ICD-10-CM) represents the reason for the visit, such as tonsillitis or an annual exam.

Imagine Abigail is a healthcare manager. What is the purpose of utilization review in her context?

• To provide legal advice to healthcare providers

• To inform providers about policy payments, benefits, and authorizations

• To schedule appointments for patients

• To conduct medical research

Answer explanation

Utilization review in healthcare informs providers about policy payments, benefits, and authorizations to ensure appropriate and cost-effective care.