Errata – UHI 8E Workbook
NOTE: This revised answer key contains updated 2006 codes.
Title Page
Change “RHTT” to “RHIT”
Chapter 1: Health Insurance Specialist Career
ASSIGNMENT 1.1 Interview of a Professional
Page 4, Federal government. Delete “through a telephone-based system. Consult your
telephone directory under U.S. Government for a local number or call (912) 757-3000;
Federal Relay Service (800) 877-8339. The first number is not toll free, and charges
may result. Information is available on.” The resultant sentence will read, “Information
on federal government jobs is available from the Office of Personnel Management
through the Internet at http://www.usajobs.opm.gov.
ASSIGNMENT 1.2 Ready, Set, Get a Job!
Page 6, Change http://www.doleta.gov/etaindex.asp to http://www.doleta.gov
ASSIGNMENT 1.5 Multiple Choice Review
3.
Documentation submitted to an insurance company requesting reimbursement
for health care services provided is called a health insurance _____.
a.
claim
c.
explanation
b.
clause
d.
remittance
6.
Data published in the Occupational Outlook Handbook indicates the job
opportunities for health insurance specialists will increase by what percentage?
a.
5% to 10%
c.
20% to 30%
b.
10% to 20%
d.
30% to 40%
Chapter 2: Introduction to Health Insurance
No changes.
Chapter 3: Managed Health Care
Assignment 3.3 Multiple Choice Review
1.
Employees and dependents who join a managed care plan are called
a.
case managers.
c.
providers.
b.
enrollees.
d.
health plans.
5.
Which is the method of controlling health care costs and quality of care by
reviewing the appropriateness and necessity of care provided to patients?
a.
b.
administrative oversight
case management
c.
d.
quality assurance
utilization management
Chapter 4: Life Cycle of an Insurance Claim
Assignment 4.4 Multiple Choice Review
10.
The person in whose name the insurance policy is issued is the
a.
patient
c.
policyholder.
b.
plan.
d.
provider.
11.
The life cycle of an insurance claim is initiated when the
a.
health insurance specialist completes the CMS-1500 claim.
b.
patient pays the balance due after the provider has been reimbursed.
c.
payer sends the provider an electronic remittance advice.
d.
provider sends supporting documentation for unusual services.
Chapter 5: Legal and Regulatory Issues
Assignment 5.4 Multiple Choice Review
8.
An individual can conduct a comprehensive review of a practitioner’s past
actions by referring to the
a.
Clinical Data Abstracting Center.
b.
Federal Register.
c.
Healthcare Integrity and Protection Data Bank.
d.
Peer Review Improvement Act.
13.
An example of an overpayment is
a.
duplicate processing of a claim.
b.
incorrect application of EOB.
c.
payment based on reasonable charge.
d.
voided claim that was not processed.
Chapter 6: ICD-9-CM Coding
Assignment 6.3 Multiple Coding
8.
Cholesteatoma, middle ear and attic
Assignment 6.12 Multiple Choice Review
1.
Codes in slanted brackets are _____ of other conditions.
a.
eponyms
c.
modifiers
b.
manifestations
d.
subterms
2.
When coding a late effect, code the _____ first.
a.
acute disease
c.
original cause
b.
main symptom
d.
residual condition
15.
Four-digit disease codes in ICD-9-CM are called _____ codes.
a.
category
c.
subcategory
b.
classification
d.
subclassification
Chapter 7: CPT Coding
Assignment 7.2 Evaluation and Management (E/M) Coding
10.
Outpatient consult, problem focused, ordered by patient’s physician
Assignment 7.7 Medicine Coding
6.
One hour of psychological testing by psychiatrist, with interpretation and report
Assignment 7.10 Multiple Choice Review
15.
The CPT definition of counseling as it relates to E/M coding includes
a.
coordinating care by the provider.
b.
discussing diagnostic tests with a patient.
c.
providing psychotherapy to the patient.
d.
writing a special report to attach to the claim.
Chapter 8: HCPCS Coding
ASSIGNMENT 8.2 HCPCS Coding
Enteral and Parenteral Therapy (B4000-B9999)
27.
Delete “Category V”
Pathology and Laboratory Services (P0000-P9999)
Delete: 95. Platelets, each unit
Renumber 96. as 95.
Renumber 97.-101. as 96.-100.
101. Pinworm examination
ASSIGNMENT 8.3 Coding Drugs in HCPCS
1.
Tetracycline 250 mg injection
9.
NPH insulin 50 units via pump
ASSIGNMENT 8.5 Coding Case Studies
PATIENT CASE #1: The first line of P: should be “The patient was given an injection of
Zithromax 500 mg. …”
ASSIGNMENT 8.6 Multiple Choice Review
18.
Which modifier is used to describe the services of a clinical psychologist?
a.
-AH
c.
-AP
b.
-AM
d.
-AS
19.
Which modifier is used to describe the right upper eyelid?
a.
b.
-E1
-E2
c.
d.
-E3
-E4
Chapter 9: CMS Reimbursement Methodologies
ASSIGNMENT 9.2 Diagnosis-Related Groups
1.e. For a patient with cerebrovascular disease …
2.a. For an age 25 patient …
ASSIGNMENT 9.3 Multiple Choice Review
4.
Column (c) AMOUNT in table should be:
$576
$576
$432
$288
$144
16.
Jeffrey Border received care from his participating physician, who charged $300
… EGHP ($208) …
a.
$32
c.
$52
b.
$42
d.
$92
Chapter 10 Coding for Medical Necessity
No changes.
Chapter 11: Essential CMS-1500 Claim Instructions
Page 123, revise Q #20 as follows:
20.
The patient is divorced, has recently graduated from college, and is currently
unemployed. Which is the appropriate way to complete Block 8 on the CMS-1500
claim?
a.
Do not enter any information in Block 8.
b.
Enter an X in the MARRIED box, and leave the other boxes blank.
c.
Enter an X in the SINGLE box, and enter an X in the OTHER box.
d.
Enter an X in the SINGLE box, and leave the other boxes blank.
Chapter 12: Commercial Insurance
Page 131 should be page 136.
ASSIGNMENT 12.3 Multiple Choice Review
2.
Another term that can be used to indicate a fee-for-service plan is a ___ plan.
a.
liability
c.
prepaid
b.
noncapitated
d.
sliding-scale
3.
When CPT code 99070 is reported in Block 24D on the CMS-1500 claim,
information that describes 99070 is entered into which block?
a.
Block 19
c.
Block 23
b.
Block 22
d.
Block 24K
8.
What is entered in block 17a of the CMS-1500 claim when the payer is a
participating provider (PAR)?
a.
employer identification number (EIN)
b.
national provider identifier (NPI)
c.
provider identification number (PIN)
d.
provider’s social security number (SSN)
15.
A balance of $12.55 is due to the patient for services provided by Dr. Brown.
Which is entered in Block 30 of the CMS-1500 claim when the physician is a
PAR provider?
a.
0 00
c.
-12 55
b.
12 55
d.
CREDIT
20.
Which is entered in Block 33 if the provider is part of a group practice?
a.
employer identification number (EIN)
b.
group practice number (GRP#)
c.
national provider identifier (NPI)
d.
social security number (SSN)
Chapter 13: Blue Cross Blue Shield
ASSIGNMENT 13.3 Multiple Choice Review
15.
a.
BCBS Federal Program
Chapter 14: Medicare
Case 14-e: Delete Level IV and enter Level III for first date of service.
Chapter 15: Medicaid
ASSIGNMENT 15.3 Multiple Choice Review
3.
Which is included in a couple’s combined resources, according to Spousal …
d.
summer home
8.
d.
patient hospitalization within the expected length of stay
9.
b.
office visits
Chapter 16: TRICARE
Page 184, Case 16-e: Change “level IV” to “level III” in the first line under “Description of
Procedure or Service.”
Chapter 17: Workers’ Compensation
No changes.