HIM350_Final_Exam_Study_Guide

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American Military University *

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350

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Mechanical Engineering

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Apr 3, 2024

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HIM350 Final Exam Study Guide YOU MAY WANT TO PRINT THIS GUIDE. 1. The Final Exam is open book and open notes. The maximum time you can spend in the exam is 3 hours, 30 minutes. If you have not clicked the Submit for Grading button by then, you will be exited from the exam automatically. In the Final Exam environment, the Windows clipboard is disabled, so you will not be able to copy exam questions or answers to or from other applications. 2. You should click the Save Answers button in the exam frequently. This helps prevent connection timeouts that might occur with certain Internet service providers and also minimizes lost answers in the event of connection problems. If your Internet connection does break, when you reconnect, you will normally be able to get back into your Final Exam without any trouble. Remember, though, that the exam timer continues to run while students are disconnected, so students should try to log in again as quickly as possible. The Help Desk cannot grant any student additional time on the exam. 3. See the Syllabus section "Due Dates for Assignments & Exams" for due date information. 4. Reminders  You will only be able to enter your online Final Exam one time.  Click the Save Answers button often.  If you lose your Internet connection during your Final Exam, log on again and try to access it. If you are unable to enter the Final Exam, first contact the Help Desk and then your instructor.  You will always be able to see the time remaining in the Final Exam at the top right of the page. 5. Assessments With Multiple Pages  Make sure to click the Save Answers button before advancing to the next page (we also suggest clicking on Save Answers while you are working).  Complete all of the pages before submitting your Final Exam for instructor review.  Do NOT use your browser's Back and Forward buttons during the Final Exam.  Please use the provided links for navigation. 6. Submitting Your Final Exam  When you are finished with the Final Exam, click on the Submit for Grading button.  Please note: Once you click the Submit for Grading button, you will NOT be able to edit or change any of your answers. 7. Exam Questions  There are 25 randomly selected multiple choice questions each worth 4 points, for a total of 100 points.  There are 7 randomly selected short answer questions each worth 10 points, for a total of 70 points.  The Final Exam covers all course TCOs and Weeks 1–7.

 The Final Exam consists of three pages, which can be completed in any order. You may go back and forth between the pages.  The Final Exam questions are pooled. This means that not everyone will have the same questions. Even if you do have some of the same questions, they may not be in the same order. These questions are distributed among the TCOs. The entire exam is worth 170 points.  On the essay questions, your answers should be succinct, should fully address each part of the question, and should demonstrate your knowledge and understanding in a concise but complete manner. Most essay questions require answers that are a couple of paragraphs (not a couple of sentences) that directly speak to each part of the question. Some students opt to work on the essay questions first, due to their higher point value and the length of time needed to adequately address each question, but this is entirely your choice.  Remember to always use proper citation when quoting other sources. This means that ANY borrowed material (even a short phrase) should be placed in quotation marks with the source (URL, author/date/page number) immediately following the end of the passage (the end quote). Changing a few words in a passage does NOT constitute putting it in your own words, and proper citation is still required. Borrowed material should NOT dominate a student’s work; it should only be used sparingly to support the student’s thoughts, ideas, and examples. Heavy usage of borrowed material (even if properly cited) can jeopardize the points for that question. Uncited material can jeopardize a passing grade on the exam. As a part of our commitment to academic integrity, your work may be submitted to turnitin.com, an online plagiarism-checking service. So please be VERY mindful of proper citation. 8. Some of the key study areas are shown below. Although these are key areas, remember that the exam is comprehensive for all of the assigned course content and this study guide may not be all- inclusive. TCO 1: Given a coding task, apply ICD-10-CM coding conventions and guidelines to accurately code and sequence a variety of diagnoses, illnesses, injuries, and procedures using exercises and examples of patient records. o Assign diagnosis codes for infectious and parasitic diseases. o Assign diagnosis codes for neoplasms. o Assign diagnosis codes for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. o Assign diagnosis codes for endocrine, nutritional, and metabolic diseases. o Assign diagnosis codes for mental and behavioral disorders. o Assign diagnosis codes for diseases of the nervous system. o Assign diagnosis codes for diseases of the eye and adnexa. o Assign diagnosis codes for diseases of the ear and mastoid process. o Assign diagnosis codes for diseases of the circulatory system. o Assign diagnosis codes for diseases of the respiratory system. o Assign diagnosis codes for diseases of the digestive system. o Assign diagnosis codes for diseases of the skin and subcutaneous tissue. o Assign diagnosis codes for diseases of the musculoskeletal system and connective tissue. o Assign diagnosis codes for diseases of the genitourinary system.

o Assign diagnosis codes for pregnancy, childbirth, and the puerperium. o Assign diagnosis codes for certain conditions originating in the perinatal period. o Assign diagnosis codes for congenital malformations, deformities, and chromosomal abnormalities. o Assign diagnosis codes for symptoms, signs, and abnormal clinical and laboratory findings not elsewhere classified. o Assign diagnosis codes for injuries. o Assign diagnosis codes for poisoning and certain other consequences of external causes. o Assign diagnosis codes to external causes of morbidity. o Assign diagnosis codes for factors influencing health. TCO 2: Given a scenario and recognizing the widespread use of the International Classification of Diseases (ICD) system within different settings, demonstrate a thorough understanding of the history, purpose, and uses of this particular coding classification system. o Trace the historical development of the International Classifications of Diseases, discussing the role of the governmental agencies that have been involved. o Outline the purposes and uses of ICD-10-CM in a hospital setting as well as in outpatient and clinical settings. o Explain key aspects of the overall structure and function of the ICD-10-CM coding system. o Describe the hospital inpatient prospective payment system, including how payment rates are determined; discuss how this relates to ICD-10-CM coding. o Describe the format and characteristics of the ICD-10-CM classification system. TCO 3: Given a sample patient record, conduct analysis to ensure documentation in the health record supports the diagnosis and reflects the patient’s progress, clinical findings, and discharge status. o Review and abstract health records and identify diseases/conditions for coding that are supported by the documentation in the sample patient record. o Review and abstract health records and identify when it is appropriate to initiate a physician query and what clinical indicators would be included on the query form. o Review the documentation in a health record to appropriately recognize types of neoplasm behavior and to identify primary and secondary malignant neoplasms according to site. o Review clinical documentation to appropriately recognize types of anemias and identify when there is clinical evidence for a higher degree of specificity or severity. TCO 4: Given a sample patient record, analyze procedural statements and operative notes to determine the objective of the procedure and the applicable root operation. o Define the meaning of the root operation and the nine subgroupings of the root operations in the Medical and Surgical section. o Discuss guidelines specific to Medical and Surgical section root operations, general guidelines, multiple procedures, discontinued procedures, and other guidelines specific to certain root operations.

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TCO 5: Given a copy of the ICD-10-PCS, utilize coding conventions and guidelines to accurately build ICD-10-PCS codes for given procedures. o List the seven characters that compose an ICD-10-PCS code. o Identify the 16 sections of ICD-10-PCS and distinguish among the Medical and Surgical, Medical and Surgical-Related, and Ancillary sections. TCO 6: Given a coding scenario and sample patient record, interpret and apply coding concepts and conventions according to AMA guidelines. o Identify the conditions that must be met before a procedure or service is included in the CPT manual. o Describe the contents of CPT: sections, subsections, subcategory headings, procedures, appendices, and index. o Describe how the structure of the codebook supports the steps in the coding process. o Describe Category I, II, and III CPT codes. o Explain the six major sections of the CPT codebook: 1. Evaluation and Management; 2. Anesthesiology; 3. Surgery; 4. Radiology; 5. Pathology and Laboratory; and 6. Medicine. TCO 7: Given a coding scenario, demonstrate accuracy in applying the CPT coding process. o Outline the basic steps in the CPT coding process. o Demonstrate proper application of CPT coding guidelines to code various types of services and procedures. o Explain when an unlisted code must be used. o Identify symbols used in the CPT codebook. o Explain current approved guidelines to assign and sequence the correct procedure codes for ambulatory services. o Identify the appropriate code for the professional versus technical component when applicable. TCO 8: Given a CPT coding scenario, demonstrate ability to select and correctly append the appropriate modifier. o Identify the purpose of modifiers. o Explain the uses of modifiers for surgical procedures. o Differentiate between the modifiers identified for Hospital Outpatient Use and the complete list of CPT modifiers used by physicians in various settings. o Differentiate between modifiers 73 and 74. o Identify the proper use of modifier 59.

o Identify Medicare Transmittals and CPT Assistant pertaining to the use of modifiers. o Explain how to append a CPT code with the correct modifier. TCO 9: Given coding scenarios, accurately assign Healthcare Common Procedure Coding System (HCPCS) Level II codes. o Identify the three levels of HCPCS codes. o Explain Level II HCPCS codes for services not found in the CPT coding manual. o Describe the use of HCPCS Level II modifiers. o Given an example of individuals or groups seeking healthcare insurance in the United States, analyze available payment methods. TCO 10: Given a coding scenario, accurately assign ICD-10-CM, ICD-10-PCS, and CPT/HCPCS codes using an encoder software tool. o Describe how technology can be effectively used to support the coding process, discussing the history, development, basic technology, and practical functions of encoder software. o Use the encoder software (through the Lab) to complete coding exercises to accurately code diagnoses and procedures. o Research the types of encoder products available on the market; assess strengths and weaknesses among the products identified. TCO 11: Given an example of a reimbursement methodology, trace its development along a historical timeline and relate it to HIM practices. o Describe the elements of the inpatient prospective payment system. o Evaluate the relative value unit and the major components of the resource-based relative value scale payment system. o Trace the origins of managed care. o Differentiate fee-for-service reimbursement from episode-of-care reimbursement. o Define basic language associated with reimbursement by commercial healthcare insurance plans and by Blue Cross and Blue Shield. o Recall the history of Medicare and Medicaid programs in the United States. TCO 12: Given the major steps in the billing cycle for an acute care hospital setting, relate the central role of the chargemaster to the requirements for billing and claims payment processing. o Identify the provisions of healthcare insurance policies and the elements of a healthcare insurance identification card. o Explain the grouping models and payment formulate associated with reimbursement under Medicare and Medicaid perspective payment systems in post-acute care.

o Describe the importance of effective revenue cycle management for a provider's fiscal stability. o Evaluate the role of the chargemaster related to the hospital billing process. TCO 13: Given an example of individuals or groups seeking healthcare insurance in the United States, analyze available payment methods. o Identify the most commonly used third party payers in your state. o Discuss the impact of the Employee Retirement Income Security Act (ERISA) on healthcare reimbursement. o Examine the role of a gatekeeper in an employer-sponsored managed care plan; note differences between a staff model HMO and a more open model. o List the ways benefit plans elements, such as preauthorization, coordination of benefits, copayments, deductibles, and use of formularies have on the reimbursement process in a given setting. o Identify examples of the health information professional's role in the provider revenue cycle (such as coding, responding to request for copies of records, or follow-up on denials). o Explain the components of the Affordable Care Act. o Describe the impact of HIPAA on health care reimbursement. 9. Areas that were discussed in the Discussion areas will be prime targets. 10. Assignments will also be prime targets for revisiting. 11. Reviewing the TCOs, which are listed below for your convenience, will also be a great preparation for the Final Exam. 1 Given a coding task, apply ICD-10-CM coding conventions and guidelines to accurately code and sequence a variety of diagnoses, illnesses, injuries, and procedures using exercises and examples of patient records. 2 Given a scenario and recognizing the widespread use of the International Classification of Diseases (ICD) system within different settings, demonstrate a thorough understanding of the history, purpose, and uses of this particular coding classification system. 3 Given a sample patient record, conduct analysis to ensure documentation in the health record supports the diagnosis and reflects the patient’s progress, clinical findings, and discharge status. 4 Given a sample patient record, analyze procedural statements and operative notes to determine the objective of the procedure and the applicable root operation. 5 Given a copy of the ICD-10-PCS, utilize coding conventions and guidelines to accurately build

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ICD-10-PCS codes for given procedures. 6 Given a coding scenario and sample patient record, interpret and apply coding concepts and conventions according to AMA guidelines. 7 Given a coding scenario, demonstrate accuracy in applying the CPT coding process. 8 Given a CPT coding scenario, demonstrate ability to select and correctly append the appropriate modifier. 9 Given coding scenarios, accurately assign Healthcare Common Procedure Coding System (HCPCS) Level II codes. 10 Given a coding scenario, accurately assign ICD-10-CM, ICD-10-PCS, and CPT/HCPCS codes using an encoder software tool. 11 Given an example of a reimbursement methodology, trace its development along a historical timeline and relate it to HIM practices. 12 Given the major steps in the billing cycle for an acute care hospital setting, relate the central role of the chargemaster to the requirements for billing and claims payment processing. 13 Given an example of individuals or groups seeking healthcare insurance in the United States, analyze available payment methods. Finally, if you have any questions for me, please post them to our Q & A Forum or e-mail me. Good luck on the exam!