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  1. Diabetic neuropathy is an example of a(n)
  2.  

    comorbidity

     

    eponym

     

    manifestation

     

    sequela

  3. 2 points  

Question 2

  1. When other insurers are initially liable for payment on a medical service or supply provided to a patient, Medicare classifies them as the _________ payer.

     

    Medicare secondary

     

    primary

     

    secondary

     

    supplemental

2 points  

Question 3

  1. What term is used to describe the types and categories of patients treated by a health care facility or provider?

     

    Medicare mix

     

    case mix

     

    secondary adverse

     

    covered population

2 points  

Question 4

  1. HCPCS level II modifiers consist of two characters that are

     

    alphabetic only

     

    alphabetic or alphanumeric

     

    alphanumeric only

     

    one letter and one symbol

2 points  

Question 5

  1. Provider services for inpatient medical cases are billed on what basis?

     

    fee-for-service

     

    global fee

     

    OPPS

     

    services not billed

2 points  

Question 6

  1. New CPT codes go into effect

     

    twice each year, on January 1 and July 1.

     

    twice each year, on October 1 and April 1.

     

    once each year, on October 1.

     

    once each year, on December 1.

2 points  

Question 7

  1. The legal business name of the practice is also called the

     

    administrative contractor

     

    billing entity

     

    provider identity

     

    third-party payer

2 points  

Question 8

  1. Modifiers are reported to

     

    alter or change the meaning of the code reported to the CMS-1500 claim.

     

    decrease the reimbursement amount to be processed by the payer.

     

    increase the reimbursement amount to be processed by the payer.

     

    indicate an alteration in the description of the procedure service performed.

2 points  

Question 9

  1. Each relative value component is multiplied by the geographic cost practice index (GCPI), and then each is further multiplied by a variable figure called the

     

    common denominator

     

    conversion factor

     

    related work total

     

    relative value unit

2 points  

Question 10

  1. Qualified diagnoses are a necessary part of the patient’s hospital and office record; however, physician offices are required to report

     

    qualified diagnoses for inpatients/outpatients

     

    qualified diagnoses related to outpatient procedures

     

    signs and symptoms in addition to qualified diagnoses

     

    signs and symptoms instead of qualified diagnoses

2 points  

Question 11

  1. RBRVS contains relative value components that consist of

     

    geographic cost, work experience, expense to the practice.

     

    intensity of work, expense to perform services, geographic location.

     

    liability and work expense, practice expense, malpractice expense.

     

    work expense, practice expense, malpractice expense.

2 points  

Question 12

  1. Q codes are used

     

    to identify services that would not ordinarily be assigned a CPT code (e.g, drugs, biologicals, and other types of medical equipment or services.

     

    to identify professional health care procedures and services that do not have codes identified in CPT.

     

    by state Medicaid agencies when no HCPCS level II permanent codes exist but are needed to administer the Medicaid program.

     

    by regional MACs when exisiting permanent national codes do not include codes needed to implement a regional MAC medical review coverage policy.

2 points  

Question 13

  1. “Incident to” relates to services provided by nonPARs that are defined as services

     

    provided incidental to other services provided by a physician.

     

    provided solely for the comfort and best interest of the beneficiary.

     

    provided without the nonparticipating provider’s supervision.

     

    that would otherwise not be reimbursed by the Medicare carrier.

2 points  

Question 14

  1. Which special codes allow payers the flexibility of establishing codes if they are needed before the next January 1 annual update?

     

    level III

     

    miscellaneous

     

    permanent

     

    temporary

2 points  

Question 15

  1. The prospective payment system providing a lump-sum payment that is dependent on the patient’s principal diagnosis, cormorbidities, complications, and principal and secondary procedures is

     

    ambulatory payment classifications (APCs)

     

    diagnosis-related groups (DRGs)

     

    Medicare Physician Fee Schedule (MPFS)

     

    resource-based relative value scale (RBRVS)

2 points  

Question 16

  1. Level I HCPCS codes are created by the

     

    AMA

     

    CMS

     

    DMERCs

     

    MACs

2 points  

Question 17

  1. Which statement is true of durable medical equipment?

     

    It can withstand repeated use.

     

    It is primarily used to serve a purpose of convenience.

     

    It is routinely purchased by individuals who are not suffering from an illness or injury.

     

    It is used by the patient in an outpatient rehabilitaiton facility.

2 points  

Question 18

  1. Level II HCPCS codes are created by the

     

    AMA

     

    CMS

     

    DMERCs

     

    MACs

2 points  

Question 19

  1. A bullet or black dot located to the left of a CPT code indicates

     

    a deleted CPT code that should not be used.

     

    a new, never previously published CPT code.

     

    a revised CPT code from an earlier publication.

     

    that special rules apply to the use of this code.

2 points  

Question 20

  1. Which organization is responsible for providing suppliers and manufacturers with assistance in determining HCPCS codes to be used?

     

    AMA

     

    CMS

     

    durable medical equipment, prosthetic, and orthotic supplies dealers.

     

    statistical analysis Medicare administrative contractor.

2 points  

Question 21

  1. HCPCS is a multilevel coding system that contains _________ levels.

     

    1

     

    2

     

    3

     

    4

2 points  

Question 22

  1. CPT-4 is published annually by

     

    AMA

     

    CMS

     

    WHO

     

    Medicare

2 points  

Question 23

  1. CPT index terms that are printed in boldface are called

     

    descriptors

     

    essential modifiers

     

    main terms

     

    subterms

2 points  

Question 24

  1. An example of a supplemental insurance plan is

     

    CHAMPUS

     

    Medicaid

     

    Medigap

     

    TRICARE

2 points  

Question 25

  1. The Medicare physician fee schedule amount for code 99213 is $100. Calculate the nonPAR allowed charge.

     

    $20

     

    $80

     

    $95

     

    $102.25

2 points  

Question 26

  1. The purpose of the creation of HCPCS codes was to furnish health care providers with a :

     

    mandate to use electronic claims submission

     

    method for obtaining higher reimbursement from Medicare.

     

    standardized language for reporting professional services, procedures, supplies, and equipment.

     

    standardized way of reporting inpatient and outpatient diagnoses.

2 points  

Question 27

  1. Medicare participating providers commonly report actual fees to Medicare but adjust fees after payment is received. The difference between the fee reported and the payment received is a

     

    fee adjustment

     

    limiting charge

     

    neutral charge

     

    write-off

2 points  

Question 28

  1. Nonparticipating (nonPAR) providers are restricted to billing at or below the

     

    fee-for-service

     

    limiting charge

     

    physician fee schedule

     

    relative value scale

2 points  

Question 29

  1. Modifiers are used with HCPCS codes to

     

    change the original description of the service, procedure, or supply item.

     

    decrease payment from Medicare.

     

    increase payment from Medicare.

     

    provide additional information regarding the product or service identified.

2 points  

Question 30

  1. When is it appropriate to file a patient’s secondary insurance claim?

     

    after a copy of the explanation of benefits is received by the practice

     

    after the explanation of benefits is received by the patient

     

    after the remittance advice is received by the medical practice

     

    at the same time the primary insurance claim is filed, if the primary and secondary payers are different

2 points  

Question 31

  1. Temporary additional payments over and above the OPPS payment made for certain innovative medical devices, drugs, and biologicals provided to Medicare beneficiaries are known as __________

     

    pass-through

     

    temporary pass-through

     

    transitional additional

     

    transitioal pass-through

2 points  

Question 32

  1. Prospective price-based rates are established by the

     

    actual charges for inpatient care reported to payers after discharge of the patient from the hospital.

     

    AMA

     

    payer, based on a particular category of patient.

     

    reported health care costs from which a per diem rate has been determined.

2 points  

Question 33

  1. When reporting CPT codes on the CMS-1500 claim, medical necessity is proven by

     

    attaching a special report to the CMS-1500 claim.

     

    linking the CPT code to its ICD-10-CM counterpart.

     

    reporting ICD-10-CM codes for the patient’s condition.

     

    sequencing CPT codes in a logical, chronological order.

2 points  

Question 34

  1. The deadline for filing Medicare claims is

     

    six months from the date of service

     

    three years from the date of service

     

    there is no deadline

     

    none of the above

2 points  

Question 35

  1. Birth dates are entered as ___________ on the CMS-1500 claim depending on block instructions.

     

    DD  MM  YYYY or DDMMYYYY

     

    MM DD YYYY  or MMDDYYYY

     

    MM DD YY or MMDDYY

     

    YYYY MM DD or YYYYMMDD

2 points  

Question 36

  1. A black triangle located to the left of a CPT code indicates that the code

     

    has been deleted and should not be used.

     

    has been revised from previous CPT publications.

     

    has special rules that apply to its use.

     

    is new to this edition of CPT.

2 points  

Question 37

  1. Hospice provides which services for patients?

     

    medical care in the home with the goal of keeping the patient out of the acute or long-term care setting

     

    medical care, as well as psychological, sociological, and spiritual care

     

    no copay if the patient has had a three-day minimum qualifying stay in an acute care facility

     

    temporary hospitalization for a terminally ill, dependent patient for the purpose of providing relief from duty for the nonpaid caregiver of that patient

2 points  

Question 38

  1. The ICD-10-CM system classifies

     

    morbidity

     

    mortality data

     

    provider services

     

    supplies and services

2 points  

Question 39

  1. When office-based services are performed at a facility other than the physician’s office, Medicare payments are reduced because the physician did not provide the supplies, drugs, utilities, or overhead. This payment reduction is called a(n)

     

    ambulatory payment classification

     

    facility write-off

     

    outpatient fee reduction

     

    site-of-service differential

2 points  

Question 40

  1. The reporting of diagnosis codes on the CMS-1500 claim is necessary to demonstrate

     

    accuracy of the procedure code

     

    higher payment

     

    medical necessity

     

    quality of care

2 points  

Question 41

  1. HCPCS “J codes” classify medications according to

     

    generic or chemical name of drug, route of administration, and dosage.

     

    generic or chemical name of drug, approval for Medicare coverage, and cost.

     

    product name of drug, method of delivery, and cost.

     

    product name of drug, route of administration, and dosage.

2 points  

Question 42

  1. The diagnosis that is the most significant condition for which procedures/services were provided is the

     

    first-listed diagnosis

     

    primary diagnosis

     

    principal diagnosis

     

    principal procedure

2 points  

Question 43

  1. CPT Appendix A contains information about

     

    deleted codes

     

    modifiers

     

    new code descriptions

     

    revised codes

2 points  

Question 44

  1. Medicare administrative contractors must keep Medicare fees within a $20 million spending ceiling, as stated in the Balanced Billing Act (BBA). This is called

     

    balanced budget rule

     

    budget neutrality

     

    Medicare spend-down

     

    the Medicare spending limit

2 points  

Question 45

  1. The document formerly known as the Explanation of Medicare Benefits is now known as the

     

    Advance Beneficiary Notice

     

    Medicare Payment Notice

     

    Medicare Remittance Advice

     

    Medicare Summary Notice

2 points  

Question 46

  1. The hospital assigns CPT codes to report

     

    inpatient ancillary services

     

    inpatient and outpatient surgery

     

    inpatient surgical procedures

     

    outpatient services and procedures

2 points  

Question 47

  1. The Medicare physician fee schedule amount for code 99213 is $100. The participating provider’s usual charge for this service is $125. Calculate the patient’s coinsurance amount.

     

    $20

     

    $25

     

    $76

     

    $80

2 points  

Question 48

  1. The unique identifier that CMS will assign to providers as part of the HIPAA requirements is called the

     

    Grp #

     

    NPI

     

    PIN

     

    UPIN

2 points  

Question 49

  1. Medicare is available to an individual who has worked at least

     

    5 years in Medicare-covered employment, is at least 65 years old, and is a permanent resident of the U.S.

     

    10 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the U.S.

     

    10 years in Medicare-covered employment, is at least 65 years old, and is a citizen or permanent resident of the U.S.

     

    25 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the U.S.

2 points  

Question 50

  1. Which resources should be referenced when determining the potential for Medicare reimbursement?

     

    CPT coding manual

     

    HCPCS coding manual

     

    ICD-10-CM coding manual

     

    Medicare Carriers Manual and Coverage Issues Manual

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