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Diabetic neuropathy is an example of a(n) comorbidity eponym manifestation sequela2 points   Question 2When 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 supplemental2 points   Question 3What 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 population2 points   Question 4HCPCS level II modifiers consist of two characters that are alphabetic only alphabetic or alphanumeric alphanumeric only one letter and one symbol2 points   Question 5Provider services for inpatient medical cases are billed on what basis? fee-for-service global fee OPPS services not billed2 points   Question 6New 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 7The legal business name of the practice is also called the administrative contractor billing entity provider identity third-party payer2 points   Question 8Modifiers 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 9Each 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 unit2 points   Question 10Qualified 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 diagnoses2 points   Question 11RBRVS 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 12Q 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″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 14Which special codes allow payers the flexibility of establishing codes if they are needed before the next January 1 annual update? level III miscellaneous permanent temporary2 points   Question 15The 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 16Level I HCPCS codes are created by the AMA CMS DMERCs MACs2 points   Question 17Which 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 18Level II HCPCS codes are created by the AMA CMS DMERCs MACs2 points   Question 19A 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 20Which 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 21HCPCS is a multilevel coding system that contains _________ levels. 1 2 3 42 points   Question 22CPT-4 is published annually by AMA CMS WHO Medicare2 points   Question 23CPT index terms that are printed in boldface are called descriptors essential modifiers main terms subterms2 points   Question 24An example of a supplemental insurance plan is CHAMPUS Medicaid Medigap TRICARE2 points   Question 25The Medicare physician fee schedule amount for code 99213 is $100. Calculate the nonPAR allowed charge. $20 $80 $95 $102.252 points   Question 26The 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 27Medicare 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-off2 points   Question 28Nonparticipating (nonPAR) providers are restricted to billing at or below the fee-for-service limiting charge physician fee schedule relative value scale2 points   Question 29Modifiers 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 30When 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 different2 points   Question 31Temporary 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-through2 points   Question 32Prospective 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 33When 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 34The 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 above2 points   Question 35Birth 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 YYYYMMDD2 points   Question 36A 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 37Hospice 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 patient2 points   Question 38The ICD-10-CM system classifies morbidity mortality data provider services supplies and services2 points   Question 39When 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 differential2 points   Question 40The reporting of diagnosis codes on the CMS-1500 claim is necessary to demonstrate accuracy of the procedure code higher payment medical necessity quality of care2 points   Question 41HCPCS “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 42The diagnosis that is the most significant condition for which procedures/services were provided is the first-listed diagnosis primary diagnosis principal diagnosis principal procedure2 points   Question 43CPT Appendix A contains information about deleted codes modifiers new code descriptions revised codes2 points   Question 44Medicare 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 limit2 points   Question 45The 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 Notice2 points   Question 46The hospital assigns CPT codes to report inpatient ancillary services inpatient and outpatient surgery inpatient surgical procedures outpatient services and procedures2 points   Question 47The 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 $802 points   Question 48The unique identifier that CMS will assign to providers as part of the HIPAA requirements is called the Grp # NPI PIN UPIN2 points   Question 49Medicare 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 50Which 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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