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| 11550451041 | The case-mix management system that utilizes information from the Minimum Data Set (MDS) in long term care settings is called A. Medicare Severity Diagnosis Related Groups (MS-DRGs) B. Resource Based Relative Value System (RBRVS) C. Resource Utilization Groups (RUGs) D. Ambulatory Patient Classifications (APCs) | C | 0 | |
| 11550459848 | The prospective payment system used to reimburse home health agencies for patients with Medicare utilizes data from the. A. MDS (Minimum Data Set) B. OASIS (Outcome and Assessment Information Set) C. UHDDS (Uniform Hospital Discharge Data Set) D. UACDS (Uniform Ambulatory Core Set) | B | 1 | |
| 11550474357 | Under APCs, the payment status indicator "N" means that payment A. is for ancillary services B. is for a clinic or an emergency visit. C. is discounted at 50% D. is packaged into the payment for other services | D | 2 | |
| 11550483609 | All of the following items are "packaged" under Medicare ASC payments, Except for A. implanted prosthetic devices B. medical supplies C. splints and casts D. brachytherapy | D | 3 | |
| 11550484475 | Under the RBRVS, each HCPCS/CPT code contains three components, each having assigned relative value units. These three components are A. geographic index, wage index, and cost of living index B. fee-for-service, per diem payment, and capitation. C. conversion factor, CMS weight, and hospital-specific rate. D. physician work, practice expense, and malpractice insurance expense. | D | 4 | |
| 11550498252 | The prospectice payment system used to reimburse hospitals for Medicare hospital outpatients is called A. APGs B. RBRVS C. APCs D. MS-DRGs | C | 5 | |
| 11550517253 | Medicare patient was seen by Dr. Zachary, who is a nonparticipating physician. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The Medicare Fee Schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termed as "balance billing," which means that the patient is A. financially liable for the Medicare Fee Schedule amount B. financially liable for charges in excess of the Medicare Fee Schedule, up to a limit C. not financially liable for any amount D. financially liable for only the deductible | B | 6 | |
| 11550530672 | The prospective payment system based on resource utilization groups (RUGs) is used for reimbursement ________ for patients with Medicare. A. freestanding ambulatory surgery centers B. hospital-based outpatients C. intermediate care facilities D. skilled nursing facilities | D | 7 | |
| 11550535922 | The _______ is a statement sent to the provider to explain payments made by third-party payers. A. remittance advice B. advance beneficiary notice C. attestation statement D. acknowledgment notice | A | 8 | |
| 11550544991 | HIPAA administrative simplification provisions require all of the following code sets to be used EXCEPT A. ICD-10-CM B. CDT C. DSM D. CPT | C | 9 | |
| 11550551141 | The computer-to-computer transfer data between providers and third-party payers in data format agreed upon by both parties is called A. HIPAA (Health Insurance Portability and Accountability Act) B. electronic data interchange (EDI) C. health information exchange (HIE) D. health data exchange (HDE) | B | 10 | |
| 11550567121 | A computer software program that assigns appropriate MS-DRGs according to the information provided for each episode of care is called a(n) A. encoder B. case-mix analyzer C. grouper D. scrubber | C | 11 | |
| 11550582567 | The standard claim form used by hospitals to request reimbursement for inpatient and outpatient procedure performed or services provided is called the A. UB-04 B. CMS-1500 C. CMS-1491 D. CMS-1600 | A | 12 | |
| 11550584815 | Under ASC PPS, when multiple procedures are performed during the same surgical session, a payment reduction is applied. The procedure in the highest level group is reimbursed at _____ and all remaining procedures are reimbursed at ______. A. 50%, 25% B. 100%, 50% C. 100%, 25% D. 100%, 75% | B | 13 | |
| 11550596952 | The _______ refers to a statement sent to the patient to show how much the provider billed, how much Medicare reimbursed the provider, and what the patient must pay the provider | A | 14 | |
| 11550602863 | Currently, which prospective payment system is used to determine the payment to the "physician" for physician services covered under Medicare Part B, such as outpatient surgery performed on a Medicare patient? A. MS-DRGs B. APCs C. RBRVS D. ASC PPS | D | 15 | |
| 11550615219 | Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare Part B services? A. The provider reimbursed at 15% above the allowed charge. B. The provider is paid according to the Medicare Physician Fee Schedule (MPFS) plus 10% C. The provider is paid according to the balance between the MPFS amount and the total charges. D. The provider is a nonparticipating provider. | C | 16 | |
| 11550622223 | When the MS-DRG payment received by the hospital is lower than the actual charges for providing the inpatient services for a patient with Medicare, then the hospital A. makes profit B. can bill the patient for the difference. C. absorbs the loss. D. can bill Medicare for the difference. | C | 17 | |
| 11550630401 | Under ASC PPS, bilateral procedures are reimbursed at ____ of the payment rate for their group A. 50% B. 100% C. 200% D. 150% | D | 18 | |
| 11550647647 | The Health Insurance Portability and Accountability Act (HIPAA) requires the retention of health insurance claims and accounting records for a minimum of _____ years, unless state law specifies a longer period. A. six B. five C. seven D. ten | A | 19 | |
| 11550653277 | ____ is knowingly making false statements or representation of material facts to obtain a benefit or payment for which no entitlement would otherwise exist. A. Fraud B. Whistle-blowing C. Abuse D. Assault | A | 20 | |
| 11550654504 | These are assigned to every HCPCS/CPT code under the Medicare hospital outpatient prospective payment system to identify how the service or procedure described by the code would be paid. A. geographic practice cost indices B. major diagnostic categories C. minimum data set D. payment status indicator | D | 21 | |
| 11550665670 | The term used to indicate that the service or procedure is reasonable and necessary for the diagnosis or treatment of illness or injury consistent with generally accepted standards of care is A. appropriateness B. evidence based medicine C. benchmarking D. medical necessity | D | 22 | |
| 11550667224 | This law prohibits a physician from referring Medicare patients to clinical laboratory services where the doctor or a member of their family has a financial interest. A. the False Claims Act B. the Civil Monetary Penalties Act C. the Federal Antikickback Statute D. the Stark I Law | D | 23 | |
| 11550678357 | _____ are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients. A. Misadventures B. Adverse preventable events. C. Never events or sentinel events D. Potential compensable events | C | 24 | |
| 11550680355 | When a provider, knowingly or unknowingly, uses practices that are inconsistent with accepted medical practice and that directly or indirectly result in unnecessary costs to the Medicare program, this is called A. fraud B. abuse C. unbundling D. hypercoding | B | 25 | |
| 11550685184 | What prospective payment system reimburses the provider according to prospectively determined rates for a 60-day episode of care? A. home health resource groups B. inpatient rehabilitation facility C. long-term care Medicare severity diagnosis-related groups D. the skilled nursing facility prospective payment system | A | 26 | |
| 11550698738 | If the Medicare nonPAR approved payment amount is $128.00 for a proctoscopy, what is the total Medicare approved payment amount for a doctor who does not accept assignment, applying the limiting charge for this procedure? A. $140.80 B. $140.00 C. $192.00 D. $147.20 | D | 27 | |
| 11550722881 | Under the inpatient prospective payment system (IPPS), there is a 3-day payment window (formerly referred to as the 72-hour rule). This rule requires that outpatient preadmissions services that are provided by a hospital up to three calendar days prior to a patient's inpatient admission be covered by the IPPS MS-DRG payment for A. diagnostic services B. therapeutic (or nondiagnostic) services whereby the inpatient principal diagnosis code (ICD-10-CM) exactly match the code used for preadmission services. C. therapeutic (or nondiagnostic) services whereby the inpatient principal diagnosis code (ICD-10-CM) does not match the code used for preadmission services. D. diagnostic services and therapeutic (or nondiagnostic) services whereby the inpatient principal diagnosis code (ICD-10-CM) exactly matches the code used for preadmission services | 28 | ||
| 11550775129 | This initiative was instituted by the goverment to eliminate fraud and abuse and recover overpayments, and involves the use of ________. Charts are audited to identify Medicare overpayments and underpayments. These entities are paid based on a percentage of money they identify and collect on behalf of the government. A. Clinical Data Abstraction Centers (CDAC) B. Quality Improvement Organizations (QIO) C. Medicare Code Editors (MCE) D. Recovery Audit Contractors (RAC) | D | 29 | |
| 11550780957 | When a patient is discharged from the inpatient rehabilitation facility and returns within three calendar days (prior to midnight on the third day) is called a(n) A. interrupted stay B. transfer C. per diem D. qualified discharge | A | 30 | |
| 11550793814 | In a global payment methodology, which is sometimes applied to radiological and similar types of procedures that involve professional and technical components, all of the following are part of the "technical" components EXCEPT A. radiological equipements B. physician services C. radiological supplies D. radiologic technicians | B | 31 | |
| 11550802889 | Changes is case-mix index (CMI) may be attributed to all of the following factors EXCEPT A. changes in medical staff composition B. changes in coding rules C. changes in services offered D. changes in coding productivity | D | 32 | |
| 11550804923 | This prospective payment system replaced the Medicare physician payment system of "customary, prevailing, and reasonable (CPR)" charges whereby physicians were reimbursed according to their historical record of the charge for the provision of each service. A. Medicare Physician Fee Schedule (MPFS) B. Medicare Severity-Diagnosis Related Groups (MS-DRGs) C. Global payment D. Capitation | A | 33 | |
| 11550821201 | CMS-identified "Hospital-Acquired Conditions" mean that when a particular diagnosis is not "present on admission," CMS determines it to be A. medically necessary B. reasonable preventable C. a valid comorbidity D. the principal diagnosis | B | 34 | |
| 11550826860 | This process involves the gathering of charge documents from all departments within the facility that have provided services to patients. The purpose is to make certain that all charges are coded and entered into the billing system. A. precertification B. insurance verification C. charge capturing D. revenue cycle | C | 35 | |
| 11550848545 | The Correct Coding Initiative (CCI) edits contain a listing of codes under two columns titled "comprehensive codes" and "component codes". According to the CCI edits, when a provider bills Medicare for a procedure that appears in both columns for the same beneficiary on the same date of service, A. code only the component code. B. do not code the component code C. code only the comprehensive code D code both the comprehensive code and the component code. | C | 36 | |
| 11550856937 | The following type of hospital is considered excluded when it applies for and receives a waiver from CMS. This means that the hospital does not participate in the inpatient prospective payment system (IPPS) A. rehabilitation hospital B. long-term care hospital C. psychiatric hospital D. cancer hospital | D | 37 | |
| 11550863151 | These are financial protections to ensure that certain types of facilities (e.g., children's hospitals) recoup all of their losses due to the differences in their APC payments and the pre-APC payments. A. limiting charge B. indemnity insurance C. hold harmless D. pass through | C | 38 | |
| 11550894547 | LCDs and NCDs are review policies that describe the circumstances of coverage for various types of medical treatment. They advise physicians which services Medicare considers reasonable and necessary and may indicate the need for an advance beneficiary notice. They are developed by the Centers for Medicare and Medicaid Services (CMS) and Medicare Administrative Contractors. LCD and NCD are acronyms that stands for A. local covered determinations and noncovered determinations. B. local coverage determinations and national coverage determinations C. list of covered decisions and noncovered decisions D. local contractor's decision and national contractor's decisions. | B | 39 |
