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

2. comorbidity

   eponym

   manifestation

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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