Place your order today and enjoy professional academic writing services—From simple class assignments to dissertations. Give us a chance to impress you.

Order a Similar Paper Order a Different Paper
  1. Diabetic neuropathy is an example of a(n)
  2. comorbidity



    Save your time - order a paper!

    Get your paper written from scratch within the tight deadline. Our service is a reliable solution to all your troubles. Place an order on any task and we will take care of it. You won’t have to worry about the quality and deadlines

    Order Paper Now


  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




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?


    global fee


    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




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





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





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?



    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.





2 points

Question 22

  1. CPT-4 is published annually by





2 points

Question 23

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


    essential modifiers

    main terms


2 points

Question 24

  1. An example of a supplemental insurance plan is





2 points

Question 25

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





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


2 points

Question 28

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


    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 __________


    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.


    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.





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


    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


    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.





2 points

Question 48

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

    Grp #




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


When writing your assignment, we aim to help you get an A, not just beat the deadline.

Order a Similar Paper Order a Different Paper