Medicare Coding and Reimbursement: A Comprehensive Guide, Exams of Nursing

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Module 4 Test QUESTIONS WITH VERIFIED

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Question 1 Voluntary compliance program guidance documents were developed by the Department of HHS OIG for the health care industry to the development and use of internal controls to adherence to applicable regulations, statutes, and program requirements. Answers: a. evaluate; regulate b. encourage; monitor c. assess; justify d. enforce; mandate Question 2 Which was developed by the Centers for Medicare and Medicaid Services to assign the unique health care provider and health plan identifiers and to serve as a database from which to extract data? Answers: a. ICD-10-CM b. HIPAA c. NPPES d. DOD OIG Question 3 Local coverage determinations specify under which a service is covered and coded

correctly. Answers: a. clinical circumstances b. service conditions c. health care settings d. medical necessity Question 4 A narrative clinic note is written in a(n) format. Answers: a. itemized b. catalogue c. paragraph

d. list Question 5 The Medicare durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) fee schedule reimburses DMEPOS either percent of the actual charge for the item or the fee schedule amount, whichever is lower. Answers: a. 100 b. 50 c. 20 d. 80 Question 6 The procedure or service provided is linked with the that provided medical necessity for performing the procedure or service. Answers: a. diagnosis b. procedure c. supply d. service Question 7 Federally Qualified Health Centers (FQHCs) are safety net providers that primarily provide services typically furnished in which type of setting? Answers: a. outpatient clinic b. home health agency c. skilled nursing facility d. inpatient hospital

Question 8 Services provided by nonphysician practitioners may also be reported to Medicare as to the supervising physician’s service, and as a result, services are reimbursed at 100 percent of the Medicare physician fee schedule and Medicare pays 80 percent of that amount directly to the physician. Selected Answer: d. incident

Answers: a. price-based costs b. allowable charges c. limiting charges d. incide nt  Question 9 2 out of 2 points Which is established in advance and based on reported health care charges from which a predetermined per diem rate is determined? Selected Answer: a. prospective cost-based rate Answers: a. prospective cost-based rate b. site-of-service differential c. retrospective reasonable cost system d. prospective price-based rate

 Question 10 2 out of 2 points Long-term acute care hospitals are defined by Medicare as having an average inpatient length of stay greater than days. Selected Answer: b.

Answers: a. 1 5 b . 25 c. 1 0 d. 3 0  Question 11 2 out of 2 points Where is the first-listed diagnosis reported on the CMS-1500 claim? Selected Answer: a. Block 21A Answers: a. Block 21A b. Block 24E c. Block 24A

d. Block 24D  Question 12 2 out of 2 points Diagnoses must be entered in the patient’s record to validate of procedures or services billed. Selected Answer: b. medical necessity Answers: a.

submission b. medical necessity c. frequen cy d. documenta tion  Question 13 2 out of 2 points The code reported in Block 21A of the CMS-1500 claim is the major reason the patient was treated by the health care provider. It is called the diagnosis. Selected Answer: d. first-listed Answers: a. prima ry b. princip al c. comor

bid d. first-listed  Question 14 2 out of 2 points Institutional and other selected providers submit claim data to payers for reimbursement of patient services. Selected Answer: a.

UB-

Answers: a. UB- b. UB- c. UB- d. CMS-  Question 15 2 out of 2 points Hospitals that treat unusually costly cases receive increased payments that are designed to protect hospitals from large financial losses due to unusually expensive cases. Selected Answer: b. outlier Answers: a. severi ty b. outli er c. indire ct

d. disproportio nate  Question 16 2 out of 2 points Which is a helpful practice that allows the coding manager to establish criteria for coding assessment purposes? Selected Answer: a. benchmarking

Answers: a. benchmarking b. auditi ng c. clinical documentation improvement d. education and training  Question 17 2 out of 2 points Which part of the SOAP note contains the chief complaint and the patient’s description of the presenting problem? Selected Answer: d. Subjective Answers: a. Objective b. Pla n c. Assessm ent d.

Subjecti ve  Question 18 2 out of 2 points Although it may vary from a short narrative description of a minor procedure to a more formal report dictated by surgeons, all operative reports contain. Selected Answer: b. procedure performed

Answers: a. pathology diagnosis b. procedure performed c. patient complete address d. preauthorization number  Question 19 2 out of 2 points An ambulatory surgical center (ASC) is a state-licensed, Medicare-certified supplier (not provider) of surgical health care services that must on Medicare claims. Selected Answer: a. accept assignment Answers: a. accept assignment b. assign benefits  Question 20 2 out of 2 points When reporting procedures and services on the CMS-1500, list one procedure per line, starting with line one of Block

24. To report more than six procedures or services for the same date of service,. Selected Answer: d. generate a new claim to enter more procedures/services

Answers: a. use the shaded lines in Block 24 of the first CMS-1500 b.

enter multiple codes on the same line in Block 24 c. increase the number of units entered in Block 24G d. generate a new claim to enter more procedures/services  Question 21 2 out of 2 points Coding compliance is the conformity to established coding. Selected Answer: c. guidelines and regulations Answers: a. nomenclatures and classifications b. methods and systems c. guidelines and regulations d. laws and mandates  Question 22 2 out of 2 points When the Medicare program does not have primary responsibility for paying a beneficiary’s medical expenses, the Medicare concept applies. Selected Answer: a. secondary payer

Answers: a. secondary payer b.

balance billing c. limiting charge d. conversion factor  Question 23 2 out of 2 points Which is a form required by Medicare for all outpatient and physician office procedures/services that are not covered by the Medicare program? Selected Answer: b. advance beneficiary notice Answers: a. patient waiver form b. advance beneficiary notice c. assignment of benefits d. fee-rendered schedule  Question 24 2 out of 2 points Medicare reimburses laboratory services according to a(n) , which is based on the submitted charge, national limitation amount, or local fee schedule amount, whichever is lowest.

Selected Answer: a. clinical laboratory fee schedule Answers: a. clinical laboratory fee schedule

b. outpatient prospective payment system c. ambulatory outpatient center rate d. pathology diagnostic fee schedule  Question 25 2 out of 2 points When a person uses a title such as Sr., Jr., II, or III,. Selected Answer: b. do not enter it on the claim unless printed on the patient’s insurance ID card Answers: a. enter the title on the claim if instructed to do so by the patient or beneficiary b. do not enter it on the claim unless printed on the patient’s insurance ID card c. verify the use of the title with the patient or guarantor before entering on the claim d. always include it after entry of the person’s last name on the CMS-1500 claim  Question 26 2 out of 2 points

A patient is admitted as a hospital inpatient for treatment of acute asthma. The patient also has hypertension, which was medically managed during the inpatient admission. Which present on admission (POA) indicator applies to the acute asthma? Select ed Answe r: b. Y (present at the time of inpatient admission) Answers: a.

W (provider is unable to clinically determine whether condition was present on admission or not) b. Y (present at the time of inpatient admission) c. U (documentation is insufficient to determine if condition is present on admission) d. N (not present at the time of inpatient admission)  Question 27 2 out of 2 points Supplemental plans usually cover the deductible and copay or coinsurance of a primary health insurance policy. Which is the best known supplemental plan? Selected Answer: a. Medigap Answers: a. Medigap b. TRICA RE c. Medica re d.

Medica id  Question 28 2 out of 2 points Which part of the SOAP note contains documentation of measurable observations made by a health care provider during the physical examination and diagnostic testing? Selected Answer: a. Objective

Answers: a. Objective b. Subjecti ve c. Pla n d. Assessm ent  Question 29 2 out of 2 points HIPAA regulations require all payers to acceptattachments. Selected Answer: c. electronic Answers: a. manu al b. encrypt ed c. electro