Understanding Medicare Parts A, B, and C, Exams of Advanced Education

Download Understanding Medicare Parts A, B, and C and more Exams Advanced Education in PDF only on Docsity! CPB PRACTICE EXAM QUESTIONS AND ANSWERS WHO IS COVERED BY CHAMPVA? A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FAMILIES B) ACTIVE DUTY MILITARY AND THEIR FAMILIES C) RETIRED MILITARY AND THEIR FAMILIES D) ACTIVE DUTY MILITARY OVER THE AGE OF 65 - A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FAMILIES RATIONALE: THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERANS AFFAIRS (CHAMPVA) COVERS VETERANS WHO ARE PERMANENTLY AND TOTALLY DISABLED DUE TO A SERVICE-RELATED DISABILITY AND THEIR SPOUSE AND CHILDREN. PATIENT IS BROUGHT TO THE LOCAL URGENT CARE AFTER FALLING FROM A LADDER WHILE HANGING EXTERIOR LIGHTS ON HIS HOUSE. X-RAYS REVEALED A CLOSED FRACTURE OF HIS LEFT FEMUR. THE PATIENT IS COVERED BY HIS EMPLOYER'S GROUP HEALTH PLAN AND HE ALSO HAS A HOMEOWNER'S LIABILITY INSURANCE POLICY. WHICH INSURANCE SHOULD BE BILLED? A) THE HOMEOWNER'S INSURANCE FIRST, FOLLOWED BY THE GROUP HEALTH PLAN B) THE EMPLOYER'S GROUP HEALTH PLAN C) THE HOMEOWNER'S INSURANCE ONLY D) FILE THE EMPLOYER'S GROUP HEALTH PLAN AS PRIMARY AND LIST THE HOMEOWNER'S INSURANCE AS SECONDARY. - B) THE EMPLOYER'S GROUP HEALTH PLAN RATIONALE: THE HEALTH INSURANCE PLAN IS BILLED FIRST AND THEN THROUGH THE PROCESS OF SUBROGATION IT WILL BE DETERMINED IF A LIABILITY PAYER SHOULD BE CONSIDERED PRIMARY. 3. PRIVATE COMPANIES CONTRACT WITH CMS TO ADMINISTER: A) MEDICARE PART A & B B) MEDICARE PART B C) MEDICARE PART C D) MEDICARE PART A, B, & C - D) MEDICARE PART A, B, AND C RATIONALE: MEDICARE PART A, B, AND C ARE ALL ADMINISTERED BY PRIVATE COMPANIES THAT CONTRACT WITH CMS AS MEDICARE ADMINISTRATIVE CONTRACTORS OR MACs. WHAT IS A CO-PAYMENT? A) AN AMOUNT PAID EVERY MONTH BY THE POLICYHOLDER TO MAINTAIN HEALTH INSURANCE COVERAGE B) A PERCENTAGE OF THE ALLOWED AMOUNT THAT THE PATIENT IS RESPONSIBLE FOR. C) A FLAT AMOUNT PAID TO THE HEALTHCARE PROVIDER WHEN THE POLICYHOLDER IS SEEN FOR AN OFFICE VISIT. D) THE ADJUSTED AMOUNT BASED ON THE INSURANCE POLICY REQUIREMENT. - C) A FLAT AMOUNT PAID TO THE HEALTHCARE PROVIDER WHEN THE POLICY HOLDER IS SEEN FOR AN OFFICE VISIT. WHICH OF THE FOLLOWING STATEMENTS IS TRUE REGARDING THE NON-PAR MEDICARE ALLOWED FEE SCHEDULE? A) THE NON-PAR PROVIDER CAN BILL THE PATIENT THE DIFFERENCE BETWEEN THE CHARGE AND THE MEDICARE ALLOWABLE. B) THE NON-PAR LIMITING CHARGE IS 115% OF THE NON-PAR MEDICARE PHYSICIAN FEE SCHEDULE C) THE NON-PAR PHYSICIAN FEE SCHEDULE IS 115% OF THE PAR MEDICARE PHYSICIAN FEE SCHEDULE D) THE NON-PAR LIMITING CHARGE IS 95% OF THE PAR MEDICARE PHYSICIAN FEE SCHEDULE. - B) THE NON-PAR LIMITING CHARGE IS 115% OF THE NON- PAR MEDICARE PHYSICIAN FEE SCHEDULE. RATIONALE: PER CMS, THE NON-PAR LIMITING CHARGE IS 115% OF THE NON- PAR MEDICARE PHYSICIAN FEE SCHEDULE. WHAT IS A MEDIGAP POLICY? A) A POLICY THAT COVERS HEALTHCARE SERVICES THAT MEDICARE DOES NOT COVER. B) A POLICY THAT WILL NOT REIMBURSE FOR OUT-OF-POCKET COSTS NOT COVERED BY MEDICARE C) A SUPPLEMENTAL INSURANCE OFFERED BY CMS. D) A POLICY REQUIRED BY MEDICARE. - A) A POLICY THAT COVERS HEALTHCARE SERVICES THAT MEDICARE DOES NOT COVER. MEDICARE PART A IS AVAILABLE TO INDIVIDUALS UNDER THE AGE OF 65 WHO HAVE: A) DIABETES MELLITUS TYPE I OR II B) ESTABLISHED PATIENT SEEN BY A MID-LEVEL PROVIDER FOR FOLLOW-UP FOR BLOOD PRESSURE CHECK, PHYSICIAN IS IN THE OFFICE SUITE. C) ESTABLISHED PATIENT SEEN BY A MID-LEVEL PROVIDER FOR AN ESTABLISHED PROBLEM, THE PHYSICIAN IS PERFORMING HOSPITAL ROUNDS. D) NEW PATIENT TO THE PRACTICE, PHYSICIAN IN EXAM ROOM NEXT DOOR, MID-LEVEL PROVIDER IS AN EMPLOYEE OF THE PHYSICIAN. - B) ESTABLISHED PATIENT SEEN BY A MID-LEVEL PROVIDER FOR FOLLOW-UP FOR BLOOD PRESSURE.CHECK, PHYSICIAN IS IN THE OFFICE SUITE. RATIONALE: MEDICARE'S INCIDENT - TO BILLING FOR MID-LEVEL PROVIDERS ALLOW FOR SERVICES TO BE BILLED UNDER THE PHYSICIAN'S PROVIDER NUMBER WHEN MEDICARE PATIENTS ARE SEEN IN COLLABORATION WITH A PHYSICIAN. NEW PATIENTS MUST BE SEEN BY THE PHYSICIAN TO ESTABLISH CARE. PHYSICIAN MUST BE READILY AVAILABLE ONSITE IN ORDER TO BILL INCIDENT-TO SERVICES. WHAT IS LINKED BY NCDs AND LCDs? A) DIAGNOSIS CODES TO PROCEDURES OR SERVICES THAT ARE DETERMINED TO BE PAYABLE FOR MEDICARE PATIENTS B) DIAGNOSIS CODES TO PROCEDURES OR SERVICES THAT ARE DETERMINED TO BE REASONABLE FOR MEDICARE PATIENTS. C) DIAGNOSIS CODES TO PROCEDURE OR SERVICES THAT ARE DETERMINED TO BE REASONABLE AND MEDICALLY NECESSARY FOR MEDICARE PATIENTS D) DIAGNOSIS CODES TO PROCEDURES OR SERVICES THAT NEED TO HAVE A SIGNED ABN. - C) DIAGNOSIS CODES TO PROCEDURE OR SERVICES THAT ARE DETERMINED TO BE REASOABLE AND MEDICALLY NECESSARY FOR MEDICARE PATIENTS RATIONALE: NATIONAL AND LOCAL COVERAGE DETERMINATIONS (NCD & LCD) ARE CONTINUALLY BEING DEVELOPED TO LINK DIAGNOSES AND PROCEDURES BASED ON MEDICAL NECESSITY AND REASONABILITY. WHEN AN NCD/LCD REVIEW DETERMINES THAT A PROCEDURE OR SERVICE IS NOT REASONABLE OR MEDICALLY NECESSARY, THE PROVIDER IS ALLOWED TO BILL THE PATIENT ONLY IF AN ABN HAS BEEN SIGNED PRIOR TO PROVIDING THE PROCEDURE OR SERVICE. CPT CODES 64418 AND 19380 WERE REPORTED TOGETHER FOR THE INJECTION OF THE SUPRA CAPSULAR NERVE WITH ANESTHETIC AGENT (64418) WITH REVERSION OF A RECONSTRUCTED BREAST (19380). THE INJECTION WAS DENIED AS A BUNDLED SERVICE. WHAT WOULD BE THE NEXT STEP FOR THE BILLER? A) RESUBMIT CORRECTED CLAIM ADDING MODIFIER -59 TO 64418 B) RESUBMIT CORRECTED CLAIM ADDING MODIFIER -51 TO 64418. C) MOVE THE CHARGE FOR THE BUNDLED PROCEDURE TO PATIENT RESPONSIBILITY D) WRITE-OFF THE CHARGE FOR 64418 BECAUSE IT IS A BUNDLED PROCEDURE - D) WRITE-OFF THE CHARGE FOR 64418 BECAUSE IT IS A BUNDLED PROCEDURE. RATIONALE: SERVICES OR PROCEDURES THAT ARE DETERMINED TO BE BUNDLED AS PART OF THE PAYER'S CONTRACT MUST BE WRITTEN OFF. COSTS FOR THE BUNDLED PROCEDURE CANNOT BE SHIFTED TO PATIENT RESPONSIBILITY. BY SIGNING THE ASSIGNMENT OF BENEFITS IN ITEM 13 OF THE CMS-1500 CLAIM FORM, THE PATIENT IS: A) DIRECTING THE INSURANCE COMPANY TO SEND THE REIMBURSEMENT TO THE PATIENT. B) DIRECTING THE INSURANCE COMPANY TO SEND THE REIMBURSEMENT TO THE PROVIDER. C) AGREEING THAT SERVICES WERE PROVIDED. D) PREVENTING THE CLAIM FROM BEING PAID. - B) DIRECTING THE INSURANCE COMPANY TO SEND THE REIMBURSEMENT TO THE PROVIDER. RATIONALE: AS STATED ON THE CMS-1500 CLAIM FORM ITEM 13. "INSURED'S OR AUTHORIZED PERSON'S SIGNATURE: I AUTHORIZE PAYMENT OF MEDICAL BENEFITS TO THE UNDERSIGNED PHYSICIAN OR SUPPLIER FOR SERVICES DESCRIBED BELOW." A REVENUE CODE INDICATING THE TYPE OR LOCATION OF SERVICE WOULD BE REPORTED ON THE A) CMS-1500 CLAIM FORM B) UB-02 CLAIM FORM C) UB-04 CLAIM FORM D) ABN FORM - C) UB-04 CLAIM FORM RATIONALE: UB-04 CLAIM FORM IS USED TO BILL FACILITY SERVICES. REVENUE CODES ARE FOUR DIGIT CODES THAT INDICATE LOCATION OR TYPE OF SERVICES PROVIDED TO A PATIENT IN A HEALTH CARE FACILITY. WHICH OF THE FOLLOWING STATEMENTS IS NOT TRUE FOR THE TOB CODES? A) DIGIT 1 IDENTIFIES THE TYPE OF FACILITY B) DIGIT 2 IDENTIFIES THE TYPE OF FACILITY C) DIGIT 3 IDENTIFIES THE TYPE OF CARE PROVIDED D) DIGIT 4 IS THE FREQUENCY CODE - A) DIGIT 1 IDENTIFIES THE TYPE OF FACILITY. RATIONALE: THE TOB (TYPE OF BILL) IS ALPHANUMERIC AND DESCRIBES THREE SPECIFIC TYPES OF INFORMATION AFTER THE LEADING "0". DIGIT 1 IS THE LEADING ZERO AND CMS DOES NOT RECOGNIZE THIS DIGIT. DIGIT 2 IDENTIFIES THE TYPE OF FACILITY, DIGIT 3 CLASSIFIES THE TYPE OF CARE PROVIDED, AND DIGIT 4 IS THE FREQUENCY CODE WHICH IDENTIFIES THE SEQUENCE OF THE BILL FOR EACH EPISODE OF CARE THE FOLLOWING TYPE OF CHARGES WOULD BE REPORTED ON THE CMS-1500 CLAIM FORM EXCEPT: A) AMBULATORY SURGERY CENTER (ASC) B) OBSERVATION SERVICES REPORTED BY A PHYSICIAN C) INPATIENT SERVICES PROVIDED BY A PHYSICIAN D) ROOM AND BOARD - D) ROOM AND BOARD RATIONALE: ASC, OBSERVATION, AND INPATIENT SERVICES PROVIDED BY A PHYSICIAN ARE REPORTED ON THE CMS-1500 CLAIM FORM. ROOM AND BOARD WOULD BE PROVIDED IN A FACILITY AND WOULD THEREFORE BE REPORTED ON THE UB-04 CLAIM FORM. MEDICARE CONDITIONS OF PARTICIPATION REQUIRES THAT MEDICAL RECORDS BE RETAINED FOR: A) 12 YEARS B) 7 YEARS C) 5 YEARS D) 2 YEARS - C) 5 YEARS RATIONALE: MEDICARE CONDITIONS OF PARTICIPATION REQUIRE PATIENT RECORDS TO BE RETAINED IN THEIR ORIGINAL OR LEGALLY REPRODUCED FORM FOR AT LEAST 5 YEARS. SOME STATES MAY REQUIRE A LONGER PERIOD OF RETENTION, BUT ALL MEDICARE PARTICIPANTS MUST BE RETAINED FOR AT LEAST 5 YEARS. THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT DEFINES ABUSE AS A) ACTIONS CAUSING PHYSICAL OR EMOTIONAL ABUSE B) DUPLICATING CHARGES ON A CLAIM C) ACTIONS NOT CONSISTENT WITH ACCEPTED AND SOUND MEDICAL, BUSINESS, OR FISCAL PRACTICES D) EXCESSIVE CHARGES FOR SUPPLIES - C) ACTIONS NOT CONSISTENT WITH ACCEPTED AND SOUND MEDICAL, BUSINESS, OR FISCAL PRACTICES INFORMATION TO CONSUMER REPORTING AGENCIES MUST ALSO COMPLY WITH CERTAIN LEGAL OBLIGATIONS SUCH AS CONDUCTING INVESTIGATIONS WHEN INFORMATION IS DISPUTED. A CLAIM HAS BEEN PROCESSED BY THE PAYER, PAYMENT RECEIVED AND POSTED TO THE PATIENT'S ACCOUNT. WHAT IS THE NEXT STEP IN THE BILLING PROCESS? A) NO FURTHER STEPS NEED TO BE TAKEN B) A RECEIPT OF PAYMENT IS SENT TO THE PAYER. C) PATIENT IS NOTIFIED AT 60 DAYS OF ANY REMAINING PATIENT RESPONSIBILITY D) A STATEMENT IS SENT NOTIFYING THE PATIENT OF THEIR REMAINING RESPONSIBILITY - D) A STATEMENT IS SENT NOTIFYING THE PATIENT OF THEIR REMAINING RESPONSIBIITY RATIONALE: THE FINAL STEP IN THE BILLING PROCESS IS TO INFORM THE PATIENT OF THE REMAINING PORTION DUE FOR THE SERVICES THEY RECEIVED. THE STATEMENT SHOULD REFLECT THE AMOUNT PAID BY THE INSURANCE, ANY ADJUSTMENTS MADE, AND THE FINAL AMOUNT DUE FROM THE PATIENT. THE STATEMENT SHOULD ALSO INCLUDE THE DATE THE PAYMENT IS DUE FROM THE PATIENT. WHEN AN ACCOUNT HAS BEEN DETERMINED (BY THE PRACTICE'S POLICY) TO BE DELINQUENT, THE ACCOUNT SHOULD: A) BE WRITTEN OFF AS A BAD DEBT B) BE CLOSED AND NO FURTHER VISITS SCHEDULED FOR THE PATIENT. C) BE TURNED OVER TO A COLLECTION AGENCY. D) CONTINUE TO BE WORKED BY THE PRACTICE'S BILLING OFFICE STAFF AS TIME ALLOWS. - C) BE TURNED OVER TO A COLLECTION AGENCY. RATIONALE: A MEDICAL PRACTICE SHOULD DEVELOP POLICIES FOR HANDLING DELINQUENT ACCOUNTS. THE FINAL STEP IN DELINQUENT ACCOUNT PROTOCOL WOULD BE TO RELEASE THE ACCOUNT TO A COLLECTION AGENCY WHO WILL CONTINUE THE COLLECTION PROCESS UNTIL RESOLUTION. WHEN A CLAIM PAYMENT HAS BEEN DENIED, THE DENIAL: A) IS ALWAYS FOUND TO BE IN ERROR AND A PROMPT APPEAL SHOULD BE MADE: B) MAY BE VALID AND SHOULD NOT BE APPEALED. C) SHOULD BE ANALYZED AND IF IT WAS DENIED IN ERROR, AN APPEAL SHOULD BE INITIATED. D) BOTH B & C - D) BOTH B & C RATIONALE: THE DENIAL SHOULD BE ANALYZED PRIOR TO SUBMITTING AN APPEAL TO DETERMINE THE REASON FOR THE DENIAL. SOME REASONS FOR A DENIAL COULD INCLUDE BILLING FOR A PROCEDURE OR SERVICE THAT WAS NOT MEDICALLY NECESSARY, OR BILLING FOR A NON COVERED BENEFIT, OR A PRE-EXISTING CONDITION. OTHER POSSIBLE REASONS COULD BE THAT THE PATIENT'S COVERAGE WAS TERMINATED OR THE PROCEDURE REQUIRED A PRE-AUTHORIZATION THAT WAS NOT OBTAINED. WHICH OF THE FOLLOWING INOFRMATION IS NOT REQUIRED WHEN REQUESTING A PRIOR AUTHORIZATION A) THE ORDERING PHYSICIAN B) THE AMOUNT OF TIME NEEDED TO COMPLETE THE PROCEDURE C) ANTICIPATED DATES OF SURGERY D) ICD-10-CM CODES - B) THE AMOUNT OF TIME NEEDED TO COMPLETE THE PROCEDURE. RATIONALE: TO OBTAIN A PRIOR AUTHORIZATION, THE FOLLOWING INOFRMATION WILL BE REQUESTED; THE PATIENT'S NAME AND ID NUMBER, ICD-10-CM CODES, CPT/HCPCS LEVEL II CODES, THE ORDERING PHYSICIAN, THE SCHEDULE DATE FOR THE PROCEDURE, AND THE SITE OR FACILITY WHERE IT WILL BE PERFORMED. A PATIENT IS SEEN IN THE PROVIDER'S OFFICE FOR A FOLLOW-UP VISIT EIGHT DAYS AFTER A PROCEDURE. THE PROCEDURE HAS A GLOBAL PERIOD OF 90 DAYS. THE PROVIDER SUBMITS AN E/M CODE BASED ON DOCUMENTATION OF THE FOLLOW-UP VISIT. THE CLAIM IS SUBMITTED AND DENIED. WHAT IS THE NEXT STEP FOR THE BILLER? A) POST THE DENIAL WITHOUT ADJUSTING THE PATIENT'S BALANCE BECAUSE THE DENIED AMOUNT WILL BECOME THE PATIENT'S RESPONSIBLITY B) POST THE DENIAL AND NOTIFY THE PATIENT OF THE DENIAL C) POST THE DENIAL AND ADJUST THE PATIENT'S BALANCE BECAUSE THE FOLLOW-UP VISIT IS INCLUDED IN THE GLOBAL PERIOD. D) RESUBMIT THE E/M CODE WITH MODIFIER -24 TO INDICATE THE VISIT WAS UNRELATED TO THE PROCEDURE THAT WAS PERFORMED EIGHT DAYS AGO. - C) POST THE DENIAL AND ADJUST THE PATIENT'S BALANCE BECAUSE THE FOLLOW-UP VISIT IS INCLUDED IN THE GLOBAL PERIOD. RATIONALE: NORMAL FOLLOW-UP VISITS FOLLOWING A PROCEDURE WITH A GLOBAL PERIOD ARE CONSIDERED TO BE INCLUDED IN THE PROCEDURE GLOBAL PERIOD AND NOT SEPARATELY BILLABLE. IF A PATIENT IS SEEN DURING A GLOBAL PERIOD FOR A SEPARATE CONDITION NOT RELATED TO THE PROCEDURE, AN E/M MAY BE BILLED BASED ON DOCUMENTATION OF THE SEPARATE CONDITION. A MEDICARE PATIENT IS SEEN ON MAY 1, 2017 AND THE CLAIM IS SUBMITTED FOR THIS VISIT ON MAY 5, 2018. WHAT WILL BE THE EXPECTED OUTCOME FOR PAYMENT OF THIS CLAIM? A) MEDICARE WILL REIMBURSE AT A 40% REDUCTION BASED ON TIMELY FILING REGULATIONS B) MEDICARE WILL REQUIRE AN ADDENDUM EXPLAINING THE REASON FOR THE DELAYED CLAIM SUBMISSION C) MEDICARE WILL DENY THE CLAIM BASED ON TIMELY FILING RULE D) MEDICARE WILL PAY THE CLAIM FOR PROVIDED SERVICES. - C) MEDICARE WILL DENY THE CLAIM BASED ON TIMELY FILING RULE. RATIONALE: MEDICARE REQUIRES ALL CLAIMS FOR SERVICES BE BILLED WITHIN ONE YEAR OF THE DATE OF SERVICE. ANY CLAIMS RECEIVED AFTER THE ONE YEAR DATE WILL BE DENIED DUE TO THE TIMELY FILING STATUTE. TIMELY FILING OF CROSS-OVER CLAIMS FOR MEDICARE-MEDICAID: A) WILL VARY DEPENDING ON EACH STATE'S MEDICAID TIMELY FILING GUIDELINES B) FOLLOW MEDICARE'S TIMELY FOLLOWING GUIDELINES C) MAY CHANGE FROM YEAR TO YEAR D) DEPEND ON INDIVIDUAL CONTRACT TIMELY FILING GUIDELINES. - B) FOLLOW MEDICARE'S TIMELY FOLLOWING GUIDELINES. RATIONALE: MEDICARE-MEDICAID CROSS-OVER CLAIMS MUST ADHERE TO THE MEDICARE'S TIMELY FILING STATUTE. A PATIENT BY THE NAME OF CHARLES DANIEL JOHNSON LISTS HIS NAME AS DANNY JOHNSON WHEN HE COMPLETES HIS PATIENT DEMOGRAPHIC SHEET. HIS INSURANCE CARD LISTS HIS NAME AS C. DANIEL JOHNSON. HOW SHOULD HIS NAME BE LISTED WHEN ENTERING HIS DEMOGRAPHIC INFORMATION INTO THE BILLING SYSTEM? A) HIS FULL GIVEN NAME, CHARLES DANIEL JOHNSON B) THE NAME HE "GOES BY". DANNY JOHNSON C) DANIELD JOHNSON AS LISTED ON HIS INSURANCE CARD D) CHARLIE DANIEL JOHNSON - C) DANIEL JOHNSON AS LISTED ON HIS INSURANCE CARD RATIONALE: CLAIMS SHOULD BE SUBMITTED USING THE NAME THAT IS LISTED ON THE INSURANCE CARD TO PREVENT DENIALS FOR INCORRECT POLICYHOLDER INFORMATION AN UNCONTROLLED TYPE 2 DIABETIC PATIENT IS DIAGNOSED WITH PERIPHERAL ANGIOPATHY. PATIENT IS COMPLIANT WITH SELF ADMINISTERED INSULIN INJECTIONS AND WILL BE STARTED ON PHYSICAL THERAPY 2 X A WEEK TO SUPPORT INCREASED CIRCULATION TO THE LIMBS. WHAT ARE THE CORRECT DIAGNOSIS CODES TO REPORT THIS PATIENT'S CONDITION? A) EO8.51, Z79.4 B) EO9.51, Z79.4 C) E11.51, I96, Z79.4 D) E11.51, Z79.4 - D) E11.51, Z79.4 THE DRUG TRISENOX IS ADMINISTERED BY WHICH ROUTE? A) INTRAMUSCULAR B) INTRAVENOUS C) INHALATION D) SUBCUTANEOUS - B) INTRAVENOUS RATIONALE: HCPCS LEVEL II INDICATES IN APPENDIX I - TABLE OF DRUGS AND BILOGICALS THAT RISENOX ROUTE OF ADMINISTRATION IS IV, INTRAVENOUS. WHAT PROVIDERS SUBMIT THE UB-04 CLAIM? I. COMMUNITY MENTAL HEALTH CENTERS (CMHCs) II. EMERGENCY DEPARTMENT III. HOSPICE ORGANIZATIONS IV. INSTITUTION BASED AMBULANCE COMPANIES V. OUTPATIENT REHABILITATION FACILITIES VI. AMBULATORY SURGERY CENTERS A) III-VI B) IV, VI C) I, III, IV, VI D) I-V - D) I-V RATIONALE: PROVIDERS THAT SUBMIT THE UB-04 CLAIM ARE COMMUNITY MENTAL HEALTH CENTERS (CMHCS), HOSPITALS (EMERGENCY DEPARTMENT, INPATIENT, AND OUTPATIENT SERVICES), HOSPICE ORGANIZATIONS, INSTITUTION BASED AMBULANCE COMPANIES, OUTPATIENT REHABILITATION FACILITIES, HOME HEALTHCARE AGENCIES, PSYCHIATRIC DRUG/ALCOHOL TREATMENT FACILITIES, SKILLED NURSING FACILITIES, SUBACUTE FACILITIES JOHN IS TASKED TO PERFORM AN ADUIT ON DR. CORBEL'S PRACTICE. WHAT ARE THE KEY ELEMENTS JOHN NEEDS FOR THE AUDIT PROCESS ON 20 RECORDS TO SUPPORT WHAT DR. CORBEL IS CHARGING? A) PATIENT ACCOUNT RECORD, ENCOUNTER FORM, AND CMS-1500 FORM B) PATIENT REGISTRATION FORM, ENCOUNTER FORM, AND CMS-1500 FORM C) MEDICAL RECORD, ENCOUNTER FORM, AND CMS-1500 FORM D) MEDICAL RECORD, DAYSHEET, AND LEDGER - C) MEDICAL RECORD, ENCOUNTER FORM, AND CMS-1500 FORM RATIONALE: JOHN SHOULD USE THE MEDICAL RECORD AND CMS-1500 CLAIM FORM TO ENSURE THE CHARGES ARE DOCUMENTED AND SUPPORTED. ALSO THE ENCOUNTER FORM SHOULD BE USED TO REVIEW THE DIAGNOSIS CODES, PROCEDURES, SUPPLIES, AND OTHER SERVICES WERE PROVIDED.