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A patient control number is a unique identifier assigned to each hospital patient at the time of:
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Individuals eligible for medicare may be classified into one or more of the following categories EXCEPT
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MidTerm-MED1850
| Question | Answer |
|---|---|
| A patient control number is a unique identifier assigned to each hospital patient at the time of: | admission |
| Individuals eligible for medicare may be classified into one or more of the following categories EXCEPT | Low-income |
| the abbreviation for ERSD stands for | End-stage renal disease |
| The Medicare coverage that consists of hospital insurance is | Medicare Part A |
| The process of collecting a patient's personal information and entering it into the hospital's database is referred to as: | registration |
| The Medicare coverage that pays for physician services is | Medicare Part B |
| It is necessary for a professional coder to exhibit ethical behavior when coding for services and procedures. T/F | True |
| HCPCS stands for health care providers code sets. T/F | False |
| HCPCS was developed by the AMA T/F | True |
| There is only one level of codes in the HCPCS. T/F | False |
| It is not permissible to use "assumption coding" T/F | True |
| An audit or formal examination of services billed, along with the codes submitted, is not necessary in a medical office setting, as all billing is always accurate. T/F | False |
| The chief complaint is the reason for the encounter. T/F | True. |
| Surgical codes may trigger an audit because they are used frequently. T/F | False |
| There is only one kind of audit. T/F | False. |
| One of the top coding and documentation errors is that the chief complaint is missing. T/F | True. |
| If a patient is covered by more than one insurance policy, a physician's office will always file both the primary and secondary/ T/F | False |
| Medicare prescription drug coverage is offered through | Medicare Part D |
| The Medicare profram that provides expanded benefits through private managed care health plans is | Medicare Advantage (MA) |
| The role of the centers for Medicare and Medicaid Services (CMS) includes all of the following EXCEPT | paying claims for Medicare beneficiaries |
| HCPCS level 2 codes are updated by who | CMS |
| A clean claim has no mistakes or missing information. T/F | True |
| The patient and the guarantor are always the same. T/F | False. |
| Superbills are also referred to as encounter forms, charge slips, or routing slips. T/F | True |
| The CMS-1500 was developed by Blue Cross Blue Shield. T/F | True |
| HCPS is the acronym for the. | Health Common Procedure Coding System. |
| The five-digit CPT codes used to report services and procedures performed by healthcare providers are also known as: | Level 1 HCPCS. |
| HCPCS was developed to achieve all of the following goals EXCEPT. | implementing standard fee structures for all providers across all plans. |
| Level 1 HCPCS codes are also known as the | American Medical Association's CPT code. |
| HCPCS level 1 codes were developed by the. | American Medical Association (AMA) |
| HCPCS level 2 codes are updated annually by the. | Centers for Medicare and Medicaid Services (CMS) |
| The code for durable medical equipment(DMA) would be found in the | Level 2 HCPCS code book. |
| A coder who needs to find the codes for prosthetic devices and related procedures would find it in the | Level 2 HCPCS code book. |
| HCPCS level 2 codes would include all of the following EXCEPT codes for: | surgical services. |
| HCPCS level 2 national codes consist of. | One alphabetic character and four digits. |
| The person who is ultimately responsible for payment to the medical office is called the: | Guarantor. |
| If an insured patient signs an assignment of benefits form, the insurance carrier will send payment directly to the: | Physician. |
| A claim can only be submitted to an insurance carrier on the patient's behalf if the patient has signed a (n): | Release of information form |
| The individual who purchases an insurance policy is known as the: | Policyholder |
| If needed information is missing from a claim when it is submitted to an insurance carrier, it is referred to as a(n). | Dirty claim. |
| When a patient has more than one insurance policy, one policy is considered the primary coverage and the additional policy is: | Secondary insurance |
| On the CMS-1500 claim form, the abbreviation NPI indicates that: | The National Provider Identifier must be entered. |
| The CMS-1500 claim form is mandatory for all Medicare claims. | A) True |
| Most providers submit healthcare claims electronically. | A) True |
| The majority of hospital reimbursement comes from: | Insurance companies. |
| A patient control number (PCN) is a unique identifier assigned to each hospital patient at the time of. | Admission. |
| The process of collecting a patient's personal information and entering it into the hospital database is referred to as: | Registration. |
| A hospital will bill for patient services: | After the discharge paperwork is completed and signed by the physician. |
| A charge description master includes all of the following information except: | Physician identification number. |
| Reimbursement methods for inpatient hospital services include all of the following EXCEPT: | Capitation. |
| The method of reimbursement that establishes the rate of payment to a hospital before services are rendered is: | Prospective payment system. |
| The method of reimbursement that pays hospitals a fixed rate per day for all services provided is. | Per Diem. |
| The ambulatory Payment classification (APC) system bases payments on: | Procedures. |
| Services covered under the ambulatory payment classification (APC) system include all of the following EXCEPT: | Inpatient surgical procedures. |
| OPPS Stands for: | Outpatient payment for preventive services. |
| The list of Ambulatory payment classification (APC) rates is maintained by: | The centers for medicare and medicaid services (CMS) |
| The diagnosis related group (DRG) system is a type of. | prospective payment system. |
| Most major diagnostic categories (MDCs) are based on | A particular organ system. |
| Diagnosis related group (DRG) classification takes into account all of the following criteria EXCEPT: | social status and family support. |
| The physician who is primarily responsible for a patient's care while in the hospital is referred to as the: | Attending physician |
| The UB-04 claim form allows for a maximum of: | 10 diagnoses. |
| A facility's case mix is based on all of the following EXCEPT: | discharge status. |
| Software that is used to calculate the diagnosis related group (DRG) payment group is called a(n) | Grouper. |
| A case that cannot be assigned an appropriate diagnosis related group (DRG) because of the typical situation is called a(n) | Cost outlier. |
| When referring to diagnosis related groups (DRGs), the abbreviation CC is used to indicate: | complications or comorbidities. |
| Individuals eligible for medicare may be classified into one or more of the following categories EXCEPT: | Low Income. |
| The abbreviation ESRD stands for | end-stage renal disease. |
| The medicare coverage that consists of hospital insurance is | Medicare Part A |
| The medicare coverage that pays for physician services is | Medicare Part B |
| The medicare program that provides expanded benefits through private managed care health plans is | Medicare Advantage (MA) |
| Medicare prescription drug coverage is offered through. | Medicare Part D. |
| The role of the Centers for medicare and medicaid (CMS) includes all of the following EXCEPT: | Paying claims for medicare beneficiaries. |
| The organization that enrolls new medicare beneficiaries into the program is the | Social Security Administration (SSA) |
| Organizations that are hired by the CMS to carry out day-to-day medicare program operations are known as: | Contractors. |
| A spouse of a deceased, retired, or disabled individual who was or is eligible for medicare benefits: | Is also eligible for medicare coverage. |
| Medicare part A provides coverage for all of the following services EXCEPT: | Inpatient physician services. |
| Individuals age 65 and older qualify for medicare if they have paid FICA taxes for at least: | 40 calendar quarters. |
| To qualify for medicare, disabled adults must have been receiving social security disability benefits for: | More than 2 years. |
| Coverage for hospice care is provided by: | Medicare Part A. |
| Hospice services covered under medicare part a may by provided as: | Short-term hospital care, Inpatiet respite care, In-home care. ALL THE ABOVE. |
| Private-duty nursing care is: | Not covered by medicare. |
| Medicare Advantage plans ( Part C) offer which of the following benefits? | Hospital coverage (Part A); Medical coverage ( Part B); Prescription drug coverage; ALL THE ABOVE. |
| Medicare Part D consists of: | Prescription drug coverage. |
| Medicare patients with Part B fee-for-service benefits are responsible for what percentage of the medicare fee schedule (MFS) after the deductible has been met and services are rendered by a provider who accepts assignment? | 20% |
| Medicare Part B provides agree to accept as payment in full the amount paid by: | Medicare plus the patient's share. |
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