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| Question | Answer |
|---|---|
| The coders responsibility is to ensure that the data are as accurately as possible not only for classification and study purposes but also to obtain appropriate reimbursement | True |
| The federal register its the official publication for all presidential documents, rules and regulations,proposed rules,and notices | True |
| Nationally unit values have been assigned for each service by Medicare (cpt and hcpcs)and determined on the basis of the resources for the physician performance of the service | True |
| Fraud is intentional deception purr misrepresentation that an individual knows to be fake | True |
| Kickbacks from patients are allowed under certain circumstances According to Medicare | False |
| ICD-10-CM codes are alphanumeric,with all codes beginning with a number | False |
| ICD-10-CM codes have a maximum of 5 Characters | False |
| The letter N is assigned as a fifth placeholder for certain six-characters codes | False |
| The ICD-10-CM the WHO version,does not include a procedure classification | True |
| The national center for health statistic is responsible for developing the procedure classification | False |
| Notable improvements in the content and format oh the ICD-10-CM include expansion of signs and symptoms codes | False |
| There 10 times more codes in the ICD-10-CM than in ICD-09-CM | False |
| All ICD-10-CM codes have all 7 letters | False |
| The1-10 has instructional notations to provide guidance | True |
| There are21 chapters I the ICD-10-CM | True |
| The Medicare program was established in what year? | 1965 |
| Medicare part a pays for | Hospital/facility care |
| Medicare part b pays for | Physician services and medical equipment |
| Who handles the day to day operation of the Medicare program f for the CMS | MACs |
| Medicare pays for what percentage of covered charges | 80% |
| The incentive to Medicare participating providers is | Direct payment on all claims 5% higher fee schedule Faster processing All the above |
| Part B services are billed using | ICD-10-CM,CPT,HCPCS |
| Who it's the largest third-party payer in the nation? | The government |
| A major change took place in with the OBRA | 1989 |
| The physician fee schedule each April and is composed of | The relative value units for each service A geographic adjustment factor to adjust for regional variations in the cost of operating a health care facility A national conversion factor All the above |
| If a surgeon performs more than one procedure on the same patient on the same day, and discounts were made on all subsequent procedures,Medicare would pay what percentages for the first,second,third,fourth,and fifth procedures | 100%,50%,50%,50%,50% |
| Medicare sets the payment level for assistant surgeons at a percentage of the fee schedule amount for the surgical service | Global |
| What editions of the federal register would hospital facilities be interested in | October |
| What edition of the federal register would outpatient facilities be interested in | November or December |
| What three items that Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services | Deductibles Premiums Coinsurance |
| Medicare funds are collected by | Social security administration |
| CMS handles the daily operations of the Medicare program through the use of Formerly fiscal intermediaries | Medicare Administration Contractor |
| Which of the following is NOT a stated goal of the physician payment reform | Limit provider liabilities |
| If a QI0 providers renders a covered service that costs $100 and bills Medicare for the service and Medicare allowed $ 58 the provider would bill this amount to the patient | $0 |
| The Medicare prescription drug. Improvement and modernization act of 2003 established these new benefits available under the Medicare | Part D |
| What program is also called Medicare Advantage | Part C |
| Are activities involving the transfer of health care information and. means the movement of electronic data between two entities and the technology that supports the transfer | Transactions,transmission |
| The program was developed by Congress to monitor the necessity of hospital admissions and reviews the treatment cost and medical records of the hospital | Quality improvement organizations |
| Identify the Medicare part hospice | Part a |
| Identify the Medicare part prescription drug | Part d |
| Identify the Medicare part physicians visit | Part B |
| Identify the Medicare part automatic coverage when age65 | Part a |
| This maps ICD-10-CM codes to ICD-9-CM codes | GEMs |
| Which of the following is true about the ICD-10-CM | There are combinations diagnosis/symptoms |
| Which of the following are characteristic of the ICD-10-CM index | Main terms are in bold type Subterms are indented under the main term Only the first four characters of some codes are given All the above |
| Which organization has been responsible for the development of ICD-6 | NCHS |
| The maximum number of characters in an ICD-10-CM code | Seven |
| CMS | Centers for Medicare& medical service |
| QIO | Quality Improvement Organization |
| RBRVS | Resourse Based Relative Value Services |
| OBRA | omnibus budget reconciliation act |
| MAAC | Maximum Actual Allowable Charge |
| RVU | Relative Value Unit |
| OIG | Office of the Inspector General |
| DHHS | Department of health human service |
| In the role as a medical coder,it is your responsibility to ensure that you code and completely to optimize reimbursement for services provided | Accurately |
| The is a national dollar amount that is applied to all services paid on the basis of the MFS | Conversion factor |
| The amount determined by multiplying the RVU weight by the geographic index and the conversion factor is called the Amount | Fee schedule |
| For endoscopic procedures Medicare allows the full value of the highest called endoscopy plus the difference between the next highest endoscopy and the Endoscopy | Highest |
| The provider or facility is When the payment hours directly to the patient | Non-participation |
| Under the RBRVS, the unit value is termed value unit | Relative |
| Select the three goals of the physician payment reform | Decrease Medicare expenditures Redistribute physician payments more equitably Sure quality health care at a reasonable cost |
| Select the three components of the relative value unit | Work Malpractice Overhead |
| Select the three types of persons edible for Medicare | Those with permanent kidney failure those 65 and over Those with disability benefits |
Created by:
Jennyftb