MidTerm-MED1850

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A patient control number is a unique identifier assigned to each hospital patient at the time of:

admission

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Individuals eligible for medicare may be classified into one or more of the following categories EXCEPT

Low-income

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the abbreviation for ERSD stands for

End-stage renal disease

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The Medicare coverage that consists of hospital insurance is

Medicare Part A

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The process of collecting a patient's personal information and entering it into the hospital's database is referred to as:

registration

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The Medicare coverage that pays for physician services is

Medicare Part B

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It is necessary for a professional coder to exhibit ethical behavior when coding for services and procedures. T/F

True

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HCPCS stands for health care providers code sets. T/F

False

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HCPCS was developed by the AMA T/F

True

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There is only one level of codes in the HCPCS. T/F

False

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It is not permissible to use "assumption coding" T/F

True

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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

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The chief complaint is the reason for the encounter. T/F

True.

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Surgical codes may trigger an audit because they are used frequently. T/F

False

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There is only one kind of audit. T/F

False.

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One of the top coding and documentation errors is that the chief complaint is missing. T/F

True.

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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

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Medicare prescription drug coverage is offered through

Medicare Part D

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The Medicare profram that provides expanded benefits through private managed care health plans is

Medicare Advantage (MA)

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The role of the centers for Medicare and Medicaid Services (CMS) includes all of the following EXCEPT

paying claims for Medicare beneficiaries

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HCPCS level 2 codes are updated by who

CMS

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A clean claim has no mistakes or missing information. T/F

True

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The patient and the guarantor are always the same. T/F

False.

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Superbills are also referred to as encounter forms, charge slips, or routing slips. T/F

True

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The CMS-1500 was developed by Blue Cross Blue Shield. T/F

True

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HCPS is the acronym for the.

Health Common Procedure Coding System.

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The five-digit CPT codes used to report services and procedures performed by healthcare providers are also known as:

Level 1 HCPCS.

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HCPCS was developed to achieve all of the following goals EXCEPT.

implementing standard fee structures for all providers across all plans.

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Level 1 HCPCS codes are also known as the

American Medical Association's CPT code.

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HCPCS level 1 codes were developed by the.

American Medical Association (AMA)

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HCPCS level 2 codes are updated annually by the.

Centers for Medicare and Medicaid Services (CMS)

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The code for durable medical equipment(DMA) would be found in the

Level 2 HCPCS code book.

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A coder who needs to find the codes for prosthetic devices and related procedures would find it in the

Level 2 HCPCS code book.

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HCPCS level 2 codes would include all of the following EXCEPT codes for:

surgical services.

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HCPCS level 2 national codes consist of.

One alphabetic character and four digits.

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The person who is ultimately responsible for payment to the medical office is called the:

Guarantor.

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If an insured patient signs an assignment of benefits form, the insurance carrier will send payment directly to the:

Physician.

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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

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The individual who purchases an insurance policy is known as the:

Policyholder

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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.

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When a patient has more than one insurance policy, one policy is considered the primary coverage and the additional policy is:

Secondary insurance

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On the CMS-1500 claim form, the abbreviation NPI indicates that:

The National Provider Identifier must be entered.

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The CMS-1500 claim form is mandatory for all Medicare claims.

A) True

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Most providers submit healthcare claims electronically.

A) True

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The majority of hospital reimbursement comes from:

Insurance companies.

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A patient control number (PCN) is a unique identifier assigned to each hospital patient at the time of.

Admission.

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The process of collecting a patient's personal information and entering it into the hospital database is referred to as:

Registration.

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A hospital will bill for patient services:

After the discharge paperwork is completed and signed by the physician.

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A charge description master includes all of the following information except:

Physician identification number.

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Reimbursement methods for inpatient hospital services include all of the following EXCEPT:

Capitation.

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The method of reimbursement that establishes the rate of payment to a hospital before services are rendered is:

Prospective payment system.

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The method of reimbursement that pays hospitals a fixed rate per day for all services provided is.

Per Diem.

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The ambulatory Payment classification (APC) system bases payments on:

Procedures.

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Services covered under the ambulatory payment classification (APC) system include all of the following EXCEPT:

Inpatient surgical procedures.

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OPPS Stands for:

Outpatient payment for preventive services.

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The list of Ambulatory payment classification (APC) rates is maintained by:

The centers for medicare and medicaid services (CMS)

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The diagnosis related group (DRG) system is a type of.

prospective payment system.

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Most major diagnostic categories (MDCs) are based on

A particular organ system.

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Diagnosis related group (DRG) classification takes into account all of the following criteria EXCEPT:

social status and family support.

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The physician who is primarily responsible for a patient's care while in the hospital is referred to as the:

Attending physician

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The UB-04 claim form allows for a maximum of:

10 diagnoses.

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A facility's case mix is based on all of the following EXCEPT:

discharge status.

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Software that is used to calculate the diagnosis related group (DRG) payment group is called a(n)

Grouper.

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A case that cannot be assigned an appropriate diagnosis related group (DRG) because of the typical situation is called a(n)

Cost outlier.

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When referring to diagnosis related groups (DRGs), the abbreviation CC is used to indicate:

complications or comorbidities.

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Individuals eligible for medicare may be classified into one or more of the following categories EXCEPT:

Low Income.

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The abbreviation ESRD stands for

end-stage renal disease.

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The medicare coverage that consists of hospital insurance is

Medicare Part A

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The medicare coverage that pays for physician services is

Medicare Part B

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The medicare program that provides expanded benefits through private managed care health plans is

Medicare Advantage (MA)

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Medicare prescription drug coverage is offered through.

Medicare Part D.

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The role of the Centers for medicare and medicaid (CMS) includes all of the following EXCEPT:

Paying claims for medicare beneficiaries.

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The organization that enrolls new medicare beneficiaries into the program is the

Social Security Administration (SSA)

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Organizations that are hired by the CMS to carry out day-to-day medicare program operations are known as:

Contractors.

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A spouse of a deceased, retired, or disabled individual who was or is eligible for medicare benefits:

Is also eligible for medicare coverage.

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Medicare part A provides coverage for all of the following services EXCEPT:

Inpatient physician services.

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Individuals age 65 and older qualify for medicare if they have paid FICA taxes for at least:

40 calendar quarters.

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To qualify for medicare, disabled adults must have been receiving social security disability benefits for:

More than 2 years.

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Coverage for hospice care is provided by:

Medicare Part A.

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Hospice services covered under medicare part a may by provided as:

Short-term hospital care, Inpatiet respite care, In-home care. ALL THE ABOVE.

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Private-duty nursing care is:

Not covered by medicare.

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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.

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Medicare Part D consists of:

Prescription drug coverage.

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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%

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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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