Question 1

Diabetic neuropathy is an example of a(n)

comorbidity

eponym

manifestation

sequela

Question 2

When other insurers are initially liable for payment on a medical service or supply provided to a patient, Medicare classifies them as the _________ payer.

Medicare secondary

primary

secondary

supplemental

Question 3

What term is used to describe the types and categories of patients treated by a health care facility or provider?

Medicare mix

case mix

secondary adverse

covered population

Question 4

HCPCS level II modifiers consist of two characters that are

alphabetic only

alphabetic or alphanumeric

alphanumeric only

one letter and one symbol

Question 5

Provider services for inpatient medical cases are billed on what basis?

fee-for-service

global fee

OPPS

services not billed

Question 6

New CPT codes go into effect

twice each year, on January 1 and July 1.

twice each year, on October 1 and April 1.

once each year, on October 1.

once each year, on December 1.

Question 7

The legal business name of the practice is also called the

administrative contractor

billing entity

provider identity

third-party payer

Question 8

Modifiers are reported to

alter or change the meaning of the code reported to the CMS-1500 claim.

decrease the reimbursement amount to be processed by the payer.

increase the reimbursement amount to be processed by the payer.

indicate an alteration in the description of the procedure service performed.

Question 9

Each relative value component is multiplied by the geographic cost practice index (GCPI), and then each is further multiplied by a variable figure called the

common denominator

conversion factor

related work total

relative value unit

Question 10

Qualified diagnoses are a necessary part of the patient's hospital and office record; however, physician offices are required to report

qualified diagnoses for inpatients/outpatients

qualified diagnoses related to outpatient procedures

signs and symptoms in addition to qualified diagnoses

signs and symptoms instead of qualified diagnoses

Question 11

RBRVS contains relative value components that consist of

geographic cost, work experience, expense to the practice.

intensity of work, expense to perform services, geographic location.

liability and work expense, practice expense, malpractice expense.

work expense, practice expense, malpractice expense.

Question 12

Q codes are used

to identify services that would not ordinarily be assigned a CPT code (e.g, drugs, biologicals, and other types of medical equipment or services.

to identify professional health care procedures and services that do not have codes identified in CPT.

by state Medicaid agencies when no HCPCS level II permanent codes exist but are needed to administer the Medicaid program.

by regional MACs when exisiting permanent national codes do not include codes needed to implement a regional MAC medical review coverage policy.

Question 13

"Incident to" relates to services provided by nonPARs that are defined as services

provided incidental to other services provided by a physician.

provided solely for the comfort and best interest of the beneficiary.

provided without the nonparticipating provider's supervision.

that would otherwise not be reimbursed by the Medicare carrier.

Question 14

Which special codes allow payers the flexibility of establishing codes if they are needed before the next January 1 annual update?

level III

miscellaneous

permanent

temporary

Question 15

The prospective payment system providing a lump-sum payment that is dependent on the patient's principal diagnosis, cormorbidities, complications, and principal and secondary procedures is

ambulatory payment classifications (APCs)

diagnosis-related groups (DRGs)

Medicare Physician Fee Schedule (MPFS)

resource-based relative value scale (RBRVS)

Question 16

Level I HCPCS codes are created by the

AMA

CMS

DMERCs

MACs

Question 17

Which statement is true of durable medical equipment?

It can withstand repeated use.

It is primarily used to serve a purpose of convenience.

It is routinely purchased by individuals who are not suffering from an illness or injury.

It is used by the patient in an outpatient rehabilitaiton facility.

Question 18

Level II HCPCS codes are created by the

AMA

CMS

DMERCs

MACs

Question 19

A bullet or black dot located to the left of a CPT code indicates

a deleted CPT code that should not be used.

a new, never previously published CPT code.

a revised CPT code from an earlier publication.

that special rules apply to the use of this code.

Question 20

Which organization is responsible for providing suppliers and manufacturers with assistance in determining HCPCS codes to be used?

AMA

CMS

durable medical equipment, prosthetic, and orthotic supplies dealers.

statistical analysis Medicare administrative contractor.

Question 21

HCPCS is a multilevel coding system that contains _________ levels.

1

2

3

4

Question 22

CPT-4 is published annually by

AMA

CMS

WHO

Medicare

Question 23

CPT index terms that are printed in boldface are called

descriptors

essential modifiers

main terms

subterms

Question 24

An example of a supplemental insurance plan is

CHAMPUS

Medicaid

Medigap

TRICARE

Question 25

The Medicare physician fee schedule amount for code 99213 is $100. Calculate the nonPAR allowed charge.

$20

$80

$95

$102.25

Question 26

The purpose of the creation of HCPCS codes was to furnish health care providers with a :

mandate to use electronic claims submission

method for obtaining higher reimbursement from Medicare.

standardized language for reporting professional services, procedures, supplies, and equipment.

standardized way of reporting inpatient and outpatient diagnoses.

Question 27

Medicare participating providers commonly report actual fees to Medicare but adjust fees after payment is received. The difference between the fee reported and the payment received is a

fee adjustment

limiting charge

neutral charge

write-off

Question 28

Nonparticipating (nonPAR) providers are restricted to billing at or below the

fee-for-service

limiting charge

physician fee schedule

relative value scale

Question 29

Modifiers are used with HCPCS codes to

change the original description of the service, procedure, or supply item.

decrease payment from Medicare.

increase payment from Medicare.

provide additional information regarding the product or service identified.

Question 30

When is it appropriate to file a patient's secondary insurance claim?

after a copy of the explanation of benefits is received by the practice

after the explanation of benefits is received by the patient

after the remittance advice is received by the medical practice

at the same time the primary insurance claim is filed, if the primary and secondary payers are different

Question 31

Temporary additional payments over and above the OPPS payment made for certain innovative medical devices, drugs, and biologicals provided to Medicare beneficiaries are known as __________

pass-through

temporary pass-through

transitional additional

transitioal pass-through

Question 32

Prospective price-based rates are established by the

actual charges for inpatient care reported to payers after discharge of the patient from the hospital.

AMA

payer, based on a particular category of patient.

reported health care costs from which a per diem rate has been determined.

Question 33

When reporting CPT codes on the CMS-1500 claim, medical necessity is proven by

attaching a special report to the CMS-1500 claim.

linking the CPT code to its ICD-10-CM counterpart.

reporting ICD-10-CM codes for the patient's condition.

sequencing CPT codes in a logical, chronological order.

Question 34

The deadline for filing Medicare claims is

six months from the date of service

three years from the date of service

there is no deadline

none of the above

Question 35

Birth dates are entered as ___________ on the CMS-1500 claim depending on block instructions.

DD MM YYYY or DDMMYYYY

MM DD YYYY or MMDDYYYY

MM DD YY or MMDDYY

YYYY MM DD or YYYYMMDD

Question 36

A black triangle located to the left of a CPT code indicates that the code

has been deleted and should not be used.

has been revised from previous CPT publications.

has special rules that apply to its use.

is new to this edition of CPT.

Question 37

Hospice provides which services for patients?

medical care in the home with the goal of keeping the patient out of the acute or long-term care setting

medical care, as well as psychological, sociological, and spiritual care

no copay if the patient has had a three-day minimum qualifying stay in an acute care facility

temporary hospitalization for a terminally ill, dependent patient for the purpose of providing relief from duty for the nonpaid caregiver of that patient

Question 38

The ICD-10-CM system classifies

morbidity

mortality data

provider services

supplies and services

Question 39

When office-based services are performed at a facility other than the physician's office, Medicare payments are reduced because the physician did not provide the supplies, drugs, utilities, or overhead. This payment reduction is called a(n)

ambulatory payment classification

facility write-off

outpatient fee reduction

site-of-service differential

Question 40

The reporting of diagnosis codes on the CMS-1500 claim is necessary to demonstrate

accuracy of the procedure code

higher payment

medical necessity

quality of care

Question 41

HCPCS "J codes" classify medications according to

generic or chemical name of drug, route of administration, and dosage.

generic or chemical name of drug, approval for Medicare coverage, and cost.

product name of drug, method of delivery, and cost.

product name of drug, route of administration, and dosage.

Question 42

The diagnosis that is the most significant condition for which procedures/services were provided is the

first-listed diagnosis

primary diagnosis

principal diagnosis

principal procedure

Question 43

CPT Appendix A contains information about

deleted codes

modifiers

new code descriptions

revised codes

Question 44

Medicare administrative contractors must keep Medicare fees within a $20 million spending ceiling, as stated in the Balanced Billing Act (BBA). This is called

balanced budget rule

budget neutrality

Medicare spend-down

the Medicare spending limit

Question 45

The document formerly known as the Explanation of Medicare Benefits is now known as the

Advance Beneficiary Notice

Medicare Payment Notice

Medicare Remittance Advice

Medicare Summary Notice

Question 46

The hospital assigns CPT codes to report

inpatient ancillary services

inpatient and outpatient surgery

inpatient surgical procedures

outpatient services and procedures

Question 47

The Medicare physician fee schedule amount for code 99213 is $100. The participating provider's usual charge for this service is $125. Calculate the patient's coinsurance amount.

$20

$25

$76

$80

Question 48

The unique identifier that CMS will assign to providers as part of the HIPAA requirements is called the

Grp #

NPI

PIN

UPIN

Question 49

Medicare is available to an individual who has worked at least

5 years in Medicare-covered employment, is at least 65 years old, and is a permanent resident of the U.S.

10 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the U.S.

10 years in Medicare-covered employment, is at least 65 years old, and is a citizen or permanent resident of the U.S.

25 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the U.S.

Question 50

Which resources should be referenced when determining the potential for Medicare reimbursement?

CPT coding manual

HCPCS coding manual

ICD-10-CM coding manual

Medicare Carriers Manual and Coverage Issues Manual