Deck 1: Reimbursement, Hipaa, and Compliance

Question 1

A major change took place in Medicare in ____ with the enactment of the Omnibus Budget Reconciliation Act.

A)1989
B)1992
C)1997
D)2000

Answer 1

1989

Question 2

The Federal Register is the official publication for all "Presidential Documents," "Rules and Regulations," "Proposed Rules," and "Notices."

Answer 2

True

Question 3

The coder's responsibility is to ensure that the data are as accurate as possible not only for classification and study purposes but also to obtain appropriate reimbursement.

Answer 3

True

Question 4

Fraud is an intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes knowing that the deception could result in some unauthorized benefit to himself/herself or some other person.

Question 5

Medicare sets the payment level for assistant surgeons at a percentage of the fee schedule amount for the ____ surgical service.

A)global
B)united
C)partial
D)subsequent

Question 6

What are the three items that the Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services?

A)personal care items
B)deductibles, drug costs, personal care items
C)premiums
D)deductibles, premiums, and coinsurance

Question 7

Medicare Part B pays for:

A)durable medical equipment
B)hospital/facility care
C)physician services and durable medical equipment
D)hospital/facility care and durable medical equipment

Question 8

The incentive to Medicare participating providers is:

A)direct payment on all claims
B)a 5% higher fee schedule
C)faster processing
D)all of the above

Question 9

Who handles the day-to-day operation of the Medicare program for the CMS?

A)HCFA
B)peer review organization
C)MACs
D)IPPS

Question 10

The Medicare program was established in:

A)1955
B)1960
C)1965
D)1970

Question 11

The physician fee schedule is updated each April 15 and is composed of:

A)the relative value units for each service
B)a geographic adjustment factor to adjust for regional variations in the cost of operating a health care facility
C)a national conversion factor
D)all of the above
E)none of the above

Question 12

Nationally, unit values have been assigned for each service by Medicare (CPT and HCPCS) and determined on the basis of the resources necessary for the physician's performance of the service.

Question 13

Who is the largest third-party payer in the nation?

A)Blue Cross Blue Shield
B)Aetna
C)Cigna
D)the government

Question 14

Kickbacks from patients are allowed under certain circumstances according to Medicare guidelines.

Question 15

What edition of the Federal Register would hospital facilities be especially interested in?

A)October
B)November or December
C)January
D)July

Question 16

Medicare pays for what percentage of covered charges?

A)70%
B)75%
C)80%
D)85%

Question 17

What edition of the Federal Register would outpatient facilities be especially interested in?

A)October
B)November or December
C)January
D)July

Question 18

Part B services are billed using:

A)RBRVS, GPCI, and RVUs
B)ICD-10-CM, CPT, HCPCS
C)MS-DRGs
D)APCs

Question 19

Medicare Part A pays for:

A)professional services and durable medical equipment
B)hospital/facility care
C)physician services and durable medical equipment
D)hospital/facility care and durable medical equipment

Question 20

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?

A)100%, 100%, 100%, 100%, 100%
B)100%, 50%, 50%, 50%, 25%
C)100%, 50%, 50%, 25%, 25%
D)100%, 50%, 50%, 50%, 50%

Question 21

Which of the following is NOT a stated goal of the Physician Payment Reform?

A)decrease Medicare expenditures
B)assure quality health care at a reasonable cost
C)limit provider liabilities
D)redistribute physician payment more equitably

Question 22

RVU ________________________________________

Question 23

Identify the Medicare part with this coverage: Automatic coverage when age 65

A)Part A
B)Part B
C)Part D

Question 24

RBRVS ________________________________________

Question 25

Identify the Medicare part with this coverage: Prescription drug

A)Part A
B)Part B
C)Part D

Question 26

The ____________________ program was developed by Congress to monitor the necessity of hospital admissions and review the treatment costs and medical records of hospitals.

A)Medicare Administrative Contractors (MACs)
B)Quality Improvement Organizations (QIO)
C)Health Maintenance Organization (HMO)
D)Special Needs Plan (SNP)

Question 27

The conversion factor (CF) is a national dollar amount that is applied to all services paid on the basis of the ____________________.

A)Special Needs Plan
B)Affordable Care Act
C)Private Fee-for-Service Plan
D)Medicare Fee Schedule

Question 28

Identify the Medicare part with this coverage: Hospice care

A)Part A
B)Part B
C)Part D

Question 29

Medicare funds are collected by:

A)U.S.Food and Drug Administration
B)Social Security Administration
C)National Centers for Health Statistics
D)Department of the Treasury

Question 30

If a QIO provider 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.

A)$42
B)$58
C)$100
D)$0

Question 31

This program is also known as Medicare Advantage.

A)Part A
B)Part B
C)Part C
D)Part D

Question 32

OIG ________________________________________

Question 33

QIO ________________________________________

Question 34

Identify the Medicare part with this coverage: Physician visits

A)Part A
B)Part B
C)Part D

Question 35

MAAC ________________________________________

Question 36

____ 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.

A)Transmissions, transaction
B)Transactions, transmission
C)Interchanges, transmission
D)Transmissions, interchange

Question 37

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established these new benefits available under the Medicare program.

A)Part A
B)Part B
C)Part C
D)Part D

Question 38

CMS ________________________________________

Question 39

OBRA ________________________________________

Question 40

CMS handles the daily operation of the Medicare program through the use of ____ ____ ____, formerly Fiscal Intermediaries.

A)Medical Adjustment Contractor
B)Medicare Administrative Cooperative
C)Medicare Administrative Contractors
D)Medical Administrative Contractors

Question 41

DHHS ________________________________________

Question 42

Select the three goals of the Physician Payment Reform.

A)increase maximum allowable charge
B)decrease Medicare expenditures
C)redistribute physician payments more equitably
D)remove standard rates of increase
E)clarify the provisions of the physician fee schedule
F)assure quality health care at a reasonable cost

Question 43

Select the three components of the relative value unit.

A)work
B)beneficiary
C)training
D)malpractice
E)processing
F)overhead

Question 44

Under the RBRVS, the unit value is termed ____________________ Value Unit.

Question 45

Select the three types of persons eligible for Medicare.

A)those with permanent kidney failure
B)those with chronic conditions
C)those 65 and over
D)those 60 and over
E)those with disability benefits

Question 46

The provider or facility is ____________________ when the payment goes directly to the patient.

Question 47

For endoscopic procedures, Medicare allows the full value of the highest valued endoscopy, plus the difference between the next highest endoscopy and the ____________________ endoscopy.

Question 48

The __________ (two words) is a national dollar amount that is applied to all services paid on the basis of the MFS.

Question 49

In the role as a medical coder, it is your responsibility to ensure that you code ____________________ and completely to optimize reimbursement for services provided.

Question 50

The amount determined by multiplying the RVU weight by the geographic index and the conversion factor is called the __________ (two words) amount.