Question 1

A company that contracts with the Centers for Medicare and Medicaid Services (CMS) to pay Medicaid claims is called a

Accepted Answer

A fiscal agent is a company that contracts with CMS to process and pay Medicaid claims on behalf of the government.

Question 2

These are financial protections to ensure that certain types of facilities (e.g., children's hospitals) recoup all of their losses due to the differences int heir APC payments and the pre-APC payments.

Accepted Answer

Hold harmless agreements protect certain providers from financial losses that result from changes in Medicare APC payments. This means that the provider is held harmless for differences between pre-APC payments and APC payments.

Question 3

If this physician is a nonparticipating physician who does NOT accept assignment for this claim, the total amount he will receive is

Accepted Answer

The answer of If this physician is a nonparticipating physician...

Question 4

If this physician is a participating physician who accepts assignment for this claim, the total amount he will receive is

Accepted Answer

The answer of If this physician is a participating physician...

Question 5

The Correct Coding Initiative (CCI) edits contain a listing of codes under two columns titled, "comprehensive codes" and "component codes." According to the CCI edits, when a provider bills Medicare for a procedure that appears in both columns for the same beneficiary on the same date of service.

Accepted Answer

When a procedure appears in both columns for the same beneficiary on the same date of service, only the comprehensive code should be coded. The comprehensive code represents the entire procedure or service, while the component code represents a portion or aspect of the procedure. Coding both codes would result in duplicate billing and could potentially result in overpayment.

Question 6

A Medicare patient has arthroscopic analysis of adhesions and shaving of the particular  The Medicare CCI (Correct Coding Initiative) edits indicate that code 29877 is not a component code for 29884, but code 29884 is a component code for 29877. The correct code(s) to be reported on this claim is (are)

Accepted Answer

The answer of A Medicare patient has arthroscopic analysis of...

Question 7

This information is printed on the UB-04 claim form to represent the cost center (e.g, lab, radiology, cardiology, respiratory, etc.) for the department in which the item is provided. It is used for Medicare billing.

Accepted Answer

The revenue code is printed on the UB-04 claim form to represent the cost center for Medicare billing. The modifier is a code used to provide additional information about the service or item provided. The charge code is not a standard billing term and general ledger key is used for accounting purposes, not billing.

Question 8

The following type of hospital is considered excluded, which means that it does not participate in any type of prospective payment system (PPS).

Accepted Answer

Cancer hospitals are considered excluded from the prospective payment system (PPS) and have their own payment arrangements.

Question 9

LCDs and NCDs are review policies that describe the circumstances of coverage for various types of medical treatment. They advise physicians which services Medicare considers reasonable and necessary and may indicate the need for an advance beneficiary notice. They are developed by the Centers for Medicare and Medicaid Services (CMS), Medicare carriers, or fiscal intermediaries LCD and NCD are acronyms that stand for

Accepted Answer

LCD and NCD stand for local coverage determinations and national coverage determinations. These policies advise physicians which services Medicare considers reasonable and necessary, and they may indicate the need for an advance beneficiary notice. They are developed by the Centers for Medicare and Medicaid Services (CMS), Medicare carriers, or fiscal intermediaries.

Question 10

This information indicates the most recent activity of an item.

Accepted Answer

Activity date is the most relevant information to determine the recent activity of an item.

Question 11

This information provides a narrative name of the services provided. This information should be presented in a clear concise manner. When possible, the narratives from the HCPCS/CPT book should be utilized.

Accepted Answer

The item description provides a narrative name of the services provided and should be clear and concise, often using narratives from the HCPCS/CPT book.

Question 12

this prospective payment system replaced the Medicare physician payment system of "customary, prevailing, and reasonable (CPR)" charges whereby physicians were reimbursed according to historical record of the charge for the provision of each service.

Accepted Answer

The Medicare Physician Fee Schedule (MPFS) replaced the CPR payment system for physician services. MPFS payment rates are based on the relative value units (RVUs) assigned to each service provided by the physician, rather than historical charges.

Question 13

The hospital outpatient prospective payment system for Medicare applies to all of the following EXCEPT.

Accepted Answer

The hospital outpatient prospective payment system for Medicare applies to facility reimbursements for outpatient hospital clinic visits, emergency department visits, and hospital-based ambulatory surgery, but not to professional services such as physician fees. These fees are paid separately through other Medicare payment systems.

Question 14

This information is used to assign each item to a particular section of the general ledger in a particular facility's accounting section. Reports can be generated from this information to include statistics related to volume in terms of numbers, dollars, and payer types.

Accepted Answer

The general ledger key is used to assign each item to a particular section of the general ledger in a particular facility's accounting section.

Question 15

The DNFB report includes all patients who have been discharged from the facility but for whom, for one reason or another, the billing process is not complete.

Accepted Answer

The DNFB report stands for "discharged not final billed," which refers to patients who have been discharged but whose billing process is incomplete.

Question 16

If this physician is a participating physician who accepts assignment for this claim, the total amount of the patient's financial liability (out-of-pocket expense) is

Accepted Answer

The Medicare-approved amount for the service is $200. If the physician accepts assignment, Medicare will pay 80% of the Medicare-approved amount, which is $160. The patient is responsible for paying the remaining 20%, which is $40. Therefore, the total amount of the patient's financial liability (out-of-pocket expense) is $40.

Question 17

This information is used because it provides a uniform system of identifying procedures, services, or supplies. Multiple columns can be available for various financial classes.

Accepted Answer

HCPCS (Healthcare Common Procedure Coding System) codes are used to provide a standardized system for identifying medical procedures, services, and supplies, which is essential for billing and insurance purposes.

Question 18

This information is the numerical identification of the service or supply. Each item has a unique number with a prefix that indicates the department number (the number assigned to a specific ancillary department) and an item number (the number assigned by the accounting department or the business officer) for a specific procedure or service represented on the chargemaster.

Accepted Answer

The charge code is a unique numerical identifier for services or supplies, including a prefix for the department and an item number, as described in the chargemaster.

Question 19

The limiting charge is a percentage limit on fees specified by legislation that the nonparticipating physician may bill Medicare beneficiaries above the nonPAR fee schedule amount. The limiting charge is

Accepted Answer

The limiting charge is a percentage limit of 15% that nonparticipating physicians can bill Medicare beneficiaries above the nonPAR fee schedule amount. Therefore, the correct choice is B.

Question 20

The patient is financially liable for the coinsurance amount which is

Accepted Answer

Coinsurance is usually defined as a percentage of the total cost of a covered healthcare service that the patient is responsible for paying after the deductible has been met. In this case, the coinsurance amount is not specified, but the question states that the patient is financially liable for it. Therefore, the correct answer is C, as that is the only choice offered that represents a percentage (20%) and is a common coinsurance percentage for healthcare services.

Exam 1: Registered Health Information Administrator