Question 1

Which modifier indicates that a signed ABN is on file?

Accepted Answer

Modifier GA indicates that a signed ABN is on file for the service or item being billed.

Question 2

The following coding system(s) /are utilized in the MS-DRG prospective payment methodology for assignment and proper reimbursement.

Accepted Answer

The MS-DRG (Medicare Severity Diagnosis Related Groups) system primarily uses ICD-9-CM codes (or ICD-10-CM/PCS codes in more recent updates) for diagnosis and procedure coding to determine hospital reimbursement.

Question 3

When billing for the admitting physician for a patient that is admitted to the hospital as an inpatient, one must use a CPT Evaluation and Management code based upon the level of care provided. These are the codes to be selected from for initial hospital care.99221 Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components. a detailed or comprehensive history a detailed or comprehensive examination and -medical decision making that is straightforward or of low complexity. 99222 Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components. a comprehensive history a comprehensive examination and -medical decision making of moderate complexity 99223 Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components. -medical decision making of high complexity The following statement is true.

Accepted Answer

The CPT codes 99221-99223 for initial hospital care can be used only once per hospitalization by the admitting physician to bill for the initial evaluation and management services provided.

Question 4

under Medicare Part B, all of the following statements are true and are applicable to nonparticipating physician providers, EXCEPT

Accepted Answer

Nonparticipating providers actually have a lower fee schedule than participating providers, as they have not agreed to accept assignment on all Medicare claims. The other statements are true for nonparticipating providers under Medicare Part B.

Question 5

In employer-sponsored health plans, employees may select their health plan.

Accepted Answer

Employees may typically only change their health plan during the open enrollment period, which is typically once a year. Choosing a different plan during the contract period, at the beginning of a fiscal year or on the first day of any month is usually not allowed, unless there is a qualifying life event such as marriage, birth of a child or loss of other coverage.

Question 6

In the managed care industry, there are specific reimbursement concepts, such as "capitation." All of the following statements are true in regard to the concept of "capitation," EXCEPT

Accepted Answer

Capitation means paying a fixed amount per member per month, and the volume and expense of services do not affect reimbursement. Therefore, statement A is false, as services are not paid based on actual charges in capitation. Statement B and C are true, and statement D is partially true, as capitation can involve a group of physicians or an individual physician.

Question 7

A fiscal year is a yearly accounting period. It is the 12-month period on which a budget is planned. The federal fiscal year is

Accepted Answer

The federal fiscal year runs from October 1st through September 30th of the next year.

Question 8

Under Medicare, a beneficiary has lifetime reserve days. All of the following statements are true, EXCEPT

Accepted Answer

Lifetime reserve days are not paid under Medicare Part B, but are part of Medicare Part A coverage. All the other statements are true.

Question 9

Accounts Receivable (A/R) refers to

Accepted Answer

Accounts Receivable (A/R) refers to cases or invoices that have not yet been paid, as opposed to cases that have already been paid (option C) or denials that have been returned to the hospital (option D). Option B may refer to total revenue, but it does not specifically relate to A/R.

Question 10

Under APCs, payment status indicator "X" means

Accepted Answer

The answer of Under APCs, payment status indicator "X" means
...

Question 11

This document is published by the Office of Inspector General (OIG) every year. It details the OIG's focus for Medicare fraud and abuse for that year. It gives health care providers an indication of general and specific areas that are targeted for review. It can be found on the Internet on CMS' Web Site.

Accepted Answer

The OIG's Workplan is published yearly and details the OIG's focus for Medicare fraud and abuse for that year. It provides guidance for health care providers regarding where the OIG will be targeting their review efforts. It can be found on the CMS website.

Question 12

There are times when documentation is incomplete or insufficient to support the diagnoses found in the chart. The most common way of communicating with the physician for answers is by

Accepted Answer

Using physician query forms is the most appropriate way to communicate with physicians for answers regarding incomplete or insufficient documentation. This method is formal, documented, and promotes adherence to coding and billing standards. Emailing, leaving notes in the chart, or calling the physician's office may be less effective, may not be appropriately documented, or may lead to misunderstandings or inconsistent practices.

Question 13

If this physician is a nonparticipating physician who does not accept assignment for this claim, the total amount of the patient's financial liability (out-of-pocket expense) is

Accepted Answer

The patient's financial liability is the difference between the total charges and the amount paid by the insurance company. In this case, the total charges are $190.00 and the amount paid by the insurance company is $123.50. Therefore, the patient's financial liability is $190.00 - $123.50 = $66.50.

Question 14

Under APCs, payment status indicator "T" means

Accepted Answer

Payment status indicator "T" under APCs indicates that a multiple procedure reduction applies.

Question 15

The following coding system(s) is/are utilized in the Impatient Psychiatric Facilities (IPFs) prospective payment methodology for assignment and proper reimbursement.

Accepted Answer

The IPFs prospective payment system primarily uses ICD-9-CM codes for diagnosis and procedural coding to determine reimbursement rates.

Question 16

Under APCs, payment status indicator "S" means

Accepted Answer

Payment status indicator "S" means that multiple procedure reduction does not apply for the given APC code.

Question 17

Under APCs, payment status indicator "C" means

Accepted Answer

Payment status indicator "C" under APCs indicates that the service is an inpatient-only service, meaning it is not paid under the outpatient prospective payment system.

Question 18

This is a ten digit, intelligence-free, numeric identifier designed to replaced all previous provider legacy numbers. This number identifies the physician universally to all payers. This number is issued to all HIPAA-covered entities. It is mandatory on the CMS­1500 and UB-04 claim forms.

Accepted Answer

The description fits the National Provider Identifier (NPI), which is a ten digit numeric identifier used to replace all previous provider legacy numbers, is mandatory on CMS-1500 and UB-04 claim forms, and is issued to all HIPAA-covered entities. The other options do not correspond to the given description.

Question 19

Under APCs, payment status indicator "V" means

Accepted Answer

Payment status indicator "V" under APCs refers to medical visits, indicating that the service is a clinic or emergency department visit.

Question 20

The term used to describe a diagram depicting grouper logic in assigning MS-DRGs is

Accepted Answer

A decision tree is a diagram that shows the decision-making process involved in assigning MS-DRGs. It includes branches and nodes that represent the various steps and criteria used in the grouping process. The term "grouper hierarchy" may also be used to refer to the overall system of grouping patients into DRGs. However, of the options provided, "decision tree" is the most specific and accurate term for the diagrammatic representation of the grouping logic.

Exam 1: Registered Health Information Administrator

Which modifier indicates that a signed ABN is on file?

The following coding system(s) /are utilized in the MS-DRG prospective payment methodology for assignment and proper reimbursement.

under Medicare Part B, all of the following statements are true and are applicable to nonparticipating physician providers, EXCEPT

In employer-sponsored health plans, employees may select their health plan.

In the managed care industry, there are specific reimbursement concepts, such as "capitation." All of the following statements are true in regard to the concept of "capitation," EXCEPT

A fiscal year is a yearly accounting period. It is the 12-month period on which a budget is planned. The federal fiscal year is

Under Medicare, a beneficiary has lifetime reserve days. All of the following statements are true, EXCEPT

Accounts Receivable (A/R) refers to

Under APCs, payment status indicator "X" means

There are times when documentation is incomplete or insufficient to support the diagnoses found in the chart. The most common way of communicating with the physician for answers is by

If this physician is a nonparticipating physician who does not accept assignment for this claim, the total amount of the patient's financial liability (out-of-pocket expense) is

Under APCs, payment status indicator "T" means

The following coding system(s) is/are utilized in the Impatient Psychiatric Facilities (IPFs) prospective payment methodology for assignment and proper reimbursement.

Under APCs, payment status indicator "S" means

Under APCs, payment status indicator "C" means

This is a ten digit, intelligence-free, numeric identifier designed to replaced all previous provider legacy numbers. This number identifies the physician universally to all payers. This number is issued to all HIPAA-covered entities. It is mandatory on the CMS1500 and UB-04 claim forms.

Under APCs, payment status indicator "V" means

The term used to describe a diagram depicting grouper logic in assigning MS-DRGs is

Exam 1: Registered Health Information Administrator

Which modifier indicates that a signed ABN is on file?

The following coding system(s) /are utilized in the MS-DRG prospective payment methodology for assignment and proper reimbursement.

under Medicare Part B, all of the following statements are true and are applicable to nonparticipating physician providers, EXCEPT

In employer-sponsored health plans, employees may select their health plan.

In the managed care industry, there are specific reimbursement concepts, such as "capitation." All of the following statements are true in regard to the concept of "capitation," EXCEPT

A fiscal year is a yearly accounting period. It is the 12-month period on which a budget is planned. The federal fiscal year is

Under Medicare, a beneficiary has lifetime reserve days. All of the following statements are true, EXCEPT

Accounts Receivable (A/R) refers to

Under APCs, payment status indicator "X" means

There are times when documentation is incomplete or insufficient to support the diagnoses found in the chart. The most common way of communicating with the physician for answers is by

If this physician is a nonparticipating physician who does not accept assignment for this claim, the total amount of the patient's financial liability (out-of-pocket expense) is

Under APCs, payment status indicator "T" means

The following coding system(s) is/are utilized in the Impatient Psychiatric Facilities (IPFs) prospective payment methodology for assignment and proper reimbursement.

Under APCs, payment status indicator "S" means

Under APCs, payment status indicator "C" means

This is a ten digit, intelligence-free, numeric identifier designed to replaced all previous provider legacy numbers. This number identifies the physician universally to all payers. This number is issued to all HIPAA-covered entities. It is mandatory on the CMS­1500 and UB-04 claim forms.

Under APCs, payment status indicator "V" means

The term used to describe a diagram depicting grouper logic in assigning MS-DRGs is

This is a ten digit, intelligence-free, numeric identifier designed to replaced all previous provider legacy numbers. This number identifies the physician universally to all payers. This number is issued to all HIPAA-covered entities. It is mandatory on the CMS1500 and UB-04 claim forms.