Question 1

CMS adjusts the Medicare Severity DRGs and the reimbursement rates every

Accepted Answer

CMS adjusts the Medicare Severity DRGs and the reimbursement rates every fiscal year beginning October 1.

Question 2

The prevention of illness through vaccination occurs due to the formation of

Accepted Answer

The prevention of illness through vaccination occurs due to the formation of memory cells. Memory cells are long-lived cells that remain in the body after an initial infection or vaccination and can quickly respond to a subsequent exposure to the same pathogen. This allows the immune system to mount a faster and stronger response, preventing the development of illness. Helper B cells, immunosurveillance, and mast cells also play important roles in the immune response, but are not specifically responsible for the prevention of illness through vaccination.

Question 3

These services are those performed by a nonphysician practitioner (such as a Physician Assistant) that are an integral yet incidental component of a physician's treatment for illness or injury. A physician must have personally performed an initial visit and must remain actively involved in the continuing care to the patient. Medicare requires direct supervision for these services to be billed.

Accepted Answer

The term "incident to" refers to services performed by nonphysician practitioners that are considered an integral part of a physician's care for a patient. These services must be performed under the direct supervision of the physician and billed under the physician's provider number.

Question 4

A HIPPS (Health insurance Prospective Payment System) code is a five-character alphanumeric code. A HIPPS code is used by

Accepted Answer

HIPPS codes are used by both home health agencies (HHAs) and inpatient rehabilitation facilities (IRFs) to submit claims for reimbursement under a prospective payment system for Medicare. Ambulatory surgery centers (ASCs) are not included in this payment system and therefore do not use HIPPS codes.

Question 5

Health plans that use _________ reimbursement methods issue lump-sum payments to providers to compensate them for all the health care services delivered to a patient fro a specific illness and/or over a specific period of time.

Accepted Answer

Episode-of-care (EOC) reimbursement methods issue lump-sum payments to providers to compensate them for all the healthcare services delivered to a patient for a specific illness and/or over a specific period of time. This approach encourages providers to focus on the quality of care and the effectiveness of treatment rather than the quantity of services provided. Capitation also issues lump-sum payments, but it is not specific to a particular illness or treatment episode. Fee-for-service pays providers for each service performed, and bundled payment combines multiple services into a single payment.

Question 6

The Quality Improvement Organizations (QIO) are given hospital-specific data from the Hospital Payment Monitoring Program (HPMP). Hospital data is provided to the QIOs for fourteen target areas on a quarterly basis. This report is called the

Accepted Answer

The Program for Evaluation Payment Patterns Electronic Report (PEPPER) is a report provided to Quality Improvement Organizations (QIO) on a quarterly basis. It includes hospital-specific data from the Hospital Payment Monitoring Program (HPMP) for fourteen target areas. PEPPER is used to identify areas for improvement and track progress over time. B) Payment Error Prevention program (PEP) is not related to the QIOs receiving hospital-specific data. C) The Office of Inspector General (OIG) Workplan outlines the priorities for the OIG's audits, evaluations, and inspections. D) The National Correct Coding Initiative (NCCI) is a coding initiative that helps providers avoid coding errors and ensures that payments are accurate. It is not related to the QIOs receiving hospital-specific data.

Question 7

A patient undergoes outpatient surgery. During the recovery period, the patient develops a trial fibrillation and is subsequently admitted to the hospital as an inpatient.

Accepted Answer

The patient was admitted to the hospital as an inpatient, indicating that their condition required more intensive medical care than can be provided in an outpatient setting. The development of atrial fibrillation is also a potential complication that may require hospitalization for treatment and monitoring.

Question 8

In calculating the fee for a physician's reimbursement, the three relative value units are each multiplied by

Accepted Answer

The three relative value units (RVUs) are multiplied by geographic practice cost indices (GPCIs) to adjust for regional cost variations in calculating physician reimbursement fees.

Question 9

If a participating provider's usual fee for a service is $700.00 and Medicare's allowed amount is $450.00, what amount is written off by the physician?

Accepted Answer

The participating provider is contracted with Medicare to accept their allowed amount as payment in full, so the physician must write off the difference between their usual fee and the allowed amount. In this case, they must write off $250.00 ($700.00 - $450.00).

Question 10

The difference between a rejected claim and a denied claim is that

Accepted Answer

A rejected claim is sent back to the provider for correction and resubmission, whereas a denied claim has been reviewed and determined not to be covered under the plan. A rejected claim may be appealed, but a denied claim may also be appealed. Additionally, a claim may be denied for reasons other than unauthorized procedures or services.

Question 11

The most common cause of dementia in the United States is

Accepted Answer

The answer of The most common cause of dementia in...

Question 12

Fee schedules are updated by third party payers

Accepted Answer

Fee schedules are typically updated by third party payers once a year. This allows for consistency and predictability in healthcare costs for providers and patients alike. However, it is important for providers to stay informed about any updates or changes to fee schedules throughout the year to ensure accurate billing and reimbursement.

Question 13

The centers for Medicare and Medicaid Services (CMS) will make an adjustment to the MS­DRG payment the hospital stay. Therefore hospitals are required to report an ____________ indicator for each diagnosis.

Accepted Answer

Hospitals are required to report a present on admission (POA) indicator for each diagnosis. This indicates whether the condition was present at the time of admission or if it was acquired during the hospital stay. This information is used by CMS to adjust MS-DRG payments based on the severity of illness and cost of care.

Question 14

A patient is admitted for a diagnostic workup for cachexia. The final diagnosis is malignant neoplasm of lung with metastasis.

Accepted Answer

Cachexia (general wasting and weight loss) is a common symptom of malignant neoplasms, and the diagnosis of metastatic lung cancer would explain the patient's symptoms.

Question 15

Commercial insurance plans usually reimburse health care providers under some type of __________ payment system, whereas the federal Medicare program uses some type of ___________ payment system.

Accepted Answer

Commercial insurance plans usually reimburse health care providers after the care has been provided, using a retrospective payment system. They pay based on the actual services provided and the fees charged by the provider. On the other hand, Medicare uses a prospective payment system, where payment is determined in advance based on a predetermined fee schedule for a particular service or procedure. This incentivizes providers to deliver care more efficiently and avoid unnecessary procedures or services. Therefore, option C is the correct answer.

Question 16

Dr. Zambrano ordered a CEA test for Mr. Logan. Dr. Zambrano may be considering a diagnosis of

Accepted Answer

CEA (carcinoembryonic antigen) is a tumor marker used to indicate the presence of certain types of cancer, particularly colorectal cancer. Therefore, Dr. Zambrano may be considering a diagnosis of cancer for Mr. Logan.

Question 17

The nursing initial assessment upon admission documents the presence of a decubitus ulcer. There is no mention of the decubitus ulcer in the physician documentation until several days after admission.

Accepted Answer

The answer of The nursing initial assessment upon admission documents...

Question 18

The cause of aplastic anemia is

Accepted Answer

Aplastic anemia is caused by bone marrow failure, which leads to a decrease in the production of all types of blood cells (red blood cells, white blood cells, and platelets). It can be caused by various factors including autoimmune disorders, exposure to certain chemicals and drugs, and viral infections. Acute and chronic blood loss can cause anemia but not aplastic anemia specifically. Inadequate iron intake can lead to iron deficiency anemia, but not aplastic anemia.

Question 19

A patient is admitted to the hospital for  a coronary artery bypass surgery. Postoperatively, he develops a pulmonary embolism.

Accepted Answer

The answer of A patient is admitted to the hospital...

Question 20

Targeted states (California, Flordia, and New York) with a large Medicare population were included in a Medicare payment recovery demonstration project. This project's purpose was to determine if the use of ___________ is a cost-effective means of ensuring correct payments are provided under Medicare. These are charged with identifying underpayments and overpayments for claims filed under Medicare Part A and Part B. They recoup overpayments from the providers.

Accepted Answer

Recovery audit contractors (RAC) are charged with identifying underpayments and overpayments for claims filed under Medicare Part A and Part B. They recoup overpayments from the providers. This demonstration project aimed to determine if the use of RACs is a cost-effective means of ensuring correct payments are provided under Medicare. So, option C is the correct answer.

Exam 1: Registered Health Information Administrator

CMS adjusts the Medicare Severity DRGs and the reimbursement rates every

The prevention of illness through vaccination occurs due to the formation of

A HIPPS (Health insurance Prospective Payment System) code is a five-character alphanumeric code. A HIPPS code is used by

Health plans that use _________ reimbursement methods issue lump-sum payments to providers to compensate them for all the health care services delivered to a patient fro a specific illness and/or over a specific period of time.

The Quality Improvement Organizations (QIO) are given hospital-specific data from the Hospital Payment Monitoring Program (HPMP) . Hospital data is provided to the QIOs for fourteen target areas on a quarterly basis. This report is called the

A patient undergoes outpatient surgery. During the recovery period, the patient develops a trial fibrillation and is subsequently admitted to the hospital as an inpatient.

In calculating the fee for a physician's reimbursement, the three relative value units are each multiplied by

If a participating provider's usual fee for a service is $700.00 and Medicare's allowed amount is $450.00, what amount is written off by the physician?

The difference between a rejected claim and a denied claim is that

The most common cause of dementia in the United States is

Fee schedules are updated by third party payers

The centers for Medicare and Medicaid Services (CMS) will make an adjustment to the MSDRG payment the hospital stay. Therefore hospitals are required to report an ____________ indicator for each diagnosis.

A patient is admitted for a diagnostic workup for cachexia. The final diagnosis is malignant neoplasm of lung with metastasis.

Commercial insurance plans usually reimburse health care providers under some type of payment system, whereas the federal Medicare program uses some type of _ payment system.

Dr. Zambrano ordered a CEA test for Mr. Logan. Dr. Zambrano may be considering a diagnosis of

The nursing initial assessment upon admission documents the presence of a decubitus ulcer. There is no mention of the decubitus ulcer in the physician documentation until several days after admission.

The cause of aplastic anemia is

A patient is admitted to the hospital for a coronary artery bypass surgery. Postoperatively, he develops a pulmonary embolism.

Exam 1: Registered Health Information Administrator

CMS adjusts the Medicare Severity DRGs and the reimbursement rates every

The prevention of illness through vaccination occurs due to the formation of

A HIPPS (Health insurance Prospective Payment System) code is a five-character alphanumeric code. A HIPPS code is used by

Health plans that use _________ reimbursement methods issue lump-sum payments to providers to compensate them for all the health care services delivered to a patient fro a specific illness and/or over a specific period of time.

The Quality Improvement Organizations (QIO) are given hospital-specific data from the Hospital Payment Monitoring Program (HPMP) . Hospital data is provided to the QIOs for fourteen target areas on a quarterly basis. This report is called the

A patient undergoes outpatient surgery. During the recovery period, the patient develops a trial fibrillation and is subsequently admitted to the hospital as an inpatient.

In calculating the fee for a physician's reimbursement, the three relative value units are each multiplied by

If a participating provider's usual fee for a service is $700.00 and Medicare's allowed amount is $450.00, what amount is written off by the physician?

The difference between a rejected claim and a denied claim is that

The most common cause of dementia in the United States is

Fee schedules are updated by third party payers

The centers for Medicare and Medicaid Services (CMS) will make an adjustment to the MS­DRG payment the hospital stay. Therefore hospitals are required to report an ____________ indicator for each diagnosis.

A patient is admitted for a diagnostic workup for cachexia. The final diagnosis is malignant neoplasm of lung with metastasis.

Commercial insurance plans usually reimburse health care providers under some type of __________ payment system, whereas the federal Medicare program uses some type of ___________ payment system.

Dr. Zambrano ordered a CEA test for Mr. Logan. Dr. Zambrano may be considering a diagnosis of

The nursing initial assessment upon admission documents the presence of a decubitus ulcer. There is no mention of the decubitus ulcer in the physician documentation until several days after admission.

The cause of aplastic anemia is

A patient is admitted to the hospital for a coronary artery bypass surgery. Postoperatively, he develops a pulmonary embolism.

The centers for Medicare and Medicaid Services (CMS) will make an adjustment to the MSDRG payment the hospital stay. Therefore hospitals are required to report an ____________ indicator for each diagnosis.

Commercial insurance plans usually reimburse health care providers under some type of payment system, whereas the federal Medicare program uses some type of _ payment system.