Center For Research On Computation And Society (Crcs-I) Practice Test

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  • 1/96 Questions

    What type of insurance sometimes includes "med-pay" or "no-fault" coverage

    • Self-insured
    • Commercial insurance
    • Liability insurance
    • Self-pay
    • HSA
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About This Quiz

The CRCS was founded to generate fresh ideas and technologies designed to address some of society's problems. Take this quiz and learn about it. Do you know about the Patient's Bill of Rights? Do you know about protected health information? Do you know what HIPPA stands for? How does a patient qualify for SNF cover? This quiz is very involved See moreand comprehensive. Those who love to learn will appreciate it.

Center For Research On Computation And Society (Crcs-I) Practice Test - Quiz

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  • 2. 

    Coordination of benefits involves determining which plan or insurance policy will pay first if two health plans or insurance policies cover the same benefits

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Coordination of benefits is a process used to determine the order in which multiple health plans or insurance policies will pay for the same benefits. This is important to avoid overpayment or duplication of coverage. By coordinating benefits, the primary plan or policy is identified, which is responsible for paying first, while the secondary plan or policy pays any remaining costs. Therefore, the statement "Coordination of benefits involves determining which plan or insurance policy will pay first if two health plans or insurance policies cover the same benefits" is true.

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  • 3. 

    Which of the following is not an example of an advanced directive? (Select one.)

    • Living Will

    • Patient Care Partnership brochure

    • Healthcare Power of Attorney or Durable Power of Attorney for Healthcare.

    • DNR order

    Correct Answer
    A. Patient Care Partnership brochure
    Explanation
    A Patient Care Partnership brochure is not an example of an advanced directive because it is a document that provides information about a patient's rights and responsibilities while receiving healthcare, rather than a legal document that outlines specific instructions for medical treatment or appoints a healthcare decision-maker. Advanced directives, such as a Living Will, Healthcare Power of Attorney, or DNR order, are legal documents that allow individuals to express their preferences for medical treatment or designate someone to make healthcare decisions on their behalf.

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  • 4. 

    To qualify for SNF cover, Medicare requires a person to have been a hospital inpatient for at least three consecutive days (not including the day of discharge.)

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Medicare requires a person to have been a hospital inpatient for at least three consecutive days (not including the day of discharge) in order to qualify for SNF cover. This means that if a person has been admitted to a hospital and stays there for a minimum of three days, they meet the requirement for Medicare to cover their stay in a skilled nursing facility (SNF). It is important to note that the day of discharge is not considered as part of the three-day requirement. Therefore, the statement "True" is the correct answer.

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  • 5. 

    Which type of LCD/NCD provides potential coverage circumstances, but most likely does not provide specific diagnosis, signs, symptoms, or ICD-10 codes that will be covered or non-covered? (Select one.)

    • Definitive LCD/NCD

    • Non-definitive LCD/NCD

    Correct Answer
    A. Non-definitive LCD/NCD
    Explanation
    A non-definitive LCD/NCD provides potential coverage circumstances without specifying the exact diagnosis, signs, symptoms, or ICD-10 codes that will be covered or non-covered. This means that while it may outline the general circumstances under which coverage may be provided, it does not provide specific guidance on whether a particular diagnosis or condition will be covered or not. This type of LCD/NCD leaves room for interpretation and may require additional documentation or justification for coverage.

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  • 6. 

    When children are covered by both parents, what does the "birthday rule" dictate? (Select one.)

    • The coverage of the older parent is primary

    • The coverage of the younger parent is primary

    • The coverage of the parent with the first birthday in the calendar year is primary

    • The coverage of the parent with the last birthday in the calendar year is primary

    Correct Answer
    A. The coverage of the parent with the first birthday in the calendar year is primary
    Explanation
    The "birthday rule" dictates that when children are covered by both parents, the coverage of the parent with the first birthday in the calendar year is considered primary.

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  • 7. 

    Because payer contracts are regulated at the state level, all contracts for payers in a given state are the same

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The statement is false because payer contracts are not regulated at the state level. Payer contracts are typically negotiated between healthcare providers and insurance companies, and the terms and conditions can vary between different payers within the same state. The contracts are based on negotiations and agreements between the parties involved, rather than being standardized across all payers in a given state.

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  • 8. 

    What is the consequence when timely-filing limits are not met? (Select one.)

    • The patient is billed for the entire remaining balance

    • The claim is written off, as billing the patient is not allowed

    Correct Answer
    A. The claim is written off, as billing the patient is not allowed
    Explanation
    When timely-filing limits are not met, the consequence is that the claim is written off. This means that the healthcare provider is not allowed to bill the patient for the remaining balance.

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  • 9. 

    Should a correction be required to a medical record, an authorized person should use correction fluid to neatly obscure the error and continue the note.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    An authorized person should draw a single line through the error, initial it, and continue the note.

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  • 10. 

    What does the acronym NCD stand for? (Select one.)

    • National Coverage Determination

    • National Coverage Department

    • New Coverage Determination

    • New Coverage Direction

    Correct Answer
    A. National Coverage Determination
    Explanation
    The acronym NCD stands for National Coverage Determination. This refers to a decision made by the Centers for Medicare and Medicaid Services (CMS) regarding whether a particular item or service is covered by Medicare. NCDs are based on national medical necessity criteria and help to ensure consistency in coverage and payment policies across the country.

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  • 11. 

    A person's own coverage is primary to that of a spouse

    • True

    • False

    Correct Answer
    A. True
    Explanation
    A person's own coverage being primary to that of a spouse means that their insurance plan will be the first to pay for any medical expenses incurred. This means that if both the person and their spouse have insurance, the person's insurance will be used first before the spouse's insurance is tapped into. This is important to understand as it affects how medical bills are processed and paid for in case both individuals have insurance coverage.

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  • 12. 

    Which of the following is not true of MSP laws? (Select one.)

    • Until 2010, Medicare was the primary payer for nearly will Medicare-covered services.

    • Before becoming entitled to Medicare, beneficiaries receive an IEQ that asks about any other healthcare coverage that might be primary to Medicare.

    • Medicare considers it a fraudulent or abusive practice to regularly submit claims that are the responsibility of another insurer under the MSP provision.

    • The CWF is a CMS file that contains Medicare patient eligibility and utilization data from the IEQ and ongoing MSPQs.

    Correct Answer
    A. Until 2010, Medicare was the primary payer for nearly will Medicare-covered services.
    Explanation
    The statement "Until 2010, Medicare was the primary payer for nearly all Medicare-covered services" is not true because even before 2010, Medicare was not the primary payer for all Medicare-covered services. Medicare has always had certain limitations and beneficiaries may have had other healthcare coverage that was primary to Medicare for certain services.

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  • 13. 

    What is the term for health insurance that covers individuals, often as an employment benefit? (Select one.)

    • Self-insured

    • Commercial insurance

    • Liability insurance

    • Self-pay

    • HSA

    Correct Answer
    A. Commercial insurance
    Explanation
    Commercial insurance is the correct answer because it refers to health insurance coverage that is provided by private insurance companies to individuals, often as an employment benefit. This type of insurance is purchased by employers on behalf of their employees and offers a range of coverage options and benefits. It is different from self-insured plans where the employer assumes the financial risk of providing healthcare benefits to its employees. Liability insurance covers damages caused by the insured party to others, self-pay refers to individuals paying for their own healthcare expenses, and HSA (Health Savings Account) is a type of savings account that individuals can use to pay for qualified medical expenses.

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  • 14. 

    A bill with late charges (posted after the DOS, after lag days have passed, or after the bill has dropped) will often have to be rebilled, causing delays in account resolution.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Late charges on a bill, which are posted after the due date or after a certain number of days have passed, can cause delays in resolving the account. This is because when late charges are added, the bill may need to be rebilled, which takes time and can prolong the process of resolving the account. Therefore, the statement "A bill with late charges will often have to be rebilled, causing delays in account resolution" is true.

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  • 15. 

    What is the name for someone who moves or changes residence and fails to notify creditors, but normally has a forwarding address? (Select one.)

    • Intentional skip

    • Unintentional skip

    • False skip

    Correct Answer
    A. Unintentional skip
    Explanation
    An unintentional skip refers to someone who moves or changes residence without notifying their creditors, but still maintains a forwarding address. This suggests that the individual did not purposely intend to avoid their creditors, but rather failed to inform them of their new address.

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  • 16. 

    Telephone orders from a referring physician may be edited for clarity by an individual authorized to received verbal orders.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The exact order must be transcribed verbatim

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  • 17. 

    Which of the following is not true of the steps to take when receiving notice that a patient is deceased? (Select one.)

    • A. Check if a legitimate estate exists and file an appropriate caveat to the estate

    •  Check the register of wills for an estate

    • Change the mailing address to "The family of [patient name]"

    • If there is no estate and no one assumes financial responsibility, write off any self-pay balance remaining after insurance liability is paid

    Correct Answer
    A. Change the mailing address to "The family of [patient name]"
    Explanation
    The steps to take when receiving notice that a patient is deceased include checking if a legitimate estate exists and filing an appropriate caveat to the estate, checking the register of wills for an estate, and writing off any self-pay balance remaining after insurance liability is paid if there is no estate and no one assumes financial responsibility. However, changing the mailing address to "The family of [patient name]" is not a step to take when receiving notice that a patient is deceased.

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  • 18. 

    Which of the following is not true of MACs? (Select one.)

    • They are the private firms that process Medicare claims

    • They were formerly known as fiscal intermediaries or carriers

    • They enroll providers in the Medicare program, provide education on Medicare billing requirements, and answer both provider and patient inquiries

    • There is one MAC in each of the 50 states

    Correct Answer
    A. There is one MAC in each of the 50 states
  • 19. 

    Which of the following is another name for the UB-04? (Select one.)

    • CMS-1450

    • CMS-1500

    • MSN

    • EOB

    Correct Answer
    A. CMS-1450
    Explanation
    The correct answer is CMS-1450 because the UB-04 is a standard claim form used by institutional healthcare providers to bill Medicare and Medicaid. It is also known as the CMS-1450 form, which is issued by the Centers for Medicare and Medicaid Services (CMS). The CMS-1500 form, on the other hand, is used by individual healthcare providers to bill for services rendered to patients. MSN stands for Medicare Summary Notice, which is a document that explains the services and supplies billed to Medicare beneficiaries. EOB stands for Explanation of Benefits, which is a statement from an insurance company that explains the services covered and the amount paid for by the insurance plan.

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  • 20. 

    What is the name for a policyholder's written authorization to have insurance benefits paid directly to the provider?

    • Conditional payments 

    • Provisional benefits

    • Assignment of benefits

    • Authorization of payments

    Correct Answer
    A. Assignment of benefits
    Explanation
    Assignment of benefits refers to a policyholder's written authorization to have insurance benefits paid directly to the provider. This means that the policyholder allows the insurance company to pay the benefits directly to the healthcare provider or service provider, rather than receiving the payment themselves and then paying the provider. This can streamline the payment process and ensure that the provider receives the payment promptly and accurately.

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  • 21. 

    Which of the following is not true of determining the responsible party for an account? (Select one.)

    • The responsible party is the adult patient him/herself, even in the case of injuries caused by the negligence of another party

    • In some states, spouses are responsible for each other's debts incurred during the marriage, even if the marriage ends or the other spouse dies

    • Adult children of a deceased person are legally responsible for any debts related to the deceased person's medical bills

    • Both parents are jointly and fully responsible for a minor patient, whether married or not and regardless of the language in a divorce decree

    Correct Answer
    A. Adult children of a deceased person are legally responsible for any debts related to the deceased person's medical bills
    Explanation
    The statement that adult children of a deceased person are legally responsible for any debts related to the deceased person's medical bills is not true. In most cases, the responsibility for the debts of a deceased person falls on the deceased person's estate, not their adult children. The estate is responsible for paying off any outstanding debts using the assets left behind by the deceased person. If there are not enough assets to cover the debts, the remaining debts are typically forgiven.

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  • 22. 

    What is the name of a statement by a collector along the lines of "This is an attempt to collect a debt and any information obtained will be used for that purpose"? (Select one.)

    • Collection acknowledgment

    • Collector warning

    • Mini Miranda

    • Statue of collection

    Correct Answer
    A. Mini Miranda
    Explanation
    The correct answer is Mini Miranda. The term "Mini Miranda" refers to a statement made by a debt collector when attempting to collect a debt. This statement is required by the Fair Debt Collection Practices Act (FDCPA) and serves as a warning to the debtor that any information obtained during the collection process will be used solely for that purpose. The name "Mini Miranda" is derived from the similarity of this statement to the Miranda warning given by law enforcement officers to individuals being arrested.

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  • 23. 

    The savings results from HIPAA's administrative simplification rules have exceeded initial projections.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The hoped-for savings have not materialized for most providers for several reasons. Most payers have not standardized their information requirements. While many payers offer ERAs, patient accounting software firms can charge prohibitive fees for parsing the ERA for posting purposes.

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  • 24. 

    A single general consent document is signed to cover all procedures and services being performed in any 24-hour period.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Special consent forms are required for major/minor surgery, anesthesia, and other services such as psychiatric treatment, HIV positive testing, and experimental procedures.

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  • 25. 

    Which of the following is authorized to make entries in the patient's medical record? (Select all that apply.)

    • Treating/attending physician

    • A physician extender

    • A licensed, registered nurse 

    • A financial counselor

    • A student from an accredited health profession program (under the supervision of his or her clinic instructor.

    Correct Answer(s)
    A. Treating/attending physician
    A. A physician extender
    A. A licensed, registered nurse 
    A. A student from an accredited health profession program (under the supervision of his or her clinic instructor.
    Explanation
    The treating/attending physician is authorized to make entries in the patient's medical record as they are responsible for the overall care and treatment of the patient. A physician extender, such as a physician assistant or nurse practitioner, may also be authorized to make entries in the medical record under the supervision of the attending physician. A licensed, registered nurse may also be authorized to make entries in the medical record as they are involved in the direct care of the patient. A student from an accredited health profession program may be authorized to make entries in the medical record under the supervision of their clinic instructor to gain practical experience. A financial counselor, however, is not typically authorized to make entries in the medical record as their role is primarily focused on financial matters related to the patient's care.

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  • 26. 

    If a patient changes Medicare Advantage status during an inpatient stay for an inpatient institution, the patient's status at admission or start of care determines liability.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    If a patient changes their Medicare Advantage status during an inpatient stay, the liability for the cost of the stay is determined based on the patient's status at the time of admission or start of care. This means that if the patient was enrolled in Medicare Advantage at the time of admission, they would be responsible for the costs associated with their stay. Therefore, the statement is true.

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  • 27. 

    Which of the following is not one of the OIG's seven elements of a compliance plan? (Select one.)

    • Written policies and procedures

    • Pre-employment background checks

    • Effective training and education

    • Responding to offenses and developing corrective action plans

    Correct Answer
    A. Pre-employment background checks
    Explanation
    Pre-employment background checks are not one of the OIG's seven elements of a compliance plan. The OIG's seven elements include written policies and procedures, effective training and education, conducting internal monitoring and auditing, responding to offenses and developing corrective action plans, establishing lines of communication, enforcing disciplinary standards, and conducting periodic evaluations. Pre-employment background checks are not specifically mentioned as one of these elements.

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  • 28. 

    Even if a responsible party does not specifically list a hospital debt in a Chapter 7 filing, the debt is automatically included in the petition.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    In a Chapter 7 filing, a responsible party is required to list all debts, including hospital debts. If a hospital debt is not specifically listed, it will not be automatically included in the petition. Therefore, the statement that the debt is automatically included in the petition is false.

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  • 29. 

    In what situation is a person prevented from consenting to services? (Select all that apply.)

    • The person is an emancipated minor.

    • The person is uninsured.

    • The person is intoxicated.

    • The person is declared mentally incompetent by the courts.

    Correct Answer(s)
    A. The person is intoxicated.
    A. The person is declared mentally incompetent by the courts.
    Explanation
    A person who is intoxicated may not be able to fully understand the nature of the services being offered and the potential consequences of their consent. Similarly, a person who has been declared mentally incompetent by the courts may lack the mental capacity to give informed consent. In both situations, the person's ability to understand and make decisions about services is compromised, making them unable to give valid consent.

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  • 30. 

    Which type of claim requires HCPCS/CPT codes? (Select one.)

    • Inpatient claims

    • Outpatient claims

    Correct Answer
    A. Outpatient claims
    Explanation
    Outpatient claims require HCPCS/CPT codes. HCPCS (Healthcare Common Procedure Coding System) and CPT (Current Procedural Terminology) codes are used to identify specific medical procedures and services provided to patients in outpatient settings. These codes help in accurately documenting and billing for the services rendered, ensuring proper reimbursement and tracking of healthcare services. Inpatient claims, on the other hand, typically use diagnosis-related group (DRG) codes to classify and bill for hospital stays.

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  • 31. 

    Which of the following is not a suggested tip for making collection efforts with internal resources? (Select one.)

    • Call frequently and have all questions and facts ready

    • Start with accounts with lower balances and work up to those with high balances

    • C. Fax needed documents and then call to ensure they were received

    • Maintain and review correspondence about denials, delays, disputes, and so on

    Correct Answer
    A. Start with accounts with lower balances and work up to those with high balances
  • 32. 

    Which of the following is not true of coordination of benefits? (Select one.)

    • Group health plans are always secondary to Medicare

    • Medicaid is always the payer of last resort except for Indian Health Service 

    • TRICARE is also the payer of last resort except for Medicaid, TRICARE supplements, the Indian Health Service, and other programs or plans as identified by the TRICARE Management Activity 

    • Almost all payers are secondary to any liability or property and casualty insurance

    Correct Answer
    A. Group health plans are always secondary to Medicare
    Explanation
    Group health plans are not always secondary to Medicare. Coordination of benefits is a process used to determine the order in which multiple health insurance plans pay for a claim. In some cases, group health plans may be primary to Medicare, meaning they pay first before Medicare pays its portion. This can depend on factors such as the size of the employer and whether the individual is still actively working. Therefore, it is not true to say that group health plans are always secondary to Medicare.

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  • 33. 

    Which payment methodology is used to determine payment for skilled nursing care? (Select one.)

    • UCR

    • RUG

    • Capitation

    • Fee-for-Service

    Correct Answer
    A. RUG
    Explanation
    RUG (Resource Utilization Group) is the payment methodology used to determine payment for skilled nursing care. RUGs classify patients into different groups based on their care needs and resource utilization. Each group has a predetermined payment rate, which is used to calculate the reimbursement for skilled nursing services provided. This methodology ensures that payment is based on the level of care required by the patient, taking into account factors such as therapy needs, activities of daily living, and medical conditions.

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  • 34. 

    Which of the following is not true of courtesy discharge? (Select one.)

    • It improves patient-hospital relations

    • It improves traffic flow

    • C. It reduces need for additional staff at peak discharge times

    • It results in more billing errors because there is one less opportunity to validate information

    Correct Answer
    A. It results in more billing errors because there is one less opportunity to validate information
    Explanation
    Courtesy discharge is a process where patients are allowed to leave the hospital without having to wait for all administrative procedures to be completed. The given answer states that courtesy discharge results in more billing errors because there is one less opportunity to validate information. This implies that when patients are discharged early, there is a higher chance of errors in billing as there is less time to verify and validate the information.

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  • 35. 

    Which of the following is not a common stall or delay with third-party payers? (Select one.)

    • Bill never received by payer

    • COB or MSP problems

    • Medical record/chart needed for review

    • Contractual requirement to hold a claim for a certain number of days

    Correct Answer
    A. Contractual requirement to hold a claim for a certain number of days
    Explanation
    A contractual requirement to hold a claim for a certain number of days is not a common stall or delay with third-party payers. This means that third-party payers do not typically require healthcare providers to wait a certain number of days before processing a claim. Other common stalls or delays with third-party payers include bills not being received by the payer, problems with coordination of benefits (COB) or Medicare Secondary Payer (MSP), and the need for medical records or charts for review.

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  • 36. 

    Which of the following is not true of electronic billing? (Select one.)

    • It results in faster entry into the payer system

    • It offers proof of receipt

    • It facilitates the process of sending attachments

    • There can be challenges with payer acceptance and upload/download issues

    Correct Answer
    A. It facilitates the process of sending attachments
    Explanation
    Electronic billing does not facilitate the process of sending attachments. This means that electronic billing does not make it easier to include additional documents or files along with the billing information.

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  • 37. 

    What does the acronym RTP stand for? (Select one?)

    • Routed to provider

    • Routed to payer

    • Returned to provider

    • Returned to payer

    Correct Answer
    A. Returned to provider
    Explanation
    The acronym RTP stands for "Returned to provider." This means that a certain item or document has been sent back to the original provider or sender.

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  • 38. 

    Which of the following is not true of a discharged bankruptcy? (Select one.)

    • It releases the guarantor/patient from financial responsibility of any and all account balances listed on the bankruptcy petition

    • The account balance is to be written off to the appropriate transaction code

    • It covers any patient accounts that occur within six months following the notification

    • It is usually entered within six months when a Chapter 7 bankruptcy is deemed to have no assets

    Correct Answer
    A. It covers any patient accounts that occur within six months following the notification
    Explanation
    A discharged bankruptcy does not cover any patient accounts that occur within six months following the notification.

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  • 39. 

    Which of the following is not an example of an administrative sanction for inappropriate/fraudulent behavior on the part of a provider?

    • Denial or revocation of the provider number applications.

    • Suspension of provider payments.

    • Application of CMPs.

    • Inclusion in a published "watch" list of providers.

    Correct Answer
    A. Inclusion in a published "watch" list of providers.
    Explanation
    The inclusion in a published "watch" list of providers is not an example of an administrative sanction for inappropriate/fraudulent behavior on the part of a provider. Administrative sanctions typically involve actions such as denial or revocation of provider number applications, suspension of provider payments, and application of Civil Monetary Penalties (CMPs). However, being included in a "watch" list does not directly impose any punitive measures or consequences on the provider; it is more of a precautionary measure to alert others about potential risks associated with the provider.

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  • 40. 

    What is the revenue code for Emergency Room General? (Select one.)

    • 0120

    • 0310

    • 0450

    • 0550

    Correct Answer
    A. 0450
    Explanation
    The revenue code 0450 is the correct answer for Emergency Room General. Revenue codes are used in healthcare settings to classify the type of services provided to patients. In this case, 0450 specifically represents the revenue code for Emergency Room General, indicating that the services provided in the emergency room fall under this category.

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  • 41. 

    What is the name of the Medicare rule that all diagnostic and clinically related non-diagnostic outpatient services provided  within a certain number of days of an inpatient admission must be combined to the inpatient claim when provided by an entity wholly owned or operated by the inpatient hospital? (Select one.)

    • 3-Day Payment Window Rule

    • 3-Day Bundle Rule

    • 5-Day Payment Window Rule

    • 7-Day Combined Charges Rule

    Correct Answer
    A. 3-Day Payment Window Rule
    Explanation
    The correct answer is the 3-Day Payment Window Rule. This rule states that all diagnostic and clinically related non-diagnostic outpatient services provided within three days of an inpatient admission must be combined to the inpatient claim when provided by an entity wholly owned or operated by the inpatient hospital. This rule helps ensure that the costs of these services are properly accounted for and reimbursed under Medicare.

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  • 42. 

    Which of the following is not a GAAP applying to the cashier role? (Select one.)

    • Endorse checks immediately with "Payable to [name of office] Only"

    • Issue receipts to customers on all cash payments and deposit them the same day as received

    • Store payments before they are deposited and other valuables in a fireproof safe

    • Maintain a payment log

    • Segregate duties

    Correct Answer
    A. Endorse checks immediately with "Payable to [name of office] Only"
    Explanation
    The correct answer is "Endorse checks immediately with 'Payable to [name of office] Only'". This is not a GAAP applying to the cashier role because endorsing checks in this way restricts the use of the funds to only the named office, which may not align with the organization's financial policies or objectives. GAAP typically requires cashiers to follow procedures that ensure transparency, accuracy, and security in handling cash and other valuables, such as issuing receipts, depositing cash payments promptly, storing payments and valuables in a secure location, maintaining a payment log, and segregating duties to prevent fraud or errors.

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  • 43. 

    Which of the following are the three primary components used in the selecting a level of E&M service? (Select one.)

    • History, examination, and counseling

    • Examination, medical decision-making, and counseling

    • History, examination, and medical decision-making

    • Examination, medical decision-making, and coordination of care

    Correct Answer
    A. History, examination, and medical decision-making
    Explanation
    The three primary components used in selecting a level of E&M service are history, examination, and medical decision-making. These components are crucial in determining the complexity of a patient's condition and the level of care required. The history includes gathering information about the patient's symptoms, medical history, and any relevant factors. The examination involves physically assessing the patient and documenting any findings. Medical decision-making involves evaluating the patient's condition, determining a diagnosis, and formulating a treatment plan. These components help healthcare providers determine the appropriate level of service and ensure that patients receive the necessary care.

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  • 44. 

    What type of UB-04 code consists for two digits and a date that together clarify a significant event or condition related to a claim? (Select one.)

    • Condition code

    • Occurrence code

    • Occurrence span code

    • Revenue code

    Correct Answer
    A. Occurrence code
    Explanation
    Occurrence codes in the UB-04 form consist of two digits and a date that provide additional information about a significant event or condition related to a claim. These codes help to clarify specific occurrences such as the date of admission, discharge, or transfer, or any other important events that may impact the claim.

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  • 45. 

    What does the acronym NCCI stand for? (Select one.)

    • National Clean Claims Initiative

    • New Clinical Code Institute 

    • Non-payable Claim Coding Identifiers

    • National Correct Coding Initiative

    Correct Answer
    A. National Correct Coding Initiative
    Explanation
    The correct answer is National Correct Coding Initiative. The National Correct Coding Initiative (NCCI) is a program developed by the Centers for Medicare and Medicaid Services (CMS) to promote correct coding methodologies and to prevent improper coding leading to inappropriate payment of Medicare claims. The NCCI edits are used to identify code pairs that should not be reported together, and they help ensure accurate and appropriate coding and billing practices.

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  • 46. 

    Which of the following is not covered by Medicare for qualified beneficiaries? (Select all that apply.)

    • Cosmetic surgery

    • Chiropractic services (limited)

    • Routine eye care and most eyeglasses in the absence of disease

    • Kidney dialysis and kidney transplants

    • Hearing aids and exams

    Correct Answer(s)
    A. Cosmetic surgery
    A. Routine eye care and most eyeglasses in the absence of disease
    A. Hearing aids and exams
    Explanation
    Medicare does not cover cosmetic surgery because it is considered an elective procedure for aesthetic purposes rather than a medical necessity. Routine eye care and most eyeglasses are also not covered unless there is an underlying disease or condition. Similarly, hearing aids and exams are not covered by Medicare as they are considered to be for personal convenience rather than essential medical treatment. Kidney dialysis and kidney transplants, on the other hand, are covered by Medicare as they are necessary for the treatment of kidney disease.

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  • 47. 

    In which of the following situations is Medicare the primary payer? (Select all that apply.)

    • Services covered by workers' compensation

    • Care related to an accident for which liability or no-fault coverage exists

    • Patients 65 or older with group coverage from their own or their spouses' employment with an employer who has 20 or more employees

    • A patient admitted  to an acute care hospital with Medicare insurance and the coverage changes to a Medicare HMO in the middle of the stay

    Correct Answer
    A. A patient admitted  to an acute care hospital with Medicare insurance and the coverage changes to a Medicare HMO in the middle of the stay
    Explanation
    Medicare is the primary payer in the situation where a patient is admitted to an acute care hospital with Medicare insurance and the coverage changes to a Medicare HMO in the middle of the stay. This means that Medicare will be responsible for paying for the majority of the patient's medical expenses during their hospital stay, even if their coverage changes to a Medicare HMO.

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  • 48. 

    The RBRVS includes a standard for the rates of increase in Medicare expenditures for physician services.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The RBRVS (Resource-Based Relative Value Scale) is a system used by Medicare to determine the payment rates for physician services. It takes into account the relative value of each service based on factors such as the time, skill, and resources required. One of the goals of the RBRVS is to control the rates of increase in Medicare expenditures for physician services, ensuring that payments are aligned with the value provided. Therefore, the statement that the RBRVS includes a standard for the rates of increase in Medicare expenditures for physician services is true.

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  • 49. 

    Which of the following is not one of the RVUs used in determining the fee schedule payment? (Select one.)

    • Work required (Work RVU)

    • Practice expense (PE)

    • Malpractice insurance expense (MP)

    • Geographic indicator (GI)

    Correct Answer
    A. Geographic indicator (GI)
    Explanation
    Geographic indicator (GI) is not one of the RVUs used in determining the fee schedule payment. RVUs, or Relative Value Units, are used to measure the value of medical services based on factors such as the work required, practice expenses, and malpractice insurance expenses. However, the geographic indicator is not a factor used in this calculation. It is likely that the geographic indicator refers to the location or region where the medical service is provided, which may affect reimbursement rates but is not directly used in determining the fee schedule payment.

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Quiz Review Timeline (Updated): Mar 21, 2023 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jul 07, 2019
    Quiz Created by
    A91anderson

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