Center For Research On Computation And Society (Crcs-I) Practice Test
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 and comprehensive. Those who love to learn will appreciate it.
- 1.
Which of the following is true of Patient Care Partnership? (Select all that apply.)
- A.
It replaces the "Patient's Bill of Rights.'
- B.
It was adopted by the AHA
- C.
It outlines what a provider can expect from a patient.
- D.
It is a plain-language brochure.
- E.
It addresses patient expectations from admission to dismissal only.
Correct Answer(s)
A. It replaces the "Patient's Bill of Rights.'
B. It was adopted by the AHA
D. It is a plain-language brochure.Explanation
The Patient Care Partnership replaces the "Patient's Bill of Rights" and was adopted by the AHA. It is also a plain-language brochure.Rate this question:
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- 2.
Which of the following is true of protected health information (PHI)? (Select all that apply.)
- A.
It refers only to any single piece of data that could directly match patients with their medical information.
- B.
It can be shared without explicit consent for treatment, payment, or healthcare operations (TPO).
- C.
It cannot be shared for marketing purposes without explicit consent.
- D.
It cannot be shared with law enforcement agencies without consent or proper notification to the patient, expect under court order.
Correct Answer(s)
B. It can be shared without explicit consent for treatment, payment, or healthcare operations (TPO).
C. It cannot be shared for marketing purposes without explicit consent.
D. It cannot be shared with law enforcement agencies without consent or proper notification to the patient, expect under court order.Explanation
Protected health information (PHI) can be shared without explicit consent for treatment, payment, or healthcare operations (TPO). This means that healthcare providers can share PHI with other healthcare professionals involved in the patient's care, with insurance companies for billing purposes, and for general healthcare operations. However, PHI cannot be shared for marketing purposes without explicit consent, ensuring patient privacy and control over their information. Additionally, PHI cannot be shared with law enforcement agencies without consent or proper notification to the patient, except under a court order, to protect patient confidentiality and maintain trust in the healthcare system.Rate this question:
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- 3.
The savings results from HIPAA's administrative simplification rules have exceeded initial projections.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 4.
Which of the following is not an example of an advanced directive? (Select one.)
- A.
Living Will
- B.
Patient Care Partnership brochure
- C.
Healthcare Power of Attorney or Durable Power of Attorney for Healthcare.
- D.
DNR order
Correct Answer
B. Patient Care Partnership brochureExplanation
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.Rate this question:
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- 5.
Which of the following is not an example of an administrative sanction for inappropriate/fraudulent behavior on the part of a provider?
- A.
Denial or revocation of the provider number applications.
- B.
Suspension of provider payments.
- C.
Application of CMPs.
- D.
Inclusion in a published "watch" list of providers.
Correct Answer
D. 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.Rate this question:
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- 6.
Which of the following is true of TJC? (Select one.)
- A.
All hospitals must be accredited by TJC.
- B.
TJC will conduct an audit of a hospital every 39 months.
- C.
TJC will conduct an audit of a laboratory every 36 months.
- D.
TJC can audit a healthcare facility without advance notice as early as 6 months after its initial audit.
Correct Answer
B. TJC will conduct an audit of a hospital every 39 months. -
- 7.
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.)
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 8.
A single general consent document is signed to cover all procedures and services being performed in any 24-hour period.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Special consent forms are required for major/minor surgery, anesthesia, and other services such as psychiatric treatment, HIV positive testing, and experimental procedures.Rate this question:
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- 9.
What is the name for a policyholder's written authorization to have insurance benefits paid directly to the provider?
- A.
Conditional payments
- B.
Provisional benefits
- C.
Assignment of benefits
- D.
Authorization of payments
Correct Answer
C. Assignment of benefitsExplanation
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.Rate this question:
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- 10.
In the ER, failure of a patient, who is aware of what is happening, to object to treatment is implied consent - in fact.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
In the given statement, it is implied that if a patient in the emergency room is aware of the treatment being administered but does not object to it, their lack of objection is considered as consent. This implies that the patient is allowing the medical professionals to proceed with the treatment. Therefore, the statement is true.Rate this question:
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- 11.
In what situation is a person prevented from consenting to services? (Select all that apply.)
- A.
The person is an emancipated minor.
- B.
The person is uninsured.
- C.
The person is intoxicated.
- D.
The person is declared mentally incompetent by the courts.
Correct Answer(s)
C. The person is intoxicated.
D. 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.Rate this question:
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- 12.
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.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
An authorized person should draw a single line through the error, initial it, and continue the note.Rate this question:
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- 13.
Which of the following is authorized to make entries in the patient's medical record? (Select all that apply.)
- A.
Treating/attending physician
- B.
A physician extender
- C.
A licensed, registered nurse
- D.
A financial counselor
- E.
A student from an accredited health profession program (under the supervision of his or her clinic instructor.
Correct Answer(s)
A. Treating/attending physician
B. A physician extender
C. A licensed, registered nurse
E. 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.Rate this question:
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- 14.
Telephone orders from a referring physician may be edited for clarity by an individual authorized to received verbal orders.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The exact order must be transcribed verbatimRate this question:
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- 15.
What does the acronym NCD stand for? (Select one.)
- A.
National Coverage Determination
- B.
National Coverage Department
- C.
New Coverage Determination
- D.
New Coverage Direction
Correct Answer
A. National Coverage DeterminationExplanation
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.Rate this question:
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- 16.
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.)
- A.
Definitive LCD/NCD
- B.
Non-definitive LCD/NCD
Correct Answer
B. Non-definitive LCD/NCDExplanation
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.Rate this question:
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- 17.
Which of the following is not true of MSP laws? (Select one.)
- A.
Until 2010, Medicare was the primary payer for nearly will Medicare-covered services.
- B.
Before becoming entitled to Medicare, beneficiaries receive an IEQ that asks about any other healthcare coverage that might be primary to Medicare.
- C.
Medicare considers it a fraudulent or abusive practice to regularly submit claims that are the responsibility of another insurer under the MSP provision.
- D.
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.Rate this question:
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- 18.
Which of the following is true of financial policies in Patient Access/Front Desk? (Select all that apply.)
- A.
They should describe the provider's policies in general terms only to allow for flexible legal interpretation
- B.
They should clearly state when charges are due and payble; provide discount information; define acceptable methods of payment; outline charity guidelines and application procedures; and explain how accounts may be sent to a collection agency.
- C.
Patient Access/Front Desk staff should not discuss these policies with patients; instead, they should refer patients to a designated Billing staff member.
- D.
An effective policy for collecting at the time of service will improve cash flow and will reduce AR days, the cost of patient statements, bad debt, and follow-up time.
Correct Answer(s)
B. They should clearly state when charges are due and payble; provide discount information; define acceptable methods of payment; outline charity guidelines and application procedures; and explain how accounts may be sent to a collection agency.
D. An effective policy for collecting at the time of service will improve cash flow and will reduce AR days, the cost of patient statements, bad debt, and follow-up time.Explanation
Financial policies in Patient Access/Front Desk should clearly state when charges are due and payable, provide discount information, define acceptable methods of payment, outline charity guidelines and application procedures, and explain how accounts may be sent to a collection agency. Additionally, an effective policy for collecting at the time of service will improve cash flow and reduce AR days, the cost of patient statements, bad debt, and follow-up time.Rate this question:
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- 19.
Which of the following is true of the Medicare Part A spell of an illness? (Select all that apply)
- A.
It is also known as the benefit period
- B.
It is also known as the deductible period
- C.
It begins when a beneficiary enters the hospital and ends 30 days after discharge from the hospital or from a SNF
- D.
It begins when a beneficiary enters the hospital and ends 60 days after discharge from the hospital or from a SNF
Correct Answer(s)
A. It is also known as the benefit period
D. It begins when a beneficiary enters the hospital and ends 60 days after discharge from the hospital or from a SNFExplanation
The Medicare Part A spell of an illness is also known as the benefit period. It begins when a beneficiary enters the hospital and ends 60 days after discharge from the hospital or from a SNF.Rate this question:
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- 20.
Which of the following is not covered by Medicare for qualified beneficiaries? (Select all that apply.)
- A.
Cosmetic surgery
- B.
Chiropractic services (limited)
- C.
Routine eye care and most eyeglasses in the absence of disease
- D.
Kidney dialysis and kidney transplants
- E.
Hearing aids and exams
Correct Answer(s)
A. Cosmetic surgery
C. Routine eye care and most eyeglasses in the absence of disease
E. Hearing aids and examsExplanation
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.Rate this question:
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- 21.
Which of the following is not a registration element shared by HMOs and PPOs? (Select one.)
- A.
Use of program practitioners
- B.
Use of specific healthcare facilities
- C.
Precertification/preauthorization requirements
- D.
State-mandated coverage limits
Correct Answer
D. State-mandated coverage limitsExplanation
State-mandated coverage limits are not a registration element shared by HMOs and PPOs. HMOs and PPOs both involve the use of program practitioners, specific healthcare facilities, and precertification/preauthorization requirements. However, state-mandated coverage limits vary depending on the regulations and requirements set by each state, and may not be a common element shared by all HMOs and PPOs.Rate this question:
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- 22.
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.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 23.
Which of the following is not true of MACs? (Select one.)
- A.
They are the private firms that process Medicare claims
- B.
They were formerly known as fiscal intermediaries or carriers
- C.
They enroll providers in the Medicare program, provide education on Medicare billing requirements, and answer both provider and patient inquiries
- D.
There is one MAC in each of the 50 states
Correct Answer
D. There is one MAC in each of the 50 states -
- 24.
Beginning April 1, 2019, providers must include only the new MBI number, not the old HICN number, on claims.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Through December 31, 2019, providers may use either the previous HICN or the MBI number on claims, not both.Rate this question:
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- 25.
What is the term for health insurance that covers individuals, often as an employment benefit? (Select one.)
- A.
Self-insured
- B.
Commercial insurance
- C.
Liability insurance
- D.
Self-pay
- E.
HSA
Correct Answer
B. Commercial insuranceExplanation
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.Rate this question:
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- 26.
What type of insurance sometimes includes "med-pay" or "no-fault" coverage
- A.
Self-insured
- B.
Commercial insurance
- C.
Liability insurance
- D.
Self-pay
- E.
HSA
Correct Answer
C. Liability insuranceExplanation
Liability insurance sometimes includes "med-pay" or "no-fault" coverage. This type of insurance provides coverage for injuries or damages caused by the insured party to others. "Med-pay" coverage helps pay for medical expenses of the injured party, regardless of who is at fault. "No-fault" coverage pays for medical expenses and other damages regardless of fault, typically in states with no-fault insurance laws. Liability insurance is commonly associated with auto insurance, where these coverages can be included to provide additional protection.Rate this question:
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- 27.
Coordination of benefits involves determining which plan or insurance policy will pay first if two health plans or insurance policies cover the same benefits
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 28.
In which of the following situations is Medicare the primary payer? (Select all that apply.)
- A.
Services covered by workers' compensation
- B.
Care related to an accident for which liability or no-fault coverage exists
- C.
Patients 65 or older with group coverage from their own or their spouses' employment with an employer who has 20 or more employees
- D.
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
D. A patient admitted to an acute care hospital with Medicare insurance and the coverage changes to a Medicare HMO in the middle of the stayExplanation
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.Rate this question:
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- 29.
Which of the following is not true of coordination of benefits? (Select one.)
- A.
Group health plans are always secondary to Medicare
- B.
Medicaid is always the payer of last resort except for Indian Health Service
- C.
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
- D.
Almost all payers are secondary to any liability or property and casualty insurance
Correct Answer
A. Group health plans are always secondary to MedicareExplanation
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.Rate this question:
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- 30.
A person's own coverage is primary to that of a spouse
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 31.
When children are covered by both parents, what does the "birthday rule" dictate? (Select one.)
- A.
The coverage of the older parent is primary
- B.
The coverage of the younger parent is primary
- C.
The coverage of the parent with the first birthday in the calendar year is primary
- D.
The coverage of the parent with the last birthday in the calendar year is primary
Correct Answer
C. The coverage of the parent with the first birthday in the calendar year is primaryExplanation
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.Rate this question:
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- 32.
What is the HIPAA-required standard transaction code for healthcare claim status response? (Select one.)
- A.
270
- B.
271
- C.
277
- D.
835
Correct Answer
C. 277Explanation
The HIPAA-required standard transaction code for healthcare claim status response is 277. This code is used to transmit information regarding the status of a healthcare claim, including whether it has been accepted, rejected, or is still pending. The 277 transaction provides important updates on the progress of the claim, allowing healthcare providers and payers to efficiently track and manage claims.Rate this question:
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- 33.
Which of the following is not true of ICD-10 codes? (Select one.)
- A.
ICD stands for International Classification of Diagnoses
- B.
The code set contains 68,000 codes for great specificity in coding
- C.
They should reflect the principal diagnosis and discharge diagnosis to the highest level of specificity
- D.
They should reflect any coexisting diagnosis to the lowest level of specificity
Correct Answer
A. ICD stands for International Classification of DiagnosesExplanation
The given statement is not true because ICD actually stands for International Classification of Diseases, not International Classification of Diagnoses.Rate this question:
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- 34.
What type of code helps identify non-payable complications, such as hospital-acquired conditions? (Select one.)
- A.
Non-payable condition (NPC)
- B.
Hospital-acquired complication (HAC)
- C.
Present on admission (POA)
- D.
Diagnosis complication code (DCC)
Correct Answer
C. Present on admission (POA)Explanation
Present on admission (POA) is a type of code that helps identify non-payable complications, such as hospital-acquired conditions. This code indicates whether a particular diagnosis was present at the time of admission or if it developed during the patient's stay in the hospital. By using the POA code, healthcare providers can determine if a condition was pre-existing or if it was acquired during the hospitalization, which can impact reimbursement and quality reporting.Rate this question:
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- 35.
Which type of claim requires HCPCS/CPT codes? (Select one.)
- A.
Inpatient claims
- B.
Outpatient claims
Correct Answer
B. Outpatient claimsExplanation
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.Rate this question:
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- 36.
Which of the following is not true of HCPCS and CPT codes? (Select one.)
- A.
The HCPCS is divided into three levels
- B.
Level I of HCPCS is the CPT, a five-digit numeric code that identifies medical services and procedures furnished by physicians and other healthcare professionals
- C.
Level I of HCPCS includes codes for items or services that are regularly billed by suppliers other than physicians
- D.
Level II of the HCPCS is five-digit alpha/numeric code that identifies products, supplies, and services not included in the CPT codes when used outside a physician's office
Correct Answer
C. Level I of HCPCS includes codes for items or services that are regularly billed by suppliers other than physiciansExplanation
Level I of HCPCS, which is the CPT code, identifies medical services and procedures provided by physicians and healthcare professionals. It does not include codes for items or services regularly billed by suppliers other than physicians. These codes are included in Level II of HCPCS, which is a five-digit alpha/numeric code used to identify products, supplies, and services not included in the CPT codes when used outside a physician's office. Therefore, the statement that Level I of HCPCS includes codes for items or services regularly billed by suppliers other than physicians is not true.Rate this question:
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- 37.
Which of the following are the three primary components used in the selecting a level of E&M service? (Select one.)
- A.
History, examination, and counseling
- B.
Examination, medical decision-making, and counseling
- C.
History, examination, and medical decision-making
- D.
Examination, medical decision-making, and coordination of care
Correct Answer
C. History, examination, and medical decision-makingExplanation
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.Rate this question:
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- 38.
Which of the following is not true of HCPCS and CPT modifiers? (Select one.)
- A.
They can define HCPCS and CPT codes to a broader level
- B.
They are two-digit numeric or alphanumeric code
- C.
They can indicate that a service or procedure was altered by some circumstance that impacts reimbursement
- D.
They can clarify the anatomic site of a procedure
Correct Answer
A. They can define HCPCS and CPT codes to a broader levelExplanation
HCPCS and CPT modifiers are not used to define HCPCS and CPT codes to a broader level. Modifiers are used to provide additional information about a service or procedure, such as indicating that it was altered by some circumstance that impacts reimbursement or clarifying the anatomic site of a procedure. Modifiers do not change the level or definition of the codes themselves.Rate this question:
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- 39.
The National Provider Identifier (NPI) is assigned by Medicare to identify participating providers
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The National Provider Identifier (NPI) is not assigned by Medicare to identify participating providers. The NPI is a unique identification number for healthcare providers, health plans, and healthcare clearinghouses, which is assigned by the Centers for Medicare and Medicaid Services (CMS). While Medicare providers are required to have an NPI, it is not exclusively assigned by Medicare and is used by various healthcare entities for identification and billing purposes. Therefore, the statement is false.Rate this question:
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- 40.
Which of the following are indicated by an NDC? (Select one.)
- A.
Drug labeler, type of product, and size and type of package
- B.
Type of product, size and type of package, and expiration date
- C.
Drug labeler, type of product, and related ICD-10 code(s)
- D.
Type of product, size and type of package, and storage requirement
Correct Answer
A. Drug labeler, type of product, and size and type of packageExplanation
An NDC (National Drug Code) is a unique identifier assigned to each medication. It consists of three segments: the labeler code, the product code, and the package code. The labeler code identifies the manufacturer or distributor of the drug. The product code indicates the specific drug formulation, strength, and dosage form. The package code identifies the size and type of package in which the drug is distributed. Therefore, the correct answer is "Drug labeler, type of product, and size and type of package" because these are the components indicated by an NDC.Rate this question:
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- 41.
An MS-DRG payment is the total payment for a case, regardless of actual charges (unless an outlier is paid in certain cases.)
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
An MS-DRG payment refers to the total payment made for a case, regardless of the actual charges incurred. This means that the payment is not based on the specific charges for services or procedures provided, but rather on a predetermined reimbursement rate set by the Medicare Severity Diagnosis Related Group (MS-DRG) system. The system categorizes patients into different groups based on their diagnosis, procedures, and other factors, and assigns a fixed payment amount for each group. Therefore, the statement that an MS-DRG payment is the total payment for a case, regardless of actual charges, is true.Rate this question:
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- 42.
CMS allows a hospital to file subsequent inpatient DRG adjustments up to 90 days from thedate of the remittance advice for Medicare beneficiaries.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement is false because CMS allows a hospital to file subsequent inpatient DRG adjustments up to 1 year from the date of the remittance advice for Medicare beneficiaries, not 90 days.Rate this question:
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- 43.
The elements required to assign an APC are HCPC/CPT, E&M, ICD-10, and MS-DRG.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement is false because the elements required to assign an APC (Ambulatory Payment Classification) are not HCPC/CPT, E&M, ICD-10, and MS-DRG. APCs are used for outpatient services, while HCPC/CPT codes are used for procedure coding, E&M codes are used for evaluation and management services, ICD-10 codes are used for diagnosis coding, and MS-DRGs are used for inpatient hospital reimbursement. Therefore, the correct answer is false.Rate this question:
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- 44.
The RBRVS includes a standard for the rates of increase in Medicare expenditures for physician services.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 45.
Which of the following is not one of the RVUs used in determining the fee schedule payment? (Select one.)
- A.
Work required (Work RVU)
- B.
Practice expense (PE)
- C.
Malpractice insurance expense (MP)
- D.
Geographic indicator (GI)
Correct Answer
D. 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.Rate this question:
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- 46.
Which payment methodology ranks physician-charge data accumulated over time from lowest to highest, then uses a specific point (for example, the 75th percentile) as the basis for payments? (Select one.)
- A.
UCR
- B.
RUG
- C.
Capitation
- D.
Per diem
Correct Answer
A. UCRExplanation
UCR stands for Usual, Customary, and Reasonable. This payment methodology ranks physician-charge data accumulated over time from lowest to highest and then uses a specific point, such as the 75th percentile, as the basis for payments. UCR is commonly used by insurance companies to determine the amount they will reimburse for medical services provided by physicians.Rate this question:
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- 47.
Which payment methodology is used to determine payment for skilled nursing care? (Select one.)
- A.
UCR
- B.
RUG
- C.
Capitation
- D.
Fee-for-Service
Correct Answer
B. RUGExplanation
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.Rate this question:
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- 48.
Which of the following is not true of a CAH? (Select one.)
- A.
They must maintain no more than 25 inpatient beds that may be used for swing bed services
- B.
They may operate a rehabilitation/psychiatric DPU, each with up to 10 beds
- C.
They can have an ALOS of 72 hours or less per patient for acute care (excluding swing bed services and beds within DPUs)
- D.
They must furnish 24/7 emergency care services
Correct Answer
C. They can have an ALOS of 72 hours or less per patient for acute care (excluding swing bed services and beds within DPUs)Explanation
A CAH (Critical Access Hospital) is a designation given to certain rural hospitals in the United States that meet specific criteria. One of the criteria for a CAH is that they must have no more than 25 inpatient beds that can be used for swing bed services. Another criterion is that they may operate a rehabilitation/psychiatric DPU with up to 10 beds. Additionally, CAHs are required to furnish 24/7 emergency care services. However, it is not true that CAHs can have an ALOS (Average Length of Stay) of 72 hours or less per patient for acute care, excluding swing bed services and beds within DPUs.Rate this question:
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- 49.
Which of the following is included in a chargemaster? (Select all that apply.)
- A.
Description and price of an item and its CPT or HCPCS codes
- B.
General ledger account an item impacts
- C.
Inventory control information for supplies and medications
- D.
NPIs of providers authorized to use an item
Correct Answer(s)
A. Description and price of an item and its CPT or HCPCS codes
B. General ledger account an item impacts
C. Inventory control information for supplies and medicationsExplanation
A chargemaster is a comprehensive list of all the items and services provided by a healthcare facility, along with their corresponding prices and codes. It is used for billing and reimbursement purposes. The description and price of an item and its CPT or HCPCS codes are included in a chargemaster to ensure accurate billing and coding. The general ledger account an item impacts is also included to track the financial impact of each item or service. Additionally, inventory control information for supplies and medications is included to manage and monitor the availability and usage of these items. The NPIs of providers authorized to use an item are not typically included in a chargemaster.Rate this question:
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- 50.
Which of the following is not true of best practices for reviewing the chargemaster? (Select one.)
- A.
The review should be done at least every other year
- B.
The review should check for items to be added or deleted
- C.
The review is important because assigning an incorrect code could be construed as fraud
- D.
Departments directors/managers should be included in the review
Correct Answer
A. The review should be done at least every other yearExplanation
The given answer is incorrect. The correct answer is "The review should be done annually." The review of the chargemaster should be conducted annually, not every other year, to ensure accuracy and compliance with regulations. This is important because any incorrect coding can be seen as fraudulent and can have legal consequences. Additionally, the review should include checking for items to be added or deleted and involving department directors/managers to ensure a comprehensive evaluation.Rate this question:
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