Billing And Reimbursement Guidelines Quiz
This assessment is designed to measure knowledge retention from the training module that you just completed. Please choose the best answer to each multiple-choice question. Note: you must achieve a score of 90% or above in order to successfully pass the training course. After successful completion of the assessment, please present your certificate to the Human Resources Coordinator for review.
Questions and Answers
- 1.
A Medicare patient has reached $1,900 for the 2017 calendar year. What action is required ASAP?
- A.
Discharge the patient after the next visit
- B.
KX the case if medically necessary
- C.
Contact Medicare to get approval to continue if medically necessary
- D.
Continue care if medically necessary and discharge patient after $3,800 is reached
Correct Answer
B. KX the case if medically necessaryExplanation
When a Medicare patient reaches the $1,900 threshold for the calendar year, it is necessary to KX the case if the continued care is medically necessary. This means that the healthcare provider must provide the necessary documentation and justification for the ongoing treatment to Medicare in order to receive reimbursement. This step is important to ensure that the patient's care is covered and that the provider receives payment for the services rendered.Rate this question:
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- 2.
Which third party payer does not accept direct access, and therefore a POC needs to be immediately signed after the evaluation?
- A.
Aetna
- B.
PC
- C.
Medicare
- D.
A & B
- E.
B & C
Correct Answer
E. B & CExplanation
Both Medicare and Aetna do not accept direct access, meaning that a POC (Plan of Care) needs to be signed immediately after the evaluation. Therefore, the correct answer is B & C.Rate this question:
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- 3.
Which insurance company will only reimburse 4 units per visit?
- A.
Aetna
- B.
Medicare
- C.
United
- D.
Cigna
Correct Answer
A. AetnaExplanation
Aetna is the insurance company that will only reimburse 4 units per visit. This means that if a person has multiple services or procedures done during a single visit, Aetna will only cover up to 4 of those units. This could be a limitation set by Aetna to control costs or ensure that only essential services are covered. Medicare, United, and Cigna do not have this specific limitation mentioned in the question.Rate this question:
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- 4.
Which of the following insurance companies will reimburse for physical performance test (PPT)?
- A.
PC
- B.
BCBS
- C.
MVA
- D.
A & B
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
All of the insurance companies mentioned, PC, BCBS, and MVA, will reimburse for the physical performance test (PPT). This means that if an individual undergoes a PPT and has insurance coverage with any of these companies, they will be eligible for reimbursement for the test.Rate this question:
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- 5.
For Medicare, when must progress reports be completed?
- A.
40 days or 15 visits, whichever comes first
- B.
30 days or 15 visits, whichever comes first
- C.
30 days or 10 visits, whichever comes first
- D.
40 days or 10 visits, whichever comes first
Correct Answer
C. 30 days or 10 visits, whichever comes firstExplanation
Progress reports for Medicare must be completed within 30 days or 10 visits, whichever comes first. This means that the healthcare provider must submit a progress report to Medicare either within 30 days of the patient's initial visit or after 10 visits, depending on which condition is met first. This ensures that Medicare stays updated on the patient's progress and can continue to provide coverage for their healthcare needs.Rate this question:
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- 6.
Aetna will only reimburse evaluations once every 180 days, even if it's a new injury.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Aetna, the insurance company, has a policy of reimbursing evaluations only once every 180 days, regardless of whether it is for a new injury or not. This means that even if a person sustains a new injury, they will not be eligible for reimbursement for an evaluation until 180 days have passed since their last evaluation.Rate this question:
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- 7.
A Medicare patient initially came in for physical therapy because of a total knee replacement. After 4 visits, the patient had to be admitted to the hospital because of an infection. When the patient returns to therapy, what would be the appropriate billing charge for their first returning visit?
- A.
Re-Evaluation
- B.
Evaluation
- C.
Range of Motion
- D.
Strength Test
- E.
Physical Performance Test
Correct Answer
A. Re-EvaluationExplanation
After being admitted to the hospital due to an infection, the Medicare patient's condition has changed, and they require a re-evaluation to assess their current status and determine the appropriate course of treatment. This is different from an initial evaluation, as it focuses on reassessing the patient's condition and adjusting the therapy plan accordingly. Therefore, the appropriate billing charge for their first returning visit would be a re-evaluation.Rate this question:
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- 8.
A patient with Keystone HMO health insurance has been to the clinic for 20 visits. What is the total reimbursement the clinic will receive from insurance?
- A.
Only the deductible
- B.
Only the co-pay and the capitated rate per patient per month.
- C.
$1,000
- D.
Nothing until the insurance company holds a manual review
Correct Answer
B. Only the co-pay and the capitated rate per patient per month.Explanation
The correct answer is "Only the co-pay and the capitated rate per patient per month." This means that the clinic will receive reimbursement from the insurance company based on the co-pay amount paid by the patient and the capitated rate agreed upon between the clinic and the insurance company. The deductible, which is the amount the patient has to pay before insurance coverage kicks in, is not mentioned in the answer. Additionally, there is no information provided to suggest that a manual review by the insurance company is required before the clinic can receive reimbursement.Rate this question:
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- 9.
A patient with Align insurance was injured at work. Which of the following statements is/are true?
- A.
The work ready script must be signed by the referring physician as soon as possible
- B.
Authorization is not needed to perform FPN
- C.
Align is not a third party administrator insurance
- D.
There is reimbursement of 5 individual codes along with WH/WC
- E.
A & C
- F.
A, C & D
Correct Answer
A. The work ready script must be signed by the referring physician as soon as possible -
- 10.
Which of the following are third party administrator insurances?
- A.
Align
- B.
Premier Comp
- C.
Corvel
- D.
Private WC Payers
- E.
A, B & C
- F.
All of the above
Correct Answer
E. A, B & CExplanation
The correct answer is A, B & C. Align, Premier Comp, and Corvel are all examples of third party administrator insurances. Third party administrators (TPAs) are organizations that process insurance claims and provide administrative services on behalf of insurance companies. These TPAs handle tasks such as claims processing, policy administration, and customer service. Private WC Payers, on the other hand, are not specifically mentioned as third party administrator insurances in the given options.Rate this question:
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- 11.
A Medicare recipient is scheduled for one hour. Physical Therapy session consisted of 45 minutes of supervised therapeutic exercises, 15 minutes of manual therapy, and 15 minutes of electrical stimulation. Total treatment time is 75 minutes which includes 60 minutes of supervised total direct minutes procedures and 15 minutes of untimed code modalities. What would be billed for the day of service?
- A.
2 units of TE, 1 unit of ES
- B.
2 units of TE, 1 unit of MT, 1 unit of ES
- C.
2 units of TE, 1 unit of MT
- D.
3 units of TE, 1 unit of MT, 1 unit of ES
Correct Answer
D. 3 units of TE, 1 unit of MT, 1 unit of ESExplanation
The correct answer is 3 units of TE, 1 unit of MT, 1 unit of ES. This is because the Medicare recipient received 45 minutes of supervised therapeutic exercises (TE), 15 minutes of manual therapy (MT), and 15 minutes of electrical stimulation (ES). Each unit represents 15 minutes of treatment time, so a total of 3 units of TE, 1 unit of MT, and 1 unit of ES would be billed for the day of service.Rate this question:
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- 12.
Support Staff can place electrical stimulation pads on patients and turn on the electrical stimulation.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement suggests that support staff can place electrical stimulation pads on patients and turn on the electrical stimulation. However, this is not true. Only trained healthcare professionals such as doctors or therapists should perform these tasks as they require specific knowledge and expertise to ensure the safety and effectiveness of electrical stimulation. Support staff may assist in the process under the supervision and guidance of healthcare professionals, but they should not independently perform these tasks.Rate this question:
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- 13.
Support Staff can initiate a patient on exercises when they arrive for the follow up visit.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Support staff are not qualified healthcare professionals who can initiate exercises for a patient. Only licensed healthcare professionals, such as physical therapists or doctors, are authorized to prescribe and initiate exercises for patients. Therefore, the statement is false.Rate this question:
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- 14.
Physical therapist assesses patient's trigger point on the upper trap and notices lack of cervical ROM rotation. PT spends 7 minutes on a soft tissue mobilization of cervical spine. PT re-assesses cervical spine rotation ROM for 2 minutes to determine if ROM increased and pain decreased. What is the correct billing for this TX?
- A.
No units can be billed because the PT did not perform more than 8 minutes of service
- B.
1 unit of manual therapy
- C.
1 unit of therapeutic exercises
- D.
1 unit of ROM
Correct Answer
B. 1 unit of manual therapyExplanation
The correct billing for this treatment is 1 unit of manual therapy. This is because the physical therapist spent 7 minutes on a soft tissue mobilization of the cervical spine, which falls under manual therapy. The PT then reassessed the cervical spine rotation ROM for 2 minutes to determine if there was an increase in ROM and a decrease in pain. Since the total time spent on these activities is less than 8 minutes, only 1 unit of manual therapy can be billed.Rate this question:
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