Crcs-I And Crcs-p Practice Exam

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Federal Regulations and Governing Bodies


Questions and Answers
  • 1. 

    Which of the following is not a goal of The Patient Bill of Rights?

    • A.

      To stress the importance of the relationship between patients and providers

    • B.

      To ensure patients do not experience discrimination in billing and collections

    • C.

      To help patients feel more confident in the U.S. healthcare system

    • D.

      To stress the role that patients have to take to get and stay healthy

    Correct Answer
    B. To ensure patients do not experience discrimination in billing and collections
    Explanation
    The Patient Bill of Rights aims to stress the importance of the relationship between patients and providers, help patients feel more confident in the U.S. healthcare system, and stress the role that patients have to take to get and stay healthy. However, it does not specifically address the goal of ensuring patients do not experience discrimination in billing and collections.

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  • 2. 

    The statute commonly called "Obamacare" is formally known as which of the following?

    • A.

      The Health Care and Education Reconciliation Act

    • B.

      The Patient Protection and Affordable Care Act

    • C.

      The Health Insurance Portability and Accountability Act

    • D.

      The Hill-Burton Act

    Correct Answer
    B. The Patient Protection and Affordable Care Act
    Explanation
    The correct answer is The Patient Protection and Affordable Care Act. This act, commonly referred to as "Obamacare," was signed into law in 2010. It aimed to provide affordable health insurance coverage for all Americans and protect them from insurance company abuses. The act introduced various reforms to the healthcare system, including the expansion of Medicaid and the creation of health insurance exchanges. It also implemented regulations such as the individual mandate, requiring most individuals to have health insurance or face a penalty. Overall, the act aimed to improve access to healthcare and make it more affordable for individuals and families.

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  • 3. 

    PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of healthcare.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The Patient Protection and Affordable Care Act (PPACA) is a healthcare reform law implemented in the United States. Its primary objective is to decrease the number of uninsured Americans by expanding access to affordable health insurance options. The law achieves this through various provisions, such as the establishment of health insurance marketplaces and the expansion of Medicaid eligibility. Additionally, the PPACA aims to reduce the overall costs of healthcare by implementing measures to improve the efficiency and quality of care delivery. Therefore, the statement that PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing healthcare costs is true.

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  • 4. 

    Which of the following is not an area where tax-exempt hospitals are affected by the PPACA?

    • A.

      Financial assistance

    • B.

      Filing deadlines

    • C.

      Charging limitations

    • D.

      Collections actions

    Correct Answer
    B. Filing deadlines
    Explanation
    Tax-exempt hospitals are affected by the PPACA in various areas, such as financial assistance, charging limitations, and collections actions. However, filing deadlines are not an area where tax-exempt hospitals are affected by the PPACA. The PPACA primarily focuses on regulating and reforming healthcare coverage and delivery, rather than imposing specific requirements or regulations regarding filing deadlines for tax-exempt hospitals.

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  • 5. 

    What is the title for individuals who help consumers fill out applications for health coverage in a state-based Marketplace or state partnership Marketplace?

    • A.

      Agents or brokers

    • B.

      Certified application counselors

    • C.

      Navigators

    • D.

      Non-Navigators

    Correct Answer
    D. Non-Navigators
    Explanation
    Non-Navigators refers to individuals who assist consumers in filling out applications for health coverage in state-based or state partnership Marketplaces but are not qualified as Navigators. Navigators are individuals who are trained and certified to provide unbiased assistance to consumers in understanding their health coverage options. Agents or brokers are licensed professionals who help individuals and businesses purchase insurance plans. Certified application counselors are trained individuals who provide assistance to consumers in completing applications for health coverage. Therefore, the correct title for individuals who help consumers fill out applications for health coverage in a state-based or state partnership Marketplace but are not Navigators is Non-Navigators.

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  • 6. 

    The organization that ensures the quality, effectiveness, and efficiency of healthcare provided to Medicare beneficiaries and reviews all written quality-of-service complaints submitted by Medicare beneficiaries is:

    • A.

      CLIA

    • B.

      ACL

    • C.

      QIO

    • D.

      TJC

    Correct Answer
    C. QIO
    Explanation
    The Quality Improvement Organization (QIO) is the organization responsible for ensuring the quality, effectiveness, and efficiency of healthcare provided to Medicare beneficiaries. They also review all written quality-of-service complaints submitted by Medicare beneficiaries. The QIO plays a crucial role in monitoring and improving the quality of healthcare services provided to Medicare beneficiaries.

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  • 7. 

    Which of the following is not true of the Hill-Burton Act?

    • A.

      It is a U.S. federal law passed in 1946.

    • B.

      It offered loans for hospital construction in exchange for future charity care.

    • C.

      The Act stopped providing funds in 1997, so hospitals are no longer obligated to offer charity care because of participation in the program.

    • D.

      It is also known as Title I.

    Correct Answer
    C. The Act stopped providing funds in 1997, so hospitals are no longer obligated to offer charity care because of participation in the program.
    Explanation
    The Hill-Burton Act, also known as Title I, is a U.S. federal law passed in 1946. It offered loans for hospital construction in exchange for future charity care. However, the statement that the Act stopped providing funds in 1997, so hospitals are no longer obligated to offer charity care because of participation in the program is not true. The Act still remains in effect, and hospitals that received funds under the program are still required to provide a certain amount of free or reduced-cost care to those who cannot afford it.

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  • 8. 

    The primary purpose of the Criminal Health Care Fraud Statute is to prohibit sharing of confidential patient information for monetary gain.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The Criminal Health Care Fraud Statute prohibits willfully or knowingly executing a scheme to obtain any money or property owned by or in control of any healthcare benefit program or defrauding any healthcare benefit program.

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  • 9. 

    The two types of OIG exclusions for healthcare providers and suppliers who have been convicted of crimes are:

    • A.

      Mandatory and retroactive

    • B.

      Restrictive and permissive

    • C.

      Mandatory and permissive

    • D.

      Restrictive and retroactive

    Correct Answer
    C. Mandatory and permissive
    Explanation
    The correct answer is Mandatory and permissive. Mandatory exclusions are required by law and must be imposed on healthcare providers and suppliers who have been convicted of certain crimes, such as Medicare or Medicaid fraud. Permissive exclusions, on the other hand, are discretionary and may be imposed by the OIG based on factors such as the seriousness of the offense or the risk posed to federal healthcare programs. This means that while mandatory exclusions are mandatory and must be imposed, permissive exclusions are optional and may or may not be imposed depending on the circumstances.

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  • 10. 

    HEAT stands for:

    • A.

      Health Care Extension Action Team

    • B.

      Health Care Executive Assistance Team

    • C.

      Health Care Fraud Elimination Team

    • D.

      Health Care Fraud Prevention and Enforcement Action Team

    Correct Answer
    D. Health Care Fraud Prevention and Enforcement Action Team
    Explanation
    The correct answer is Health Care Fraud Prevention and Enforcement Action Team. This team is responsible for preventing and enforcing actions against health care fraud. They work towards eliminating fraudulent activities in the health care industry and ensuring that proper measures are taken to prevent such frauds in the future.

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  • 11. 

    When someone applies for credit, creditors may not ask about the person's race, sex, or national origin.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The applicant may be asked to disclose this information to assist federal agencies to enforce anti-discrimination laws. However, creditors may not use the information when deciding whether to give a person credit or when setting the terms of the credit.

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  • 12. 

    Which of the following is not true of TJC?

    • A.

      Accreditation by TJC is a requirement of participation in the Medicare program.

    • B.

      TJC will conduct an audit of the hospital every five years.

    • C.

      TJC can audit without advance notice.

    • D.

      TJC requires hospitals to have facility-wide disaster plans.

    Correct Answer
    B. TJC will conduct an audit of the hospital every five years.
    Explanation
    The given statement states that TJC will conduct an audit of the hospital every five years. However, this is not true of TJC as they can conduct audits without advance notice. Therefore, the statement that TJC will conduct an audit of the hospital every five years is not true.

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  • 13. 

    Which of the following is not a typical goal for reengineering Patient Access?

    • A.

      Place the focus on customer service so that the initial impression is a positive one.

    • B.

      Identify mechanisms to decrease wait times.

    • C.

      Free up staff time for training on new technology and regulations.

    • D.

      Make the process a positive and painless experience for the patient, guarantor, and/or family.

    Correct Answer
    C. Free up staff time for training on new technology and regulations.
    Explanation
    The goal of reengineering Patient Access is to improve efficiency and effectiveness in the registration and scheduling processes. This includes focusing on customer service, decreasing wait times, and making the process positive and painless for patients and their families. However, freeing up staff time for training on new technology and regulations is not a typical goal for reengineering Patient Access. This is because staff training is necessary to ensure that employees are knowledgeable and competent in using new technology and complying with regulations, which ultimately contributes to improving patient access.

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  • 14. 

    What is the recommendation for the percentage of scheduled admissions to be pre-registered within 24 hours of the service date?

    • A.

      40% - 50%

    • B.

      50% - 70%

    • C.

      60% - 80%

    • D.

      70% - 90%

    Correct Answer
    D. 70% - 90%
    Explanation
    The recommendation for the percentage of scheduled admissions to be pre-registered within 24 hours of the service date is 70% - 90%. This means that it is recommended for 70% to 90% of the scheduled admissions to be pre-registered within 24 hours of the service date. Pre-registering admissions helps in streamlining the process and ensures that necessary information is collected beforehand, saving time and improving efficiency.

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  • 15. 

    Which of the following is not gathered during pre-registration or pre-admission?

    • A.

      History of chief complaint

    • B.

      Patient demographics

    • C.

      Financial information

    • D.

      Socioeconomic information

    Correct Answer
    A. History of chief complaint
    Explanation
    During pre-registration or pre-admission, the history of the chief complaint is not gathered. This information is typically collected during the initial assessment or examination of the patient, after they have been admitted or registered. Pre-registration or pre-admission mainly focuses on gathering patient demographics, such as name, address, contact information, and insurance details, as well as financial and socioeconomic information to determine eligibility for financial assistance or support.

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  • 16. 

    What is the term for patient screening before surgical or invasive procedures to determine hospitalization and/or surgical suitability?

    • A.

      Therapeutic medical screening

    • B.

      Pre-admission testing (PAT)

    • C.

      Pre-admission screening (PAS)

    • D.

      Diagnostic medical screening (DMS)

    Correct Answer
    B. Pre-admission testing (PAT)
    Explanation
    Pre-admission testing (PAT) refers to the process of screening patients before surgical or invasive procedures to assess their suitability for hospitalization and surgery. This testing helps healthcare providers evaluate the patient's overall health condition, identify any potential risks or complications, and determine the appropriate course of action. PAT involves various diagnostic tests, such as blood tests, imaging scans, and electrocardiograms, to ensure that the patient is physically fit for the procedure. By conducting PAT, healthcare professionals can minimize the chances of adverse events during surgery and optimize patient outcomes.

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  • 17. 

    Which of the following is not an example of affiliated health services?

    • A.

      Marketing for staff physicians

    • B.

      Telephone triage available to the community

    • C.

      Referral for physicians and/or services

    • D.

      Registration for in-house or hospital-sponsored medical education programs

    Correct Answer
    A. Marketing for staff physicians
    Explanation
    Marketing for staff physicians is not an example of affiliated health services because it pertains to promoting and advertising the services of specific physicians, rather than providing direct healthcare services or support. Affiliated health services typically involve activities such as telephone triage, referrals for physicians or services, and registration for medical education programs.

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  • 18. 

    When is insurance verification typically done?

    • A.

      During pre-certification only

    • B.

      During admitting/registration only

    • C.

      During pre-certification and/or admitting/registration

    • D.

      After admitting/registration

    Correct Answer
    C. During pre-certification and/or admitting/registration
    Explanation
    Insurance verification is typically done during pre-certification and/or admitting/registration processes. This is because these are the stages where the patient's insurance coverage is confirmed and verified. Pre-certification involves obtaining approval from the insurance company before a medical procedure or hospitalization, while admitting/registration is the process of gathering patient information and initiating their hospital stay. Both of these stages require insurance verification to ensure that the patient's insurance will cover the necessary medical services.

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  • 19. 

    If a physician classifies an admission as an emergency, the hospital can still refuse the admission.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement is false because if a physician classifies an admission as an emergency, the hospital is legally obligated to accept and provide necessary medical care to the patient. This is because emergency admissions are typically considered urgent and require immediate attention to prevent further harm or complications. Refusing such admissions would go against the principle of providing timely and appropriate healthcare to those in need.

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  • 20. 

    To qualify for SNF coverage, 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. True
    Explanation
    To qualify for SNF (Skilled Nursing Facility) coverage, Medicare requires a person to have been admitted to a hospital and stayed as an inpatient for a minimum of three consecutive days. This means that the person must have been formally admitted to the hospital and not just receiving outpatient treatment. The day of discharge is not counted towards the three-day requirement. Therefore, the statement is true.

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  • 21. 

    CMS has indicated that instances would be rare that a patient would remain in observation for more than 24 hours.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement suggests that it is rare for a patient to remain in observation for more than 24 hours according to CMS. The correct answer is False, indicating that the statement is not true. This means that CMS has not indicated that instances of patients staying in observation for more than 24 hours are rare.

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  • 22. 

    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. False
    Explanation
    The statement is false because it is not common practice to have a single general consent document that covers all procedures and services performed in any 24-hour period. In reality, separate consent forms are typically required for each specific procedure or service to ensure that patients fully understand and agree to the risks, benefits, and alternatives of each individual treatment. Having separate consent forms also helps to ensure that patients are giving informed consent for each specific procedure or service.

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  • 23. 

    In the ER, failure of a patient, who is aware of what is happening, to object to treatment is implied consent--by law.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement is false because implied consent by law does not apply in the given scenario. Implied consent typically refers to situations where a patient is unconscious or unable to provide explicit consent, and treatment is necessary to save their life or prevent serious harm. In the case described, the patient is aware of what is happening, and their failure to object does not automatically imply consent. Informed consent, where the patient provides explicit consent after being fully informed about the treatment, is required in such situations.

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  • 24. 

    An emancipated minor is able to give his or her own consent to receive treatment.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    An emancipated minor refers to a person who is under the legal age of adulthood but has been granted legal independence from their parents or guardians. As a result, they are considered to have the same legal rights and responsibilities as an adult. This includes the ability to make decisions about their own healthcare, including giving consent to receive treatment. Therefore, the statement that an emancipated minor is able to give their own consent to receive treatment is true.

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  • 25. 

    Should a correction be required to a medical record, an authorized person should draw a single line through to error, initial it, and continue the note.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    When a correction is needed in a medical record, it is important to maintain the integrity of the original information. Drawing a single line through the error and initialing it ensures that the correction is clearly marked and attributed to the authorized person making the correction. By continuing the note after initialing, it is clear that the correction is a part of the original record. This procedure helps to maintain transparency and accuracy in medical documentation. Therefore, the statement "Should a correction be required to a medical record, an authorized person should draw a single line through the error, initial it, and continue the note" is true.

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  • 26. 

    Which of the following is not a true statement about the ABN?

    • A.

      The ABN must contain a complete description of the test(s) in question and the reason(s) that denial is likely.

    • B.

      Patients sign and date the ABN to indicate they understand and agree to pay for the tests if they are deemed noncovered.

    • C.

      The ABN must be signed and faxed to Medicare no later than 24 hours after the test is performed.

    • D.

      A beneficiary should not be given an ABN unless there is genuine doubt of Medicare payment.

    • E.

      Entities that issue ABNs are known by CMS as "notifiers."

    Correct Answer
    C. The ABN must be signed and faxed to Medicare no later than 24 hours after the test is performed.
    Explanation
    The correct answer is "The ABN must be signed and faxed to Medicare no later than 24 hours after the test is performed." This statement is not true because the ABN does not need to be faxed to Medicare within 24 hours after the test is performed. The ABN must be given to the patient before the test is performed, and the patient must sign and date it to indicate their understanding and agreement to pay if the test is deemed noncovered. The ABN does not need to be sent to Medicare unless requested.

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  • 27. 

    Which of the following clinical and medical personnel are authorized to make entries in the patient's medical record? (Select all that apply)

    • A.

      Treating and/or attending physician

    • B.

      A physician extender (physician assistant, nurse practitioner, etc.)

    • 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 clinical instructor)

    Correct Answer(s)
    A. Treating and/or attending physician
    B. A physician extender (physician assistant, nurse practitioner, etc.)
    C. A licensed, registered nurse
    E. A student from an accredited health profession program (under the supervision of his or her clinical instructor)
    Explanation
    The treating and/or attending physician, a physician extender (physician assistant, nurse practitioner, etc.), a licensed, registered nurse, and a student from an accredited health profession program (under the supervision of his or her clinical instructor) are authorized to make entries in the patient's medical record. These individuals have the necessary qualifications and expertise to document and update the patient's medical information accurately and responsibly.

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  • 28. 

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

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Telephone orders from a referring physician cannot be edited for clarity by an individual authorized to receive verbal orders. This means that any orders given over the phone must be accurately recorded without any changes or edits to ensure that the original intent of the physician is preserved.

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  • 29. 

    If a triggering event for an ABN occurs when there is a discontinuation in the services being provided, it is called:

    • A.

      Initiation

    • B.

      Reduction

    • C.

      Cessation

    • D.

      Termination

    Correct Answer
    D. Termination
    Explanation
    When there is a discontinuation in the services being provided, it is referred to as "termination." This term signifies the end or conclusion of the services, indicating that they have been stopped or discontinued. It is different from initiation, which implies the beginning or start of something, reduction, which suggests a decrease in the services, and cessation, which means the act of ceasing or stopping something. Therefore, "termination" is the most appropriate term to describe the scenario described in the question.

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  • 30. 

    Per CMS, an ABN must be retained for three years from discharge or completion of care unless there is another state-specific requirement.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    An ABN must be retained for five years from the date of service, not three years from discharge or completion of care. This is important because it ensures that healthcare providers have the necessary documentation in case of any audits or disputes.

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  • 31. 

    Which type of LCD/NCD provides potential coverage circumstances, but most likely does not provide specific diagnoses, signs, symptoms, or ICD-9-CM codes that will be covered or non-covered?

    • A.

      Definitive LCD/NCD

    • B.

      Non-definitive LCD/NCD

    Correct Answer
    B. Non-definitive LCD/NCD
    Explanation
    A non-definitive LCD/NCD provides potential coverage circumstances, but does not provide specific diagnoses, signs, symptoms, or ICD-9-CM codes that will be covered or non-covered. This means that while it may give some general guidelines for coverage, it does not provide specific details about what conditions or treatments will be covered or not covered.

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  • 32. 

    Which of the following is not a true statement about MSP laws?

    • A.

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

    • B.

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

    • C.

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

    • D.

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

    Correct Answer
    A. Until 2010, Medicare was the primary payer for nearly all Medicare-covered services.
    Explanation
    Until 2010, Medicare was not the primary payer for nearly all Medicare-covered services. This statement is false because Medicare has always been the primary payer for Medicare-covered services.

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  • 33. 

    Which fo the following is not part of Medicare's requirements to consider an item or service medically necessary?

    • A.

      It must be established as safe and effective.

    • B.

      It must be consistent with the symptoms or diagnosis of the illness or injury.

    • C.

      It must be considered cost effective.

    • D.

      It must not be furnished primarily for convenience.

    Correct Answer
    C. It must be considered cost effective.
    Explanation
    The given answer states that the requirement for an item or service to be considered medically necessary is that it must be considered cost effective. However, this statement is incorrect. The other options provided in the question are all valid requirements for Medicare to consider an item or service medically necessary. The fact that an item or service is cost-effective is not a requirement for Medicare, as the focus is primarily on the safety, effectiveness, and relevance to the illness or injury being treated.

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  • 34. 

    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 an SNF.

    • D.

      It begins when a beneficiary enters the hospital and ends 60 days after discharge from the hospital or from an 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 an SNF.
    Explanation
    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 an SNF.

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  • 35. 

    What is the frequency of coverage for intensive behavioral therapy for obesity?

    • A.

      One visit every week for month 1

    • B.

      One visit every other week for months 2-6

    • C.

      One visit every week for months 1-3

    • D.

      One visit every other week for months 4-6

    • E.

      One visit every month for months 7-12

    Correct Answer(s)
    A. One visit every week for month 1
    B. One visit every other week for months 2-6
    E. One visit every month for months 7-12
  • 36. 

    Which of the following are 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

    • D.

      Kidney dialysis and kidney transplants

    • E.

      Hearing aids

    Correct Answer(s)
    A. Cosmetic surgery
    C. Routine eye care and most eyeglasses
    E. Hearing aids
    Explanation
    Medicare provides coverage for a wide range of medical services for qualified beneficiaries. However, there are certain services that are not covered. Cosmetic surgery is not covered by Medicare as it is considered elective and not medically necessary. Routine eye care and most eyeglasses are also not covered, although Medicare does cover certain eye-related conditions such as cataract surgery. Similarly, hearing aids are not covered by Medicare, although there may be some exceptions for certain Medicare Advantage plans. Kidney dialysis and kidney transplants are covered by Medicare for qualified beneficiaries.

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  • 37. 

    Which of the following is not a true statement about the Medicare Participating Physician Program?

    • A.

      It is also called "accepting assignment."

    • B.

      It is imperative that assignment be obtained prior to discharge, when applicable.

    • C.

      It enables providers to ask the beneficiary to pay the entire charge at the time of service.

    • D.

      It offers higher fee schedule payments and fewer collection efforts.

    Correct Answer
    C. It enables providers to ask the beneficiary to pay the entire charge at the time of service.
    Explanation
    The Medicare Participating Physician Program, also known as "accepting assignment," does not enable providers to ask the beneficiary to pay the entire charge at the time of service. This program actually offers higher fee schedule payments and fewer collection efforts, and it is imperative to obtain assignment prior to discharge, when applicable.

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  • 38. 

    Which of the following accurately describe HICN formats and suffixes?

    • A.

      HICNs will either have 6 or 9 numeric digits.

    • B.

      The suffix for a husband, age 65 or over, is B1.

    • C.

      The suffix for a widow, age 65 or over and first claim, is D.

    • D.

      Option4

    Correct Answer(s)
    A. HICNs will either have 6 or 9 numeric digits.
    B. The suffix for a husband, age 65 or over, is B1.
    C. The suffix for a widow, age 65 or over and first claim, is D.
    Explanation
    HICNs can have either 6 or 9 numeric digits. The suffix "B1" is used for husbands who are 65 years or older, while the suffix "D" is used for widows who are 65 years or older and filing their first claim.

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  • 39. 

    Medicare is secondary in each of the following situations except for:

    • A.

      Services covered by workers' compensation, including the Black Lung Benefits Act

    • 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.

      Patients with ESRD who have completed their 30-month COB period.

    Correct Answer
    D. Patients with ESRD who have completed their 30-month COB period.
    Explanation
    Patients with ESRD who have completed their 30-month COB period are not an exception to Medicare being secondary. In this situation, Medicare would still be considered secondary to any other insurance coverage the patient may have. This means that Medicare would only cover costs that are not already covered by the primary insurance.

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  • 40. 

    A superbill is:

    • A.

      An invoice to document the services ordered or rendered during a patient visit.

    • B.

      Often referred to as an invoice of services.

    • C.

      A tool to eliminate the need for transcribing medical record notes from a patient chart.

    • D.

      All of the above.

    Correct Answer
    D. All of the above.
    Explanation
    A superbill is a document that serves as an invoice to record the services that were either ordered or provided during a patient's visit. It is often referred to as an invoice of services because it lists the specific procedures, tests, or treatments that were performed. Additionally, a superbill can be considered a tool to eliminate the need for transcribing medical record notes from a patient chart, as it provides a concise summary of the services rendered. Therefore, the correct answer is "All of the above" as all the statements mentioned accurately describe a superbill.

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  • 41. 

    Which of the following is not a true statement about the CMS 1500 form?

    • A.

      The equivalent electronic transaction is the 5010A1, formerly the 837P.

    • B.

      Paper forms are printed in red ink for scanning.

    • C.

      No photocopies are allowed.

    • D.

      One claim can report up to 8 lines of service.

    Correct Answer
    D. One claim can report up to 8 lines of service.
  • 42. 

    When completing the CMS 1500 form, there are special restrictions (no adhesive-backed label, printing, correction fluid, and so on) regarding the:

    • A.

      Top left margin of the form.

    • B.

      Top right margin of the form.

    • C.

      Bottom left margin of the form.

    • D.

      Bottom right margin of the form.

    Correct Answer
    B. Top right margin of the form.
    Explanation
    When completing the CMS 1500 form, there are special restrictions regarding the top right margin of the form. This means that there are limitations on what can be done in that specific area of the form. The restrictions may include not using adhesive-backed labels, printing, or correction fluid in the top right margin. It is important to adhere to these restrictions to ensure that the form is filled out correctly and accurately.

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  • 43. 

    Where would you enter the FECA number on a 1500 claim form for a patient claiming work-related conditions?

    • A.

      Item 9

    • B.

      Item 11

    • C.

      Item 19

    • D.

      Item 22

    Correct Answer
    B. Item 11
    Explanation
    The FECA number, which stands for Federal Employees' Compensation Act, is entered in Item 11 on a 1500 claim form for a patient claiming work-related conditions. This is the specific field designated for entering the FECA number, which is used to identify the patient's eligibility for compensation under the federal workers' compensation program.

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  • 44. 

    What is the appropriate  bill frequency code for replacement of a prior claim when resubmitting a claim?

    • A.

      Code 7, item 22

    • B.

      Code 8, item 22

    • C.

      Code 2, item 23

    • D.

      Code 8, item 24

    Correct Answer
    A. Code 7, item 22
    Explanation
    The appropriate bill frequency code for replacement of a prior claim when resubmitting a claim is Code 7, item 22. This code indicates that the claim being resubmitted is a replacement for a previously submitted claim.

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  • 45. 

    Which of the following is not a true statement about a discharged bankruptcy?

    • A.

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

    • B.

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

    • C.

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

    • D.

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

    Correct Answer
    C. 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. This means that the guarantor/patient is still responsible for any new account balances that arise within this period.

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  • 46. 

    Which of the following is not a true statement about a dismissed bankruptcy?

    • A.

      It is a court ruling whereby the bankruptcy is rejected.

    • B.

      The most common reason for dismissal is the debtor agreeing to pay each creditor a portion of the debt owed.

    • C.

      It means a creditor can bill the debtor directly, refer the account to a collection agency, or pursue litigation.

    Correct Answer
    B. The most common reason for dismissal is the debtor agreeing to pay each creditor a portion of the debt owed.
    Explanation
    A dismissed bankruptcy refers to a court ruling where the bankruptcy is rejected, meaning it is not accepted or approved. This ruling implies that the debtor is not granted the benefits of bankruptcy protection. The statement that "the most common reason for dismissal is the debtor agreeing to pay each creditor a portion of the debt owed" is incorrect. In fact, this statement contradicts the concept of a dismissed bankruptcy, as it suggests that the debtor is willing to make partial payments to creditors, which would typically be associated with a different outcome such as a debt repayment plan or a settlement agreement.

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  • 47. 

    Which of the following is not a true statement about the steps to be taken when notice is received that a patient is deceased?

    • A.

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

    • B.

      Check the register of wills for an estate.

    • C.

      Change the mailing address to "The Family of [Patient Name]."

    • D.

      If there is no estate and no one assumes financial responsibility, write off any remaining self-pay balance.

    Correct Answer
    C. Change the mailing address to "The Family of [Patient Name]."
    Explanation
    The statement "Change the mailing address to 'The Family of [Patient Name].'" is not a true statement about the steps to be taken when notice is received that a patient is deceased. The correct steps include checking if a legitimate estate exists and filing an appropriate caveat to the estate, checking the register of wills for an estate, and if there is no estate and no one assumes financial responsibility, writing off any remaining self-pay balance. Changing the mailing address to "The Family of [Patient Name]" is not a necessary step in this process.

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  • 48. 

    Advantages of courtesy discharge include: 

    • A.

      Improves patient-hospital relations

    • B.

      Improves traffic flow

    • C.

      Reduces need for additional staff at peak discharge times

    • D.

      Allows for greater accuracy in billing

    • E.

      All of the above

    Correct Answer
    E. All of the above
    Explanation
    The advantages of courtesy discharge include improving patient-hospital relations, improving traffic flow, reducing the need for additional staff at peak discharge times, and allowing for greater accuracy in billing. By implementing courtesy discharge, hospitals can enhance their relationship with patients, ensuring a positive experience. It also helps in streamlining the discharge process, minimizing congestion and delays. Additionally, courtesy discharge reduces the burden on staff during busy periods and enables more accurate billing, avoiding any discrepancies or errors.

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  • 49. 

    Common stalls and delays with third party payers include all of the following except:

    • A.

      Bill never received by payer

    • B.

      COB or MSP problems

    • C.

      Medical record/chart needed for review

    • D.

      Excessive number of staff working claims

    Correct Answer
    D. Excessive number of staff working claims
    Explanation
    The correct answer is "Excessive number of staff working claims". This option is the exception because it does not contribute to stalls and delays with third party payers. The other options, such as bills not being received by the payer, COB or MSP problems, and the need for medical records/charts for review, are all potential causes of stalls and delays in the payment process. However, having an excessive number of staff working claims would typically help expedite the process rather than cause delays.

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  • 50. 

    Someone who moves or changes residence and fails to notify creditors, but has a forwarding address available, is a(n):

    • A.

      Intentional skip

    • B.

      Unintentional skip

    • C.

      False skip

    Correct Answer
    B. Unintentional skip
    Explanation
    An unintentional skip refers to someone who moves or changes residence without notifying their creditors, but they have a forwarding address available. This suggests that the person did not intentionally try to avoid their creditors, but rather failed to inform them about their new address. They may have simply overlooked this step or been unaware of the importance of notifying creditors.

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Quiz Review Timeline +

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

  • Current Version
  • Sep 14, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jul 26, 2014
    Quiz Created by
    CRCSstudent
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