MOA 183 - Medical Billing and Coding » Fall 2020 » Exam 3
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Question #1
Common problems while completing the CMS-1500 include all the following EXCEPT:
A.
the diagnosis code does not match the CPT code.
B.
patient's insurance number is incorrect.
C.
date of last menstrual period (LMP) is missing.
D.
accept assignment is checked.
Question #2
A claim can only be submitted to an insurance carrier on the patient's behalf if the patient has signed a(n):
A.
patient information form.
B.
release of information form.
C.
explanation of benefits form.
D.
assignment of benefits form.
Question #3
Most physicians bill insurance carriers by completing paper or electronic versions of which form?
A.
UB-04 claim form
B.
Superbill
C.
CMS-1500 claim form
D.
Verification of benefits form
Question #4
A company that receives claims from providers, audits them, and forwards them on to insurance carriers is a(n):
A.
billing service.
B.
third-party administrator.
C.
independent auditing firm.
D.
clearinghouse.
Question #5
The employer identification number (EIN) or federal tax ID number is issued by:
A.
the Centers for Medicare and Medicaid Services (CMS).
B.
insurance carriers.
C.
the Internal Revenue Service (IRS).
D.
the Health Insurance Portability and Accountability Act (HIPAA).
Question #6
If needed information is missing from a claim when it is submitted to an insurance carrier, it is referred to as a(n):
A.
incomplete claim
B.
clean claim.
C.
erroneous claim.
D.
dirty claim.
Question #7
If an individual is covered under Plan A through her employment and is covered under Plan B through her spouse's employment:
A.
only Plan A will pay for her benefits.
B.
Plan A is primary, and Plan B is secondary.
C.
Plan B will pay all of the benefits.
D.
Plan B is primary, and Plan A is secondary.
Question #8
What information should be filled out in form locator 28?
A.
total charges.
B.
amount paid.
C.
physician's federal tax ID number.
D.
patient's account number.
Question #9
Components of the Administration Simplification subsection of HIPAA include all of the following EXCEPT:
A.
privacy and security rules.
B.
transaction and code sets.
C.
compliance and auditing guidelines.
D.
uniform identifiers.
Question #10
On the CMS-1500 claim form, the abbreviation NPI indicates that:
A.
a condition was Not Present or Indicated upon examination.
B.
the National Health Plan Identifier must be entered.
C.
the National Preferred Identifier for clearinghouses must be entered.
D.
the National Provider Identifier must be entered.
Question #11
On the CMS-1500 claim form, the abbreviation EIN refers to:
A.
Examination Indicates Nothing.
B.
Employer Identifier for National Coverage.
C.
Employer Identification Number.
D.
Estimated Insurance Number for payment.
Question #12
The source document used by a medical office specialist to enter patient encounter data into a computerized accounting system is the superbill.
A.
TRUE
B.
FALSE
Question #13
To prevent a cash flow problem, hospital records should be completed and signed no later than:
A.
1—2 days following discharge.
B.
30 days following admittance.
C.
7 days following admittance.
D.
14 days following discharge.
Question #14
The Ambulatory Payment Classification (APC) system bases payments on:
A.
usual fees.
B.
diagnoses.
C.
number of days.
D.
procedures.
Question #15
Most major diagnostic categories (MDCs) are based on:
A.
a particular organ system.
B.
age of the patient.
C.
health status of the patient.
D.
number of diagnoses.
Question #16
The physician who is primarily responsible for a patient's care while in the hospital is referred to as the:
A.
admitting physician.
B.
primary care physician.
C.
rendering physician.
D.
attending physician.
Question #17
A pre-existing condition that, because of its effect on the principal diagnosis, results in more intensive therapy or a longer stay is a(n):
A.
complication.
B.
exacerbation.
C.
chronic condition.
D.
comorbidity.
Question #18
When using a FOUR-digit Medicare "type of bill" code in form locator 4, the type of facility is represented by the:
A.
third digit.
B.
fourth digit.
C.
second digit.
D.
first digit.
Question #19
Which of the following codes would be entered to report that the patient is female in form locator 11 on the UB-04?
A.
M
B.
1
C.
F
D.
2
Question #20
If the time that a patient was admitted to the hospital is unknown, which code would be entered in form locator 13?
A.
It would be left blank.
B.
Code 00
C.
It would be noted as "unknown."
D.
Code 99
Question #21
In form locator 17 on the UB-04 claim form, the codes for "Left against medical advice or discontinued care," "Expired (or did not recover)," and "Admitted as an inpatient to this hospital" represent:
A.
discharge status codes.
B.
condition codes.
C.
admission source codes.
D.
admission type codes.
Question #22
The type of care that provides palliative services for terminally ill patients is known as:
A.
terminal care.
B.
home healthcare.
C.
critical care.
D.
hospice care.
Question #23
Per diem is a type of reimbursement that pays a fixed rate per day for all services provided by a hospital.
A.
TRUE
B.
FALSE
Question #24
A case that cannot be assigned an appropriate DRG because of an atypical situation is called a cost outlier.
A.
FALSE
B.
TRUE
Question #25
The Medicare program that provides expanded benefits through private managed care health plans is:
A.
Medicare Part A.
B.
Medicare Advantage (MA).
C.
Medicare Part D.
D.
Medicare Part B.
Question #26
Organizations that are hired by the CMS to carry out day-to-day Medicare program operations are known as:
A.
contractors.
B.
intermediaries.
C.
carriers.
D.
administrators.
Question #27
For each benefit period, a Medicare Part A beneficiary will receive coverage for:
A.
30 days of hospital care.
B.
60 days of hospital care.
C.
90 days of hospital care.
D.
unlimited days of hospital care if medically necessary.
Question #28
Hospice services covered under Medicare Part A may be provided as:
A.
short-term hospital care.
B.
inpatient respite care.
C.
in-home care.
D.
All of these.
Question #29
Certain organ transplants are covered under Part A as long as:
A.
the patient has not exceeded his or her Part A benefit limit.
B.
an in-home caregiver will be available to care for the patient after surgery.
C.
a second opinion has been obtained before the surgery.
D.
services are performed in a hospital that is an approved Medicare provider.
Question #30
Which of the following services is covered by Medicare Part A or Part B?
A.
Routine eye care
B.
Dental care
C.
Acupuncture
D.
Physical therapy
Question #31
The original Medicare plan is based on which type of payment method?
A.
Capitation
B.
Per diem
C.
Fee-for-service
D.
Sliding scale
Question #32
Medicare patients with Part B fee-for-service benefits are responsible for what percentage of the Medicare Fee Schedule (MFS) after the deductible has been met and services are rendered by a provider who accepts assignment?
A.
15%
B.
30%
C.
25%
D.
20%
Question #33
Which of the following is true of nonparticipating providers who accept assignment?
A.
They receive 15% lower fees for services than participating providers.
B.
They are required to file Medicare claims on behalf of Medicare patients.
C.
They have access to beneficiary eligibility information.
D.
They receive 10% lower fees for services than participating providers.
Question #34
In which of the following cases involving a patient who is age 65 or older is Medicare considered the primary payer?
A.
The patient has group health insurance through a working spouse.
B.
The patient's condition is the result of an automobile accident.
C.
The patient's injury or condition is covered by workers' compensation.
D.
The patient works for an employer with 20 or fewer employees.
Question #35
Part C is the Medicare option that allows beneficiaries to enroll in their choice of managed care plan, known as a Medicare Advantage plan.
A.
TRUE
B.
FALSE
Question #36
All Medicare beneficiaries are automatically enrolled in Medicare Part D.
A.
TRUE
B.
FALSE
Question #37
Hearing aids are NOT routinely covered by Medicare.
A.
FALSE
B.
TRUE
Question #38
The types of Medicare Advantage plans include HMOs.
A.
TRUE
B.
FALSE
Question #39
The largest funding for healthcare for America's low-income individuals comes from:
A.
Medicaid.
B.
Medicare.
C.
individuals.
D.
private insurance.
Question #40
Groups included as eligible for Medicaid include:
A.
special groups.
B.
the categorically needy.
C.
the medically needy.
D.
All of these
Question #41
In some states, a spend-down program requires that individuals must spend a portion of their income or resources each month on medical expenses before:
A.
Medicaid begins paying for services.
B.
a coinsurance amount applies.
C.
Medicare begins paying for services.
D.
a deductible is paid.
Question #42
To qualify for federal matching funds for the medically needy, states must include coverage for
A.
pregnant women.
B.
the disabled.
C.
the blind.
D.
the elderly.
Question #43
Eligibility for Temporary Assistance for Needy Families (TANF) is determined by the:
A.
state.
B.
city.
C.
nation.
D.
county.
Question #44
Which types of nominal cost sharing can states require of most Medicaid beneficiaries?
A.
Copayments
B.
Coinsurance
C.
All of these
D.
Deductibles
Question #45
Optional Medicaid services that are eligible for federal matching funds include all of the following EXCEPT:
A.
rehabilitation services.
B.
optometrist services and eyeglasses.
C.
acupuncture for pain relief.
D.
transportation services.
Question #46
A.
UB-04 claim form.
B.
Medicaid claim form.
C.
Title XIX claim form.
D.
CMS-1500 claim form.
Question #47
A copayment may NOT be collected from a Medicaid patient for:
A.
hospital services.
B.
preventive care services.
C.
family planning services.
D.
physician office visits.
Question #48
States may pay for Medicaid services on a fee-for-service basis or:
A.
based on the Medicare fee schedule.
B.
through contracts with managed care organizations.
C.
through a per-diem rate.
D.
using a scale based on the beneficiary's annual income.
Question #49
The abbreviation PCCM used in regard to Medicaid managed care plans stands for:
A.
per case care management.
B.
primary care case management.
C.
preventive care case management.
D.
primary coverage and care management.
Question #50
Special groups that may be eligible for Medicaid include all the following EXCEPT:
A.
children with disabilities
B.
families that need temporary assistance.
C.
disabled adults.
D.
immigrants.
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