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.
accept assignment is checked.
B.
date of last menstrual period (LMP) is missing.
C.
the diagnosis code does not match the CPT code.
D.
patient's insurance number is incorrect.
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.
assignment of benefits form.
B.
explanation of benefits form.
C.
patient information form.
D.
release of information form.
Question #3
Most physicians bill insurance carriers by completing paper or electronic versions of which form?
A.
Verification of benefits form
B.
UB-04 claim form
C.
Superbill
D.
CMS-1500 claim form
Question #4
A company that receives claims from providers, audits them, and forwards them on to insurance carriers is a(n):
A.
independent auditing firm.
B.
billing service.
C.
clearinghouse.
D.
third-party administrator.
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.
erroneous claim.
B.
clean claim.
C.
dirty claim.
D.
incomplete 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.
Plan B is primary, and Plan A is secondary.
B.
Plan A is primary, and Plan B is secondary.
C.
Plan B will pay all of the benefits.
D.
only Plan A will pay for her benefits.
Question #8
What information should be filled out in form locator 28?
A.
amount paid.
B.
patient's account number.
C.
physician's federal tax ID number.
D.
total charges.
Question #9
Components of the Administration Simplification subsection of HIPAA include all of the following EXCEPT:
A.
privacy and security rules.
B.
compliance and auditing guidelines.
C.
transaction and code sets.
D.
uniform identifiers.
Question #10
On the CMS-1500 claim form, the abbreviation NPI indicates that:
A.
the National Health Plan Identifier must be entered.
B.
a condition was Not Present or Indicated upon examination.
C.
the National Provider Identifier must be entered.
D.
the National Preferred Identifier for clearinghouses must be entered.
Question #11
On the CMS-1500 claim form, the abbreviation EIN refers to:
A.
Employer Identification Number.
B.
Estimated Insurance Number for payment.
C.
Examination Indicates Nothing.
D.
Employer Identifier for National Coverage.
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.
FALSE
B.
TRUE
Question #13
To prevent a cash flow problem, hospital records should be completed and signed no later than:
A.
30 days following admittance.
B.
1—2 days following discharge.
C.
14 days following discharge.
D.
7 days following admittance.
Question #14
The Ambulatory Payment Classification (APC) system bases payments on:
A.
usual fees.
B.
procedures.
C.
number of days.
D.
diagnoses.
Question #15
Most major diagnostic categories (MDCs) are based on:
A.
health status of the patient.
B.
age of the patient.
C.
a particular organ system.
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.
primary care physician.
B.
rendering physician.
C.
attending physician.
D.
admitting 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.
comorbidity.
B.
exacerbation.
C.
complication.
D.
chronic condition.
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.
F
B.
2
C.
M
D.
1
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.
Code 00
B.
It would be noted as "unknown."
C.
Code 99
D.
It would be left blank.
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.
admission type codes.
B.
admission source codes.
C.
discharge status codes.
D.
condition 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.
hospice care.
D.
critical 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.
FALSE
B.
TRUE
Question #24
A case that cannot be assigned an appropriate DRG because of an atypical situation is called a cost outlier.
A.
TRUE
B.
FALSE
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 B.
D.
Medicare Part D.
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.
administrators.
D.
carriers.
Question #27
For each benefit period, a Medicare Part A beneficiary will receive coverage for:
A.
90 days of hospital care.
B.
60 days of hospital care.
C.
unlimited days of hospital care if medically necessary.
D.
30 days of hospital care.
Question #28
Hospice services covered under Medicare Part A may be provided as:
A.
in-home care.
B.
inpatient respite care.
C.
short-term hospital care.
D.
All of these.
Question #29
Certain organ transplants are covered under Part A as long as:
A.
services are performed in a hospital that is an approved Medicare provider.
B.
the patient has not exceeded his or her Part A benefit limit.
C.
a second opinion has been obtained before the surgery.
D.
an in-home caregiver will be available to care for the patient after surgery.
Question #30
Which of the following services is covered by Medicare Part A or Part B?
A.
Acupuncture
B.
Routine eye care
C.
Physical therapy
D.
Dental care
Question #31
The original Medicare plan is based on which type of payment method?
A.
Capitation
B.
Per diem
C.
Sliding scale
D.
Fee-for-service
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.
20%
B.
15%
C.
30%
D.
25%
Question #33
Which of the following is true of nonparticipating providers who accept assignment?
A.
They are required to file Medicare claims on behalf of Medicare patients.
B.
They receive 10% lower fees for services than participating providers.
C.
They have access to beneficiary eligibility information.
D.
They receive 15% 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 works for an employer with 20 or fewer employees.
C.
The patient's condition is the result of an automobile accident.
D.
The patient's injury or condition is covered by workers' compensation.
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.
FALSE
B.
TRUE
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.
FALSE
B.
TRUE
Question #39
The largest funding for healthcare for America's low-income individuals comes from:
A.
private insurance.
B.
Medicaid.
C.
Medicare.
D.
individuals.
Question #40
Groups included as eligible for Medicaid include:
A.
the medically needy.
B.
special groups.
C.
All of these
D.
the categorically needy.
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.
a coinsurance amount applies.
B.
a deductible is paid.
C.
Medicare begins paying for services.
D.
Medicaid begins paying for services.
Question #42
To qualify for federal matching funds for the medically needy, states must include coverage for
A.
pregnant women.
B.
the blind.
C.
the elderly.
D.
the disabled.
Question #43
Eligibility for Temporary Assistance for Needy Families (TANF) is determined by the:
A.
city.
B.
nation.
C.
state.
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.
transportation services.
C.
acupuncture for pain relief.
D.
optometrist services and eyeglasses.
Question #46
Medicaid participating hospitals and other inpatient facilities file claims electronically using the:
A.
Title XIX claim form.
B.
UB-04 claim form.
C.
CMS-1500 claim form.
D.
Medicaid claim form.
Question #47
A copayment may NOT be collected from a Medicaid patient for:
A.
physician office visits.
B.
family planning services.
C.
hospital services.
D.
preventive care services.
Question #48
States may pay for Medicaid services on a fee-for-service basis or:
A.
based on the Medicare fee schedule.
B.
through a per-diem rate.
C.
using a scale based on the beneficiary's annual income.
D.
through contracts with managed care organizations.
Question #49
The abbreviation PCCM used in regard to Medicaid managed care plans stands for:
A.
primary coverage and care management.
B.
primary care case management.
C.
preventive care case management.
D.
per case care management.
Question #50
Special groups that may be eligible for Medicaid include all the following EXCEPT:
A.
disabled adults.
B.
families that need temporary assistance.
C.
immigrants.
D.
children with disabilities
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