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.
assignment of benefits form.
C.
explanation of benefits 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.
Superbill
C.
CMS-1500 claim form
D.
UB-04 claim 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.
clearinghouse.
D.
independent auditing firm.
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.
the Health Insurance Portability and Accountability Act (HIPAA).
C.
insurance carriers.
D.
the Internal Revenue Service (IRS).
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.
erroneous claim.
C.
clean 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.
Plan B is primary, and Plan A is secondary.
B.
only Plan A will pay for her benefits.
C.
Plan A is primary, and Plan B is secondary.
D.
Plan B will pay all of the benefits.
Question #8
What information should be filled out in form locator 28?
A.
physician's federal tax ID number.
B.
amount paid.
C.
total charges.
D.
patient's account number.
Question #9
Components of the Administration Simplification subsection of HIPAA include all of the following EXCEPT:
A.
compliance and auditing guidelines.
B.
transaction and code sets.
C.
privacy and security rules.
D.
uniform identifiers.
Question #10
On the CMS-1500 claim form, the abbreviation NPI indicates that:
A.
the National Provider Identifier must be entered.
B.
a condition was Not Present or Indicated upon examination.
C.
the National Health Plan 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 Identifier for National Coverage.
B.
Employer Identification Number.
C.
Estimated Insurance Number for payment.
D.
Examination Indicates Nothing.
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.
7 days following admittance.
C.
14 days following discharge.
D.
30 days following admittance.
Question #14
The Ambulatory Payment Classification (APC) system bases payments on:
A.
usual fees.
B.
number of days.
C.
diagnoses.
D.
procedures.
Question #15
Most major diagnostic categories (MDCs) are based on:
A.
number of diagnoses.
B.
age of the patient.
C.
health status of the patient.
D.
a particular organ system.
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.
complication.
B.
chronic condition.
C.
comorbidity.
D.
exacerbation.
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.
first digit.
B.
second digit.
C.
fourth digit.
D.
third 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.
It would be noted as "unknown."
B.
It would be left blank.
C.
Code 00
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.
admission type codes.
B.
admission source codes.
C.
condition codes.
D.
discharge status codes.
Question #22
The type of care that provides palliative services for terminally ill patients is known as:
A.
home healthcare.
B.
hospice care.
C.
terminal 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.
FALSE
B.
TRUE
Question #25
The Medicare program that provides expanded benefits through private managed care health plans is:
A.
Medicare Part B.
B.
Medicare Part A.
C.
Medicare Part D.
D.
Medicare Advantage (MA).
Question #26
Organizations that are hired by the CMS to carry out day-to-day Medicare program operations are known as:
A.
carriers.
B.
contractors.
C.
administrators.
D.
intermediaries.
Question #27
For each benefit period, a Medicare Part A beneficiary will receive coverage for:
A.
90 days of hospital care.
B.
30 days of hospital care.
C.
60 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.
All of these.
B.
in-home care.
C.
inpatient respite care.
D.
short-term hospital care.
Question #29
Certain organ transplants are covered under Part A as long as:
A.
an in-home caregiver will be available to care for the patient after surgery.
B.
a second opinion has been obtained before the surgery.
C.
the patient has not exceeded his or her Part A benefit limit.
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.
Dental care
B.
Routine eye care
C.
Physical therapy
D.
Acupuncture
Question #31
The original Medicare plan is based on which type of payment method?
A.
Sliding scale
B.
Per diem
C.
Fee-for-service
D.
Capitation
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.
25%
B.
15%
C.
30%
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 injury or condition is covered by workers' compensation.
C.
The patient works for an employer with 20 or fewer employees.
D.
The patient's condition is the result of an automobile accident.
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.
TRUE
B.
FALSE
Question #39
The largest funding for healthcare for America's low-income individuals comes from:
A.
Medicare.
B.
individuals.
C.
private insurance.
D.
Medicaid.
Question #40
Groups included as eligible for Medicaid include:
A.
special groups.
B.
All of these
C.
the categorically needy.
D.
the medically 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.
Medicaid begins paying for services.
B.
a deductible is paid.
C.
Medicare begins paying for services.
D.
a coinsurance amount applies.
Question #42
To qualify for federal matching funds for the medically needy, states must include coverage for
A.
the elderly.
B.
pregnant women.
C.
the disabled.
D.
the blind.
Question #43
Eligibility for Temporary Assistance for Needy Families (TANF) is determined by the:
A.
city.
B.
county.
C.
state.
D.
nation.
Question #44
Which types of nominal cost sharing can states require of most Medicaid beneficiaries?
A.
Copayments
B.
Deductibles
C.
All of these
D.
Coinsurance
Question #45
Optional Medicaid services that are eligible for federal matching funds include all of the following EXCEPT:
A.
transportation services.
B.
rehabilitation 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.
UB-04 claim form.
B.
Title XIX 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.
through a per-diem rate.
B.
using a scale based on the beneficiary's annual income.
C.
through contracts with managed care organizations.
D.
based on the Medicare fee schedule.
Question #49
The abbreviation PCCM used in regard to Medicaid managed care plans stands for:
A.
preventive care case management.
B.
primary coverage and care management.
C.
primary care case management.
D.
per case care management.
Question #50
Special groups that may be eligible for Medicaid include all the following EXCEPT:
A.
immigrants.
B.
children with disabilities
C.
families that need temporary assistance.
D.
disabled adults.
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