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.
date of last menstrual period (LMP) is missing.
B.
patient's insurance number is incorrect.
C.
accept assignment is checked.
D.
the diagnosis code does not match the CPT code.
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.
explanation of benefits form.
B.
release of information form.
C.
patient information form.
D.
assignment of benefits form.
Question #3
Most physicians bill insurance carriers by completing paper or electronic versions of which form?
A.
Superbill
B.
CMS-1500 claim form
C.
Verification of benefits 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.
independent auditing firm.
C.
third-party administrator.
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.
the Internal Revenue Service (IRS).
C.
the Health Insurance Portability and Accountability Act (HIPAA).
D.
insurance carriers.
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.
incomplete 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.
Plan A is primary, and Plan B is secondary.
C.
only Plan A will pay for her benefits.
D.
Plan B will pay all of the benefits.
Question #8
What information should be filled out in form locator 28?
A.
total charges.
B.
physician's federal tax ID number.
C.
amount paid.
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.
uniform identifiers.
C.
transaction and code sets.
D.
compliance and auditing guidelines.
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 Provider Identifier must be entered.
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.
Estimated Insurance Number for payment.
B.
Employer Identification Number.
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.
14 days following discharge.
B.
1—2 days following discharge.
C.
7 days following admittance.
D.
30 days following admittance.
Question #14
The Ambulatory Payment Classification (APC) system bases payments on:
A.
procedures.
B.
diagnoses.
C.
usual fees.
D.
number of days.
Question #15
Most major diagnostic categories (MDCs) are based on:
A.
health status of the patient.
B.
a particular organ system.
C.
age 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.
comorbidity.
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.
second digit.
B.
first digit.
C.
third digit.
D.
fourth 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.
F
C.
2
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.
Code 99
C.
It would be noted as "unknown."
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.
condition codes.
B.
admission source codes.
C.
admission type codes.
D.
discharge status codes.
Question #22
The type of care that provides palliative services for terminally ill patients is known as:
A.
terminal care.
B.
hospice care.
C.
critical care.
D.
home healthcare.
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 D.
B.
Medicare Part A.
C.
Medicare Advantage (MA).
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.
intermediaries.
B.
contractors.
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.
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.
in-home care.
B.
All of these.
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.
the patient has not exceeded his or her Part A benefit limit.
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.
Dental care
B.
Acupuncture
C.
Physical therapy
D.
Routine eye care
Question #31
The original Medicare plan is based on which type of payment method?
A.
Capitation
B.
Sliding scale
C.
Fee-for-service
D.
Per diem
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.
30%
B.
25%
C.
15%
D.
20%
Question #33
Which of the following is true of nonparticipating providers who accept assignment?
A.
They have access to beneficiary eligibility information.
B.
They are required to file Medicare claims on behalf of Medicare patients.
C.
They receive 10% lower fees for services than participating providers.
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 works for an employer with 20 or fewer employees.
B.
The patient's injury or condition is covered by workers' compensation.
C.
The patient has group health insurance through a working spouse.
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.
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.
TRUE
B.
FALSE
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.
Medicaid.
B.
Medicare.
C.
individuals.
D.
private insurance.
Question #40
Groups included as eligible for Medicaid include:
A.
the categorically needy.
B.
special groups.
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.
a deductible is paid.
B.
Medicaid begins paying for services.
C.
a coinsurance amount applies.
D.
Medicare begins paying for services.
Question #42
To qualify for federal matching funds for the medically needy, states must include coverage for
A.
the blind.
B.
the elderly.
C.
pregnant women.
D.
the disabled.
Question #43
Eligibility for Temporary Assistance for Needy Families (TANF) is determined by the:
A.
state.
B.
city.
C.
county.
D.
nation.
Question #44
Which types of nominal cost sharing can states require of most Medicaid beneficiaries?
A.
Copayments
B.
Deductibles
C.
Coinsurance
D.
All of these
Question #45
Optional Medicaid services that are eligible for federal matching funds include all of the following EXCEPT:
A.
transportation services.
B.
acupuncture for pain relief.
C.
optometrist services and eyeglasses.
D.
rehabilitation services.
Question #46
A.
Title XIX claim form.
B.
Medicaid claim form.
C.
UB-04 claim form.
D.
CMS-1500 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.
through contracts with managed care organizations.
C.
using a scale based on the beneficiary's annual income.
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 care case management.
C.
per case care 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.
immigrants.
C.
disabled adults.
D.
families that need temporary assistance.
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