Question 1

________ provides hospitals and healthcare services to military veterans.

Accepted Answer

A)   The Federal Employee Compensation Act
B)   Workers' compensation
C)   Medicaid
D)   Civilian Health and Medical Program-Veterans Affairs
E)   The Veteran's Administration E

Question 2

Providers are not required to tell a Medicare patient in advance if he or she will have to pay for a test or service because it is not covered by Medicare.

Accepted Answer

A) True 
 B)False  False

Question 3

The skilled nursing facility (SNF) prospective payment system reimbursement rate is based on:

Accepted Answer

A)   DRGs.
B)   APCs.
C)   RUG-III.
D)   HCPCS.
E)   RAIs. C

Question 4

________ were created to measure the value of one procedure compared to other procedures.

Accepted Answer

A)   Fee schedules
B)   Reimbursement methodologies
C)   Procedure codes
D)   Charge masters
E)   Relative value units

Question 5

The Medicare payment schedule for all procedure codes is updated every ________ by the CMS.

Accepted Answer

A)   year
B)   2 years
C)   4 years
D)   6 years
E)   10 years

Question 6

Inpatient acute care hospitals are reimbursed a single total payment for each patient discharge based on a(n) ________ code, which assumes that patients with the same sort of diagnoses require about the same length of stay and use approximately the same amount of resources.

Accepted Answer

A)   ICD-9-CM
B)   HCPCS
C)   CPT-4
D)   DRG
E)   ABC

Question 7

When a patient is admitted to a skilled nursing facility, the first assessment must be recorded:

Accepted Answer

A)   on the day of admission.
B)   within 48 hours of admission.
C)   within 8 days of admission.
D)   within 10 days of admission.
E)   within 30 days of admission.

Question 8

Medicare payments to inpatient psychiatric facilities are based on a ________ rate.

Accepted Answer

A)   diagnosis
B)   standard
C)   per diem
D)   group
E)   basic

Question 9

The reason (after study) that the patient was admitted to the hospital is called the:

Accepted Answer

A)   principle diagnosis.
B)   discharge diagnosis.
C)   final diagnosis.
D)   Both A and B
E)   Both B and C

Question 10

All of the following statements about PPOs are true, EXCEPT:

Accepted Answer

A)   patients have the option of seeing other providers, but must pay a higher coinsurance.
B)   patients are encouraged to use the PPO physicians.
C)   the PPO tries to encourage members to make choices that save the plan money.
D)   copays encourage patients to use PPO doctors because patients pay only a small fee regardless of the complexity of the visit.
E)   a PPO provides fewer choices for the patient.

Question 11

A physician must renew an order for home health care every:

Accepted Answer

A)   5 days.
B)   10 days.
C)   14 days.
D)   30 days.
E)   60 days.

Question 12

A capitation model succeeds when the group of HMO patients is large enough that the costs of treating members who need services and those who never see the doctor average out.

Accepted Answer

A) True 
 B)False

Question 13

All of the following statements are true of ICD-10-CM EXCEPT:

Accepted Answer

A)   HHS has proposed that the ICD-10 code sets be used for billing 01/01/10.
B)   it is used broadly in Europe and Canada.
C)   transition to ICD-10 will require significant time and effort.
D)   it is used in the United States for reporting the cause of death on death certificates.
E)   clinical modifications in ICD-10 will include only volumes 1 and 2.

Question 14

A fixed amount a health plan may require a patient to pay at each visit is called a:

Accepted Answer

A)   deductible.
B)   copay.
C)   reimbursement.
D)   premium.
E)   payment.

Question 15

When the cost of treating a patient exceeds the payment for the MS-DRG by a certain amount, Medicare will increase the payment.

Accepted Answer

A) True 
 B)False

Question 16

Medicare is a health insurance program for:

Accepted Answer

A)   people under the age of 65 who have disabilities.
B)   people of any age with kidney failure requiring dialysis or transplant.
C)   people 65 and older.
D)   All of the above
E)   None of the above

Question 17

Which of the following is NOT one of the MS-DRG levels of severity?

Accepted Answer

A)   Non CC
B)   CC
C)   MCC
D)   Multiple CC
E)   All of the above are levels of severity.

Question 18

The primary person on the health insurance card is referred to as the:

Accepted Answer

A)   subscriber.
B)   enrollee.
C)   beneficiary.
D)   member.
E)   All of the above

Question 19

Both RBRVS units and DRG relative weights change by geographic location.

Accepted Answer

A) True 
 B)False

Question 20

A numerical value assigned to each DRG code is called the:

Accepted Answer

A)   comorbidity.
B)   relative value.
C)   relative weight.
D)   reimbursement rate.
E)   medical severity index.

Exam 9: Healthcare Coding and Reimbursement

________ provides hospitals and healthcare services to military veterans.

Providers are not required to tell a Medicare patient in advance if he or she will have to pay for a test or service because it is not covered by Medicare.

The skilled nursing facility (SNF) prospective payment system reimbursement rate is based on:

________ were created to measure the value of one procedure compared to other procedures.

The Medicare payment schedule for all procedure codes is updated every ________ by the CMS.

Inpatient acute care hospitals are reimbursed a single total payment for each patient discharge based on a(n) ________ code, which assumes that patients with the same sort of diagnoses require about the same length of stay and use approximately the same amount of resources.

When a patient is admitted to a skilled nursing facility, the first assessment must be recorded:

Medicare payments to inpatient psychiatric facilities are based on a ________ rate.

The reason (after study) that the patient was admitted to the hospital is called the:

All of the following statements about PPOs are true, EXCEPT:

A physician must renew an order for home health care every:

A capitation model succeeds when the group of HMO patients is large enough that the costs of treating members who need services and those who never see the doctor average out.

All of the following statements are true of ICD-10-CM EXCEPT:

A fixed amount a health plan may require a patient to pay at each visit is called a:

When the cost of treating a patient exceeds the payment for the MS-DRG by a certain amount, Medicare will increase the payment.

Medicare is a health insurance program for:

Which of the following is NOT one of the MS-DRG levels of severity?

The primary person on the health insurance card is referred to as the:

Both RBRVS units and DRG relative weights change by geographic location.

A numerical value assigned to each DRG code is called the: