Bucks Step by Step Medical Coding 2022 Edition 1st Edition Elsevier Test Bank Chapter 1: Reimbursement, HIPAA, and Compliance Elsevier: Buck's Step -by-Step Medical Coding, 2022 Edition TRUE/FALSE 1. The coder’s responsibility is to ensure that the data are as accurate as possible not only for classification and study purposes but also to obtain appropriate reimbursement. ANS: T PTS: 1 DIF: 1 TOP: THEORY 2. The Federal Register is the official publication for all “Presidential Documents,” “Rules and Regulations,” “Proposed Rules,” and “Notices.” ANS: T PTS: 1 DIF: 1 TOP: THEORY 3. Nationally, unit values have been assigned for each service by Medicare (CPT and HCPCS) and determined on the basis of the resources necessary for the physician’s performance of the service. ANS: T PTS: 1 DIF: 1 TOP: THEORY 4. Fraud is an intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes knowing that the deception could result in some unauthorized benefit to himself/herself or some other person. ANS: T PTS: 1 DIF: 1 TOP: THEORY 5. Kickbacks from patients are allowed under certain circumstances according to Medicare guidelines. ANS: F PTS: 1 DIF: 1 TOP: THEORY MULTIPLE CHOICE 6. The Medicare program was established in: a. 1955 c. 1965 b. 1960 d. 1970 ANS: C PTS: 1 DIF: 1 TOP: THEORY 7. Medicare Part A pays for: a. professional services and durable medical equipment b. hospital/facility care c. physician services and durable medical equipment d. hospital/facility care and durable medical equipment ANS: B PTS: 1 DIF: 1 TOP: THEORY 8. Medicare Part B pays for: a. durable medical equipment b. hospital/facility care c. physician services and durable medical equipment d. hospital/facility care and durable medical equipment ANS: C PTS: 1 DIF: 1 TOP: THEORY 9. Who handles the day-to-day operation of the Medicare program for the CMS? a. HCFA c. MACs b. peer review organization d. IPPS ANS: C PTS: 1 DIF: 1 TOP: THEORY 10. Medicare pays for what percentage of covered charges? a. 70% c. 80% b. 75% d. 85% ANS: C PTS: 1 DIF: 1 TOP: THEORY 11. The incentive to Medicare participating providers is: a. direct payment on all claims c. faster processing b. a 5% higher fee schedule d. all are correct ANS: D PTS: 1 DIF: 1 TOP: THEORY 12. Part B services are billed using: a. RBRVS, GPCI, and RVUs c. MS-DRGs b. ICD-10-CM, CPT, HCPCS d. APCs ANS: B PTS: 1 DIF: 1 TOP: THEORY 13. Who is the largest third -party payer in the nation? a. Blue Cross Blue Shield c. Cigna b. Aetna d. the government ANS: D PTS: 1 DIF: 1 TOP: THEORY 14. A major change took place in Medicare in with the enactment of the Omnibus Budget Reconciliation Act. a. 1989 c. 1997 b. 1992 d. 2000 ANS: A PTS: 1 DIF: 1 TOP: THEORY 15. The physician fee schedule is updated each April 15 and is composed of: a. the relative value units for each service b. a geographic adjustment factor to adjust for regional variations in the cost of operating a health care facility c. a national conversion factor d. all are correct e. none are correct ANS: D PTS: 1 DIF: 3 TOP: THEORY 16. If a surgeon performs more than one procedure on the same patient on the same day, and discounts were made on all subsequent procedures, Medicare would pay what percentages for the first, second, third, fourth, and fifth procedures? a. 100%, 100%, 100%, 100%, 100% c. 100%, 50%, 50%, 25%, 25% b. 100%, 50%, 50%, 50%, 25% d. 100%, 50%, 50%, 50%, 50% ANS: D PTS: 1 DIF: 2 TOP: THEORY 17. Medicare sets the payment level for assistant surgeons at a percentage of the fee schedule amount for the surgical service. a. global c. partial b. united d. subsequent ANS: A PTS: 1 DIF: 2 TOP: THEORY 18. What edition of the Federal Register would hospital facilities be especially interested in? a. October c. January b. November or December d. July ANS: A PTS: 1 DIF: 2 TOP: THEORY 19. What edition of the Federal Register would outpatient facilities be especially interested in? a. October c. January b. November or December d. July ANS: B PTS: 1 DIF: 2 TOP: THEORY 20. What are the three items that the Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services? a. personal care items b. deductibles, drug costs, personal care items c. premiums d. deductibles, premiums, and coinsurance ANS: D PTS: 1 DIF: 3 TOP: THEORY 21. Medicare funds are collected by: a. U.S. Food and Drug Administration c. National Centers for Health Statistics b. Social Security Administration d. Department of the Treasury ANS: B PTS: 1 DIF: 3 TOP: THEORY 22. CMS handles the daily operation of the Medicare program through the use of , formerly Fiscal Intermediaries. a. Medical Adjustment Contractor b. Medicare Administrative Cooperative c. Medicare Administrative Contractors d. Medical Administrative Contractors ANS: C PTS: 1 DIF: 1 TOP: THEORY 23. Which of the following is NOT a stated goal of the Physician Payment Reform? a. decrease Medicare expenditures b. assure quality health care at a reasonable cost c. limit provider liabilities d. redistribute physician payment more equitably ANS: C PTS: 1 DIF: 1 TOP: THEORY 24. If a QIO provider renders a covered service that costs $100 and bills Medicare for the service and Medicare allowed $58, the provider would bill this amount to the patient. a. $42 c. $100 b. $58 d. $0 ANS: D PTS: 1 DIF: 1 TOP: THEORY 25. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established these new benefits available under the Medicare program. a. Part A c. Part C b. Part B d. Part D ANS: D PTS: 1 DIF: 1 TOP: THEORY 26. This program is also known as Medicare Advantage. a. Part A c. Part C b. Part B d. Part D ANS: C PTS: 1 DIF: 1 TOP: THEORY 27. are activities involving the transfer of health care information and means the movement of electronic data between two entities and the technology that supports the transfer. a. Transmissions, transaction c. Interchanges, transmission b. Transactions, transmission d. Transmissions, interchange ANS: B PTS: 1 DIF: 1 TOP: THEORY 28. The progra m was developed by Congress to monitor the necessity of hospital admissions and review the treatment costs and medical records of hospitals. a. Medicare Administrative Contractors (MACs) b. Quality Improvement Organizations (QIO) c. Health Maintenance Organization (HMO) d. Special Needs Plan (SNP) ANS: B PTS: 1 DIF: 1 TOP: THEORY 29. The conversion factor (CF) is a national dollar amount that is applied to all services paid on the basis of the . a. Special Needs Plan c. Private Fee-for-Service Plan b. Affordable Care Act d. Medicare Fee Schedule
