CCA Exam Prep - Reimbursement Methodologies
The electronic claim format (837I) replaces which paper billing form? a. CMS-1500 b. CMS-1450 (UB-04) c. UB-92 d. CMS-1400
b. CMS-1450 (UB-04)
Timely and correct reimbursement is dependent on: a. Adjudication b. Clean claims c. Remittance advice d. Actual charge
b. Clean claims
The front end of the revenue cycle process does not include: a. Enterprise wide scheduling system b. Claims appeals c. Order tracking system d. Financial function system
b. Claims appeals
Effective October 16, 2003, under the Administrative Simplification Compliance section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), all healthcare providers must electronically submit claims to Medicare. Which is the electronic format for hospital technical fees? a. 837I b. 837P c. UB-04 d. 1500
a. 8371
If a provider believes a service may be denied by Medicare because it could be considered unnecessary, the provider must notify the patient before the treatment begins by using a(n) ________. a. Advance beneficiary notice (ABN) b. Advance notice of coverage (ANC) c. Notice of payment (NOP) d. Consent for payment (CFP)
a. Advance beneficiary notice (ABN)
Fee schedules are updated by third-party payers: a. Annually b. Monthly c. Semiannually d. Weekly
a. Annually
Which of the following would a health record technician use to perform the billing function for a physician's office? a. CMS-1500 b. UB-04 c. UB-92 d. CMS 1450
a. CMS-1500
Under the OPPS, on which code set is the APC system primarily based for outpatient procedures and services including devices, drugs, and other covered items? a. CPT/HCPCS b. ICD-10-CM c. CDT d. MS-DRG
a. CPT/HCPCS
Which of the following hospitals are excluded from the Medicare acute-care prospective payment system? a. Children's b. Small community c. Tertiary d. Trauma
a. Children's
Which of the following types of hospitals are excluded from the Medicare inpatient prospective payment system? a. Children's b. Rural c. State supported d. Tertiary
a. Children's
The Office of Inspector General (OIG) has identified risk areas for physician practices. One type of risk is "clustering." Identify its definition. a. Coding or charging one or two middle levels of service codes exclusively b. Billing for a more expensive service than the one actually performed c. Billing for noncovered services as if they are covered d. Assigning additional codes inherent to the main code
a. Coding or charging one or two middle levels of service codes exclusively
Assignment of benefits is a contract between a physician and Medicare in which the physician agrees to bill Medicare directly for covered services and the beneficiary for ________ and to accept the Medicare payment as payment in full. a. Coinsurance or deductible b. Deductible only c. Coinsurance only d. Balance of charges
a. Coinsurance or deductible
Health insurance for spouses, children, or both is known as ________. a. Dependent (family) coverage b. Individual (single) coverage c. Group coverage d. Inclusive coverage
a. Dependent (family) coverage
A fee schedule is ________. a. Developed by third-party payers and includes a list of healthcare services, procedures, and charges associated with each b. Developed by providers and includes a list of healthcare services, procedures, and charges associated with each c. Developed by third-party payers and includes a list of healthcare services provided to a patient d. Developed by providers and lists charge codes
a. Developed by third-party payers and includes a list of healthcare services, procedures, and charges associated with each
What is one way that physicians can prevent or minimize potentially abusive or fraudulent activities? a. Developing a compliance plan b. Upcoding c. Unbundling d. Billing for noncovered services
a. Developing a compliance plan
The Medicare program pays for health care services Social Security benefits for those age 65 and older, permanently disabled people and those with: a. End stage renal disease b. Military experience c. Medicaid d. Skilled nursing services
a. End stage renal disease
Which of the following best describes the type of coding utilized when a CPT/HCPCS code is assigned directly through the charge description master for claim submission and bypasses the record review and code assignment by the facility coding staff? a. Hard coding b. Soft coding c. Encoder coding d. Natural-language processing coding
a. Hard coding
What is the basic formula for calculating each MS-DRG hospital payment? a. Hospital payment = DRG relative weight × hospital base rate b. Hospital payment = DRG relative weight × hospital base rate − 1 c. Hospital payment = DRG relative weight / hospital base rate + 1 d. Hospital payment = DRG relative weight / hospital base rate
a. Hospital payment = DRG relative weight × hospital base rate
Which of the following actions would be best to determine whether present on admission (POA) indicators for the conditions selected by CMS are having a negative impact on the hospital's Medicare reimbursement? a. Identify all records for a period having these indicators for these conditions and determine if these conditions are the only secondary diagnoses present on the claim that will lead to higher payment. b. Identify all records for a period that have these indicators for these conditions. c. Identify all records for a period that have these indicators for these conditions and determine whether or not additional documentation can be submitted to Medicare to increase reimbursement. d. Take a random sample of records for a period of time for records having these indicators for these conditions and extrapolate the negative impact on Medicare reimbursement.
a. Identify all records for a period having these indicators for these conditions and determine if these conditions are the only secondary diagnoses present on the claim that will lead to higher payment.
Medical necessity for inpatient services does not always include: a. LCDs b. Related monetary benefits to payers c. Uniform written procedures for appeals d. Concurrent review
a. LCDs
The goal of coding compliance programs is to reduce: a. Liability in regards to fraud and abuse b. Delays in claims processing c. Billing errors d. Inaccurate code assignments
a. Liability in regards to fraud and abuse
The middle process of the revenue cycle's objectives is ________. a. Manage clinical procedural documentation and charging services b. Denial and appeal management c. Revenue audits and recovery procedures d. Registration processing and quality audits
a. Manage clinical procedural documentation and charging services
The government sponsored program that provides expanded coverage of many health care services including HMO plans, PPO plans, special needs and Medical Savings accounts is: a. Medicare Advantage b. Medicare Part A c. Medicare Part B d. Medigap
a. Medicare Advantage
The NCCI editing system used in processing OPPS claims is referred to as: a. Outpatient code editor (OCE) b. Outpatient national editor (ONE) c. Outpatient perspective payment editor (OPPE) d. Outpatient claims editor (OCE)
a. Outpatient code editor (OCE)
In a managed fee-for-service arrangement, which of the following would be used as a cost-control process for inpatient surgical services? a. Prospectively precertify the necessity of inpatient services b. Determine what services can be bundled c. Pay only 80% of the inpatient bill d. Require the patient to pay 20% of the inpatient bill
a. Prospectively precertify the necessity of inpatient services
In the laboratory section of CPT, if a group of tests overlaps two or more panels, report the panel that incorporates the greatest number of tests to fulfill the code definition. What would a coder do with the remaining test codes that are not part of a panel? a. Report the remaining tests using individual test codes, according to CPT. b. Do not report the remaining individual test codes. c. Report only those test codes that are part of a panel. d. Do not report a test code more than once regardless whether the test was performed twice.
a. Report the remaining tests using individual test codes, according to CPT.
Which of the following fails to meet the CMS classification of a hospital-acquired condition? a. Stage I pressure ulcers b. Falls and trauma c. Catheter-associated infection d. Vascular catheter-associated infection
a. Stage I pressure ulcers
Solutions to address the problem of dirty claims include all of the following except: a. Submitting paper claims b. Submitting claims electronically c. Using electronic health record system that eliminates manual or duplicate entry of data d. Auditing claims' accuracy and compliance with edits prior to submitting
a. Submitting paper claims
Which one of the following statements is true? a. The higher the relative weight, the higher the payment rates. b. The lower the relative weight, the higher the payment rates. c. The lower the relative weight, the sicker the patient. d. The higher the relative weight, the lesser reimbursement due the facility.
a. The higher the relative weight, the higher the payment rates.
What was the goal of the MS-DRG system? a. To improve Medicare's capability to recognize severity of illness in its inpatient hospital payments. The new system is projected to increase payments to hospitals for services provided to sicker patients and decrease payments for treating less severely ill patients. b. To improve Medicare's capability to recognize poor quality of care and pay hospitals on an incentive grid that allows hospitals to be paid by performance. c. To improve Medicare's capability to recognize groups of data by patient populations, which will further allow Medicare to adjust the hospitals' wage indexes based on the data. This adjustment will be a system to pay hospitals fairly across all geographic locations. d. To improve Medicare's capability to recognize practice patterns among hospitals that are inappropriately optimizing payments by keeping patients in the hospital longer than the median length of stay.
a. To improve Medicare's capability to recognize severity of illness in its inpatient hospital payments. The new system is projected to increase payments to hospitals for services provided to sicker patients and decrease payments for treating less severely ill patients.
The next generation of consumer-directed healthcare will be driven by a design where copayments are set based on the value of the clinical services rather than the traditional practices that focus only on costs of clinical services. What new design will focus on both the benefit and cost? a. Value-based insurance design (VBID) b. Cost-based reimbursement (CBR) c. Pay for performance design (PPD) d. Prospective payment system (PPS)
a. Value-based insurance design (VBID)
What is the maximum number of diagnosis codes that can appear on the UB-04 paper claim form locator 67 for a hospital inpatient principal and secondary diagnoses? a. 35 b. 25 c. 18 d. 9
b. 25
If another status T procedure were performed, how much would the facility receive for the second status T procedure? 998323 V 99285-25 0612 998324 T 25500 0044 998325 X 72050 0261 998326 S 72128 0283 998327 S 70450 0283 a. 0% b. 50% c. 75% d. 100%
b. 50%
What is the best reference tool to determine how CPT codes should be assigned? a. Local coverage determination from Medicare b. American Medical Association's CPT Assistant newsletter c. American Hospital Association's Coding Clinic d. CMS website
b. American Medical Association's CPT Assistant newsletter
Which answer is not required for assignment of the MS-DRG? a. Diagnoses and procedures (principal and secondary) b. Attending and consulting physicians c. Presence of major or other complications and comorbidities (MCC or CC) d. Discharge disposition or status
b. Attending and consulting physicians
Which of the following situations would be identified by the NCCI edits? a. Determining the MS-DRG b. Billing for two services that are prohibited from being billed on the same day c. Whether data submitted electronically were successfully submitted d. Receiving the remittance advice
b. Billing for two services that are prohibited from being billed on the same day
How does Medicare or other third-party payers determine whether the patient has medical necessity for the tests, procedures, or treatment billed on a claim form? a. By requesting the medical record for each service provided b. By reviewing all the diagnosis codes assigned to explain the reasons the services were provided c. By reviewing all physician orders d. By reviewing the discharge summary and history and physical report of the patient over the last year
b. By reviewing all the diagnosis codes assigned to explain the reasons the services were provided
A patient has two health insurance policies: Medicare and a Medicare supplement. Which of the following statements is true? a. The patient receives any monies paid by the insurance companies over and above the charges. b. Coordination of benefits is necessary to determine which policy is primary and which is secondary so that there is no duplication of payments. c. The decision on which company is primary is based on remittance advice. d. The patient should not have a Medicare supplement.
b. Coordination of benefits is necessary to determine which policy is primary and which is secondary so that there is no duplication of payments.
Which of the following is not reimbursed according to the Medicare outpatient prospective payment system? a. CMHC partial hospitalization services b. Critical access hospitals c. Hospital outpatient departments d. Vaccines provided by CORFs
b. Critical access hospitals
What system reimburses hospitals a predetermined amount for each Medicare inpatient admission? a. APR-DRG b. DRG c. APC d. RUG
b. DRG
The charge description master contains all of the following general data elements except: a. Charge code description b. DRG assignment c. Insurance coverage determination d. Price
b. DRG assignment
The MS-DRG system creates a hospital's case-mix index (types or categories of patients treated by the hospital) based on the relative weights of the MS-DRG. The case mix can be figured by multiplying the relative weight of each MS-DRG by the number of ________ within that MS-DRG. a. Admissions b. Discharges c. CCs d. MCCs
b. Discharges
Which of the following software applications would be used to aid in the coding function in a physician's office? a. Grouper b. Encoder c. Pricer d. Diagnosis calculator
b. Encoder
This is a statement sent by third-party payers to the patient to explain services provided, amounts billed, and payments made by the health plan. a. Coordination of benefits (COB) b. Explanation of benefits (EOB) c. Medicare summary notice (MSN) d. Remittance advice (RA)
b. Explanation of benefits (EOB)
CMS developed medically unlikely edits (MUEs) to prevent providers from billing units of services greater than the norm would indicate. These MUEs were implemented on January 1, 2007, and are applied to which code set? a. Diagnosis-related groups b. HCPCS/CPT codes c. ICD-10-CM/PCS diagnosis and procedure codes d. Resource utilization groups
b. HCPCS/CPT codes
Reimbursement for healthcare services is dependent on patients having a(n) ________. a. Attending physician b. Insurance benefit c. Explanation of benefits d. Qualified provider
b. Insurance benefit
Prospective payment systems were developed by the federal government to: a. Increase healthcare access b. Manage Medicare and Medicaid costs c. Implement managed care programs d. Eliminate fee-for-service programs
b. Manage Medicare and Medicaid costs
The government sponsored supplemental medical insurance that covers physicians and surgeons services, emergency department, outpatient clinic, labs and physical therapy is: a. Medicaid b. Medicare Part B c. Medicare Part A d. Medicare Part D
b. Medicare Part B
Medicare's newest claims processing payment contract entities are referred to as ________. a. Recovery audit contractors (RACs) b. Medicare administrative contractors (MACs) c. Fiscal intermediaries (FIs) d. Office of Inspector General contractors (OIGCs)
b. Medicare administrative contractors (MACs)
A patient has two health insurance policies: Medicare and a Medicare supplement. Which of the following statements is true? a. The patient receives any monies paid by the insurance companies over and above the charges. b. Monies paid to the healthcare provider cannot exceed charges. c. The decision on which company is primary is based on remittance advice. d. The patient should not have a Medicare supplement.
b. Monies paid to the healthcare provider cannot exceed charges.
What is the name of the organization that develops the billing form that hospitals are required to use? a. American Academy of Billing Forms (AABF) b. National Uniform Billing Committee (NUBC) c. National Uniform Claims Committee (NUCC) d. American Billing and Claims Academy (ABCA)
b. National Uniform Billing Committee (NUBC)
When a provider accepts assignment, this means the: a. Patient authorizes payment to be made directly to the provider b. Provider agrees to accept as payment in full the allowed charge from the fee schedule c. Balance billing is allowed on patient accounts, but at a limited rate d. Participating provider receives a fee-for-service reimbursement
b. Provider agrees to accept as payment in full the allowed charge from the fee schedule
What system assigns each service a value representing the true resources involved in producing it, including the time and intensity of work, the expenses of practice, and the risk of malpractice? a. DRGs b. RVUs c. CPT d. SVR
b. RVUs
What is the name of the national program to detect and correct improper payments in the Medicare Fee-for-Service (FFS) program? a. Medicare administrative contractors (MACs) b. Recovery audit contractors (RACs) c. Comprehensive error rate testing (CERT) d. Fiscal intermediaries (FIs)
b. Recovery audit contractors (RACs)
Which payment system was introduced in 1992 and replaced Medicare's customary, prevailing, and reasonable (CPR) payment system? a. Diagnosis-related groups b. Resource-based relative value scale system c. Long-term care drugs d. Resource utilization groups
b. Resource-based relative value scale system
Two patients were hospitalized with bacterial pneumonia. One patient was hospitalized for three days, and the other patient was hospitalized for 30 days. Both cases result in the same DRG with different lengths of stay. Which answer most closely describes how the hospital will be reimbursed? a. The hospital will receive the same DRG for both patients but additional reimbursement will be allowed for the patient who stayed 30 days because the length of stay was greater than the geometric length of stay for this DRG. b. The hospital will receive the same reimbursement for the same DRG regardless of the length of stay. c. The hospital can appeal the payment for the patient who was in the hospital for 30 days because the cost of care was significantly higher than the average length of stay for the DRG payment. d. The hospital will receive a day outlier for the patient who was hospitalized for 30 days.
b. The hospital will receive the same reimbursement for the same DRG regardless of the length of stay.
What is a guarantor? a. The patient who is an inpatient b. The person responsible for the bill, such as a parent c. The person who bills the patient, such as the Medicare biller d. The patient who is an outpatient
b. The person responsible for the bill, such as a parent
An electrolyte panel (80051) in the laboratory section of CPT consists of tests for carbon dioxide (82374), chloride (82435), potassium (84132), and sodium (84295). If each of the component codes are reported and billed individually on a claim form, this would be a form of: a. Optimizing b. Unbundling c. Sequencing d. Classifying
b. Unbundling
If a patient's total outpatient bill is $500, and the patient's healthcare insurance plan pays 80% of the allowable charges, what is the amount owed by the patient? a. $10 b. $40 c. $100 d. $400
c. $100
From the information provided, how many APCs would this patient have? 998323 V 99285-25 0612 998324 T 25500 0044 998325 X 72050 0261 998326 S 72128 0283 998327 S 70450 0283 a. 1 b. 4 c. 5 d. 3
c. 5
What is a chargemaster? a. Cost-sharing in which the policy or certificate holder pays a preestablished percentage of eligible expenses after the deductible has been met b. A plan that converts the organization's goals and objectives into targets for revenue and spending c. A financial management system that contains information about the organization's charges for the healthcare services it provides to patients d. Charged amounts that are billed as costs by an organization to the current year's activities of operation
c. A financial management system that contains information about the organization's charges for the healthcare services it provides to patients
What is the best reference tool for ICD-10-CM/PCS coding advice? a. CMS Inpatient Prospective Payment System (IPPS) b. CMS ICD-10-CM and ICD-10-PCS Coding Guidelines c. AHA's Coding Clinic for ICD-10-CM/PCS d. National Correct Coding Initiative (NCCI)
c. AHA's Coding Clinic for ICD-10-CM/PCS
What healthcare organizations collect UHDDS data? a. All outpatient settings including physician clinics and ambulatory surgical centers b. All outpatient settings including cancer centers, independent testing facilities, and nursing homes c. All non outpatient settings including acute care, short-term care, long-term care, and psychiatric hospitals; home health agencies; rehabilitation facilities; and nursing homes d. All inpatient settings and outpatient settings with a focus on ambulatory surgical centers
c. All non outpatient settings including acute care, short-term care, long-term care, and psychiatric hospitals; home health agencies; rehabilitation facilities; and nursing homes
When clean claims are submitted, they can be adjudicated in many ways through computer software automatically. Which statement is not one of the outcomes that can occur as part of auto-adjudication? a. Auto-pay b. Auto-suspend c. Auto-calculate d. Auto-deny
c. Auto-calculate
A provision of the law that established the resource-based relative value scale (RBRVS) stipulates that refinements to relative value units (RVUs) must maintain ________. a. Moderate rate increases b. Market basket increases c. Budget neutrality d. Sustainable growth rate
c. Budget neutrality
What is the term used when a Medicare hospital inpatient admission results in exceptionally high costs when compared to other cases in the same DRG? a. Rate increase b. Charge outlier c. Cost outlier d. Day outlier
c. Cost outlier
A coding audit shows that an inpatient coder is using multiple codes that describe the individual components of a procedure rather than using a single code that describes all the steps of the procedure performed. Which of the following should be done in this case? a. Require all coders to implement this practice b. Report the practice to the OIG c. Counsel the coder and stop the practice immediately d. Put the coder on unpaid leave of absence
c. Counsel the coder and stop the practice immediately
Several key principles require appropriate physician documentation to secure payment from the insurer. Which answer (listed here) fails to impact payment based on physician responsibility? a. The health record should be complete and legible. b. The rationale for ordering diagnostic and other ancillary services should be documented or easily inferred. c. Documenting the charges and services on the itemized bill. d. The patient's progress and response to treatment and any revision in the treatment plan and diagnoses should be documented.
c. Documenting the charges and services on the itemized bill.
Which of the following fails to meet the CMS classification of a hospital-acquired condition? a. Foreign object retained after surgery b. Air embolism c. Gram-negative pneumonia d. Blood incompatibility
c. Gram-negative pneumonia
Which classification system is in place to reimburse home health agencies? a. MS-DRGs b. RUGs c. HHRGs d. APCs
c. HHRGs
Sometimes hospital departments must work together to solve claims issue errors to prevent them from happening over and over again. What departments would need to work together if an audit found that the claim did not contain the procedure code or charge for a pacemaker insertion? a. Health Information and Business Office b. Health Information and Materials Management c. Health Information, Business Office, and Cardiac Department d. Health Information and Radiology
c. Health Information, Business Office, and Cardiac Department
CMS identified conditions that are not present on admission and could be "reasonably preventable." Hospitals are not allowed to receive additional payment for these conditions when the condition is present on admission. What are these conditions called? a. Conditions of Participation b. Present on admission c. Hospital-acquired conditions d. Hospital-acquired infection
c. Hospital-acquired conditions
The purpose of a physician query is to ________. a. Identify the MS-DRG b. Identify the principal diagnosis c. Improve documentation for patient care and proper reimbursement d. Increase reimbursement as form of optimization
c. Improve documentation for patient care and proper reimbursement
Diagnosis-related groups are organized into: a. Case-mix classifications b. Geographic practice cost indices c. Major diagnostic categories d. Resource-based relative values
c. Major diagnostic categories
MS diagnostic-related groups are organized into: a. Case-mix classifications b. Geographic practice cost indices c. Major diagnostic categories d. Resource-based relative values
c. Major diagnostic categories
Denials of outpatient claims are often generated from all of the following edits except: a. NCCI (National Correct Coding Initiative) b. OCE (outpatient code editor) c. OCE (outpatient claims editor) d. National and local policies
c. OCE (outpatient claims editor)
Which governmental agency develops an annual work plan that delineates the specific target areas for Medicare that will be monitored in a given year? a. Centers for Medicare and Medicaid (CMS) b. Federal Bureau of Investigation (FBI) c. Office of Inspector General (OIG) d. Defense Criminal Investigative Service (DCIS)
c. Office of Inspector General (OIG)
What reimbursement system uses the Medicare fee schedule? a. APCs b. MS-DRGs c. RBRVS d. RUG-III
c. RBRVS
A hospital needs to know how much Medicare paid on a claim so they can bill the secondary insurance. What should the hospital refer to? a. Explanation of benefits b. Medicare Summary Notice c. Remittance advice d. Coordination of benefits
c. Remittance advice
Given NCCI edits, if the placement of a catheter is billed along with the performance of an infusion procedure for the same date of service for an outpatient beneficiary, Medicare will pay for: a. The placement of the catheter b. The placement of the catheter and the infusion procedure c. The infusion procedure d. Neither the placement of the catheter nor the infusion procedure
c. The infusion procedure
The health care program for active duty members of the military and other qualified family members is: a. Children's Health Insurance Program (CHIP) b. V.A. Funding Inc. c. Tricare d. Worker's Compensation
c. Tricare
The sum of a hospital's total relative DRG weights for a year was 15,192 and the hospital had 10,471 total discharges for the year. Given this information, what would be the hospital's case-mix index for that year? a. 0.689 b. 1.59 c. 1.45 × 100 d. 1.45
d. 1.45
85.What statement is not reflective of meeting medical necessity requirements? a. A service or supply provided for the diagnosis, treatment, cure, or relief of a health condition, illness, injury, or disease. b. A service or supply provided that is not experimental, investigational, or cosmetic in purpose. c. A service provided that is necessary for and appropriate to the diagnosis, treatment, cure, or relief of a health condition, illness, injury, disease, or its symptoms. d. A service provided solely for the convenience of the insured, the insured's family, or the provider.
d. A service provided solely for the convenience of the insured, the insured's family, or the provider.
What are the possible "add-on" payments that a hospital could receive in addition to the basic Medicare DRG payment? a. Additional payments may be made for locum tenens, increased emergency room services, stays over the average length of stay, and cost outlier cases. b. Additional payments may be made to critical access hospitals, for higher-than-normal volumes, unexpected hospital emergencies, and cost outlier cases. c. Additional payments may be made for increased emergency room services, critical access hospitals, increased labor costs, and cost outlier cases. d. Additional payments may be made to disproportionate share hospitals for indirect medical education, new technologies, and cost outlier cases.
d. Additional payments may be made to disproportionate share hospitals for indirect medical education, new technologies, and cost outlier cases.
A denial of a claim is possible for all of the following reasons except: a. Not meeting medical necessity b. Billing too many units of a specific service c. Unbundling d. Approved precertification
d. Approved precertification
Promoting correct coding and control of inappropriate payments is the basis of NCCI claims processing edits that help identify claims not meeting medical necessity. The NCCI automated prepayment edits used by payers is based on all of the following except: a. Coding conventions defined in the CPT book b. National and local policies and coding edits c. Analysis of standard medical and surgical practice d. Clinical documentation in the discharge summary
d. Clinical documentation in the discharge summary
In processing a bill under the Medicare outpatient prospective payment system (OPPS) in which a patient had three surgical procedures performed during the same operative session, which of the following would apply? a. Bundling of services b. Outlier adjustment c. Pass-through payment d. Discounting of procedures
d. Discounting of procedures
Medicare defines fraud as ________. a. Billing practices that are inconsistent with generally acceptable fiscal policies b. Making unintentional billing errors c. Accurately representing the types of services provided, dates of services, or identity of the patient d. Intentional deception or misrepresentation that results in an unauthorized benefit to an individual
d. Intentional deception or misrepresentation that results in an unauthorized benefit to an individual
Medicare beneficiaries who have low incomes and limited financial resources may also receive assistance from which federal matching program? a. Social Security b. Medicare Advantage c. Tricare d. Medicaid
d. Medicaid
Which of the following is not an essential data element for a healthcare insurance claim? a. Revenue code b. Procedure code c. Provider name d. Procedure name
d. Procedure name
The documentation of each patient encounter should include the following to secure payment from the insurer except ________. a. The reason for the encounter and the patient's relevant history, physical examination, and prior diagnostic test results b. A patient assessment, clinical impression, or diagnosis c. A plan of care d. The identity of the patient's nearest relative and emergency contact number
d. The identity of the patient's nearest relative and emergency contact number
