During which period of history did the World Health Organization (WHO) take on diagnostic coding?
Why was the HCPCS Level II code set developed?
Which is the best explanation of Medicare coverage?
Which of the following Medicare plans refers to the prescription drug benefit?
Which of the following terms refers to the separate reporting (coding) of services and procedures inherently part of another service or procedure?
Which of the following federal acts specifically forbids conspiracy to file a false claim or fraudulent claim with the government?
Which of the following terms refers to the processing of insurance claims for the purpose of reimbursement?
What is the name of the legislation that refers to the prohibition of financial kickbacks for health care referrals?
What does the acronym CPT stand for?
What does ICD-10-CM stand for?
Provider services are billed on a:
A financial inducement or reward for sending business between a provider and a hospital or a provider and a DME supplier is called:
What comprises the main body of the CPT book?
What are the three relative values used in calculating physician fees?
ABC codes were developed to report what type of procedures and services?
Which, among the following code sets, is the HIPAA standard for outpatient procedure coding?
Which part of Medicare is also known as the Medicare Advantage Program?
Which one of the following federal offices is responsible for the implementation and oversight ofprivacy regulations?
Which of the following acts contains penalties for filing intentionally misleading information to receive highest reimbursement through a federal government contract?
For surgical procedures involving more than one surgeon, who is the person responsible for signing the procedural note?
The HIPAA standards for code sets include which of the following two?
Which of the following is the name for the identifier physicians and other health care providers must use when claiming Medicare reimbursement?
What does CM mean in the diagnostic classification system ICD-10-CM?
According to the Birthday Rule, both parents are covered by an employer-provided health policy, the insurance policy that would be primary for reporting their child’s services is:
------- refers to auditing patient records against proposed billing information.
Which two descriptions are false in regards to the format of a HCPCS level II modifier? (Choose two)
The purpose of an ABN is:
Which of the following statements regarding advanced beneficiary notices (ABN) is TRUE?
Which of the following services are covered by Medicare Part B?
This program was developed by CMS to promote national correct coding methods and to control inappropriate payment of Part B claims and hospital outpatient claims.
Which of the following is not considered fraud or abuse?
Select the true statement regarding ABNs.
Who is responsible for explaining medical necessity coverage rules to beneficiaries?
In which of the following instances should you obtain an advance beneficiary notice from a Medicare beneficiary?
When should you obtain an ABN for a patient who presents to the emergency room (ER) under medical duress?
Which modifier would you use on form CMS 1500 to bill for the services when you have obtained an ABN?
Which of the following actions violates the false claims act?
What are the penalties for violating the False Claims Act?
What factor does government consider when deciding whether to initiate a false claims act case?
Which of the following is not considered fraudulent billing?
When can hospitals request insurance “prior authorization” for patients with emergency medical conditions?
When may a hospital transfer an ED patient to another facility?
When can a hospital transfer or discharge a woman in labor?
Which of the following is an EMTALA violation?
Which of the following groups are protected under EMTALA?
Who can initiate a qui tam case?
Which of the following do you need to ensure medical records contain before billing?
Which of the following regulations prohibits physicians from making certain Medicare referrals to entities with which the physician has financial relationship?
Which option below would be considered medically necessary?
What form is provided to a patient to indicate a service may not be covered by Medicare and the patient may be responsible for the charges?
Select the true statement regarding ABNs.
When presenting a cost estimate on an ABN for a potentially noncovered service, the cost estimate should be within what range of the actual cost?
Who would not be considered a covered entity under HIPAA?
Under HIPAA, what would be a policy requirement for “Minimum necessary”?
Which Act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security?
What document has been created to assist physicin offices with the development of compliancemanuals?
What document should be referred to when looking for potential problem areas identified by the government indicating scrutiny of the services within the coming year?
PCP is ------------------
Medicare is a ----------------- insurance.
---------------- refers to the form submitted to the insurance company for payment of benefits.
An arrangement where the patient and the insurance company share payment of a health care service.
CPT is ------------------
CPT is used to code ------------------
CPT is revised ---------------
CPT is published by ---------------
The manual used to code diagnoses is --------------------
ICD-10-CM is --------------
ICD-10-CM is revised ------------- of every year.
HCPCS is published by -----------------
CMS stands for --------------------
-------------- is the amount paid periodically to purchase health insurance benefits.
The personal and insurance information is collectively called as ------------- information.
This program was developed by CMS to promote national correct coding methods and to control inappropriate payment of Part B claims and hospital outpatient claims
Which of the following is not considered fraud or abuse?
This document is a notification in advance of services that Medicare probably will not pay for and the estimated cost to the patient
Which of the following place of service codes is reported for fracture care performed by an orthopedic physician in the ED?
Which of the following is an example of fraud?
Which of the following statements regarding advanced beneficiary notices (ABN) is TRUE?
Which of the following services are covered by Medicare Part B?
Which modifier should be append to a CPT®, for which the provider had a patient sign an ABN form because there is a possibility the service may be denied because the patient’s diagnosis might not meet medical necessity for the covered service?
What is the patient’s right when it involves making changes in the personal medical record?
Medigap is a supplementary insurance for
Which is incorrect for COBRA?
SSN number has ------ digit
------- codes are alphanumeric representatives of alternative medicine, nursing and other integrative health care interventions established by Foundation for Integrative Healthcare and an information product and consulting service firm called Alternative Link
CMS delegates the daily operation of the Medicare program to
