TEST BANK for Understanding Health Insurance A Guide to Billing and Reimbursement, 2023 Edition 18th

TEST BANK Understanding Health Insurance: A Guide to Billing and Reimbursement, 2023 Edition 18th Edition

TABLE OF CONTENTS 1. Health Insurance Specialist Career.

2. Introduction to Health Insurance and Managed Care.

3. Introduction to Revenue Management.

4. Revenue Management: Insurance Claims, Denied Claims and Appeals and Credit and Collections.

5. Legal Aspects of Health Insurance and Reimbursement.

6. ICD-10-CM Coding.

7. CPT Coding.

8. HCPCS Level II Coding.

9. CMS Reimbursement Methodologies.

10. Coding Compliance, Clinical Documentation Improvement and Coding for Medical Necessity.

11. CMS-1500 and UB-04 Claims.

12. Commercial Insurance.

13. BlueCross BlueShield.

14. Medicare.

15. Medicaid.

16. TRICARE. 17. Workers’ Compensation.

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Test Bank For Understanding Health Insurance A Guide to Billing and Reimbursement, 2023 Edition 18th Edition Michelle Green Chapter 1-17 Chapter 01: Health Insurance Specialist Career 1. If the insurance plan has a hold harmless clause, it means that the patient a. is charged for fees by the health care provider, per the EOB. b. automatically has lower out-of-pocket health care expenses. c. is not responsible for paying what the insurance plan denies. d. was required to pay any amounts that the insurance plan denies.

ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 2. The process of reporting __________ as numeric and alphanumeric characters on the insurance claim is called coding. a. dates of service for procedures b. diagnoses and procedures/services c. health insurance claims identifiers d. national provider identifiers ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 3. A claims examiner employed by a third-party payer reviews health-related claims to determine whether the charges are reasonable, in addition to a. assigning ICD-10-CM and CPT codes. b. billing patients for copayments and coinsurance. c. determining medical necessity of services/procedures. d. resubmitting denied claims to health care providers.

ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved.

UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance specialists.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 4. Which is another name for a health insurance specialist? a. billing specialist b. coding specialist c. health information specialist d. reimbursement specialist ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance specialists.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 5. A claims examiner is employed by a a. facility to submit claims. b. governmental agency to process claims. c. physician’s office to submit claims. d. third-party payer to review claims.

ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance specialists.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 6. Which involves linking every procedure or service code reported on the claim to a condition code that justifies the necessity of performing that procedure or service? a. claims adjudication b. diagnosis coding c. medical necessity d. reimbursement processing ANSWER: c POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 7. The CPT manual is published by the a. American Billing Association. b. American Board of Physicians. c. American Dental Association. d. American Medical Association.

ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 8. Which is submitted to the payer requesting reimbursement? a. explanation of benefits b. health insurance claim c. remittance advice d. prior approval form ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.5 - Describe the job responsibilities of a health insurance specialist.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 9. The Centers for Medicare and Medicaid Services (CMS) agency is located in the __________. a. ACF b. DHHS c. FDA d. OIG ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 10. When a health insurance plan’s prior approval requirements are not met by providers, a. administrative costs are reduced. b. patients’ coverage is canceled. c. payment of the claim is denied. d. providers pay a fine to the plan.

ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 11. Which coding system is used to report procedures and services on claims? a. CPT b. ICD-10-CM c. SNDO d. SNOMED ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 12. Which would be found on a remittance advice? a. detected errors and omissions from claims b. documentation of medical necessity c. payment information about a claim d. provider qualifications and responsibilities ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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LEARNING OBJECTIVES: UHI_GREEN_24_1.5 - Describe the job responsibilities of a health insurance specialist.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 13. Which guarantees repayment for financial losses resulting from an employee’s act or failure to act? a. bonding insurance b. liability insurance c. property insurance d. workers’ compensation insurance ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by contractors and employers.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 14. Medical malpractice insurance is which type of insurance? a. bonding b. liability c. property d. workers’ compensation ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by contractors and employers.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 15. Which type of insurance covers employees and their dependents against injury and death that occurs during the course of employment? a. bonding b. liability c. property d. workers’ compensation ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by Copyright Cengage Learning. Powered by Cognero.

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contractors and employers.

11/1/2022 11:32 AM 11/1/2022 11:32 AM

16. The word embezzle means to _____. a. compensate b. disburse c. remunerate d. steal ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by contractors and employers.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 17. Independent contractors should purchase __________ liability insurance, which provides protection from liability as a result of errors and omissions when performing their professional services. a. bonding b. business c. professional d. property ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by contractors and employers.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 18. Which term describes the principles of right or good conduct and includes rules that govern the conduct of members of a profession? a. biased b. ethics c. immoral d. misleading ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.7 - Explain the role of workplace professionalism for a health Copyright Cengage Learning. Powered by Cognero.

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insurance specialist.

11/1/2022 11:32 AM 11/1/2022 11:32 AM

19. The Healthcare Common Procedure Coding System (HCPCS) consists of __________ codes. a. CPT and national b. DSM and CDT c. ICD-10-CM and ICD-10-PCS d. SNOMED and SNDO ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 20. Health information technicians _____. a. assist with direct patient care b. document clinical information c. manage medical records d. process health insurance claims ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance specialists.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 21. The organization that hires a(n) __________ is not liable for the acts or omissions of that individual. a. health insurance specialist b. health care provider c. independent contractor d. medical assistant ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by contractors and employers.

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11/1/2022 11:32 AM 11/1/2022 11:32 AM

22. During completion of a student internship, the facility will likely require students to sign a nondisclosure agreement to protect __________. a. facility resources b. health care finances c. patient confidentiality d. quality of patient care ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.4 - List the education and training requirements of a health insurance specialist.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 23. Which coding system is used to report procedures and services on inpatient hospital claims? a. CPT b. HCPCS level II c. ICD-10-CM d. ICD-10-PCS ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 24. Which does a provider usually employ to perform administrative and clinical tasks, which help keep the office or clinic running smoothly? a. health information technician b. medical assistant c. nurse practitioner d. reimbursement specialist ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance Copyright Cengage Learning. Powered by Cognero.

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specialists.

11/1/2022 11:32 AM 11/1/2022 11:32 AM

25. Which organization offers the CPB exam? a. AAPC b. AHIMA c. AMBA d. CMS ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.9 - Identify coding and reimbursement professional associations and credentials offered.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 26. Which are published by CMS and used to report procedures, services, and supplies not classified in CPT? a. dental codes b. disease codes c. injury codes d. national codes ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 27. Conduct or qualities that characterize a professional person are called __________. a. certification b. credentials c. professionalism d. specialization ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.7 - Explain the role of workplace professionalism for a health insurance specialist.

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11/1/2022 11:32 AM 11/1/2022 11:32 AM

28. Which is an insurance agreement that protects business contents against fire, theft, and other risks? a. bonding insurance b. business liability insurance c. errors and omissions insurance d. property insurance ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by contractors and employers.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 29. Which is Latin for “let the master answer,” which means that the employer is liable for the actions and omissions of employees as performed and committed within the scope of their employment? a. res gestae b. res ipsa loquitur c. respondeat superior d. requiescat in pace ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by contractors and employers.

DATE CREATED: 11/1/2022 11:32 AM DATE MODIFIED: 11/1/2022 11:32 AM 30. Which defines a profession, delineates qualifications and responsibilities, and clarifies supervision requirements? a. job description b. policy and procedure c. scope of practice d. workforce development ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_1.5 - Describe the job responsibilities of a health insurance specialist.

DATE CREATED: 11/1/2022 11:32 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care 1. Which may specifically result in the early detection of health problems, allowing less drastic and less expensive treatment options? a. health care insurance b. medical necessity c. preventive examination d. third-party payment ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and managed care concepts.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 2. Which provides health insurance coverage? a. continuity of care b. health insurance exchange c. meaningful use d. third-party payer ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and managed care concepts.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 3. Which type of health insurance coverage is subsidized by employers and other organizations? a. group health insurance b. individual health insurance c. public health insurance d. universal health insurance ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and managed care concepts.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 4. Which type of health insurance coverage is purchased by families who do not have access to employer-subsidized Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care coverage? a. group health insurance b. individual health insurance c. public health insurance d. universal health insurance ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and managed care concepts.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 5. Which type of health insurance coverage includes federal and state government health programs (e.g., Medicare, Medicaid, CHIP, TRICARE) that are available to eligible individuals? a. group health insurance b. individual health insurance c. public health insurance d. universal health insurance ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and managed care concepts.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 6. Which is a type of single-payer system in which the government owns and operates health care facilities and providers (e.g., physicians) receive salaries? a. government health plan b. managed care c. socialized medicine d. universal health insurance ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and managed care concepts.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care 7. Which act provided federal grants for modernizing hospitals that had become obsolete because of a lack of capital investment during the Great Depression and World War II (1929–1945)? a. Brady Act b. Gramm-Leach-Bliley Act c. Hill-Burton Act d. Taft-Hartley Act ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 8. Which is the amount for which the patient is financially responsible before an insurance policy provides payment? a. coinsurance b. copayment c. deductible d. exclusionary ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and managed care concepts.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 9. Title XIX of the Social Security Amendments of 1965 is a cost-sharing program between the federal and state governments to provide health care services to low-income Americans. It is a government plan known as __________. a. CHAMPVA b. Medicaid c. Medicare d. TRICARE ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 10. Prior to implementation of a prospective payment system for acute care hospital inpatient stays, reimbursement was Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care generated on a __________ basis, which issued payment based on daily rates. a. capitated b. per diem c. prospective d. res gestae ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 11. Medicare requires providers to submit the __________ claim for payment of outpatient and office services. a. CMS-1450 b. CMS-1500 c. UB-02 d. UB-04 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 12. Clinical Laboratory Improvement Act (CLIA) legislation established __________ for all laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test was performed. a. advance directives b. case management c. plan administration d. quality standards ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/12/2022 7:18 AM 13. The Resource-Based Relative Value Scale (RBRVS) system reimburses physicians’ practice expenses using a __________. a. fee schedule Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care b. guaranteed issue method c. prospective payment system d. usual and reasonable payment basis ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 14. The National Correct Coding Initiative (NCCI) was created to promote national correct coding methodologies and to eliminate __________ coding. a. credentialed b. improper c. outdated d. provider ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 15. The Skilled Nursing Facility Prospective Payment System (SNF PPS) was implemented to cover all costs (routine, ancillary, and capital) related to services furnished to Medicare Part A beneficiaries. SNF PPS generates per diem payments for each admission. These payments are case-mix adjusted using a resident classification system called __________. a. diagnosis-related groups b. minimum data set c. outcomes and assessment information set d. resource utilization groups ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 16. The Outpatient Prospective Payment System (OPPS), which uses __________ to calculate reimbursement, is implemented for billing of hospital-based Medicare outpatient claims. a. ambulatory payment classifications Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care b. diagnosis-related groups c. outcomes and assessment information d. resource utilization groups ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 17. Which was created by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) to identify and recover improper Medicare payments paid to health care providers under fee-for-service Medicare plans? a. government health care program b. medical audit program c. quality assurance program d. recovery audit contractor program ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 18. The Medicare Contracting Reform (MCR) initiative was established to integrate the administration of Medicare Parts A and B fee-for-service benefits with new entities called __________. a. carriers b. fiscal intermediaries c. Medicare administrative contractors d. third-party payers ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 19. The American Recovery and Reinvestment Act of 2009 (ARRA) established electronic health record (EHR) __________ during three stages to achieve the goal of improved patient care outcomes and delivery as well as data capture and sharing, advance clinical processes, and improved outcomes. a. acquisition of health information technology systems Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care b. health care reform initiatives c. meaningful use objectives and measures d. privacy and security requirements ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 20. The primary purpose of the patient record is to provide for __________ of care, which involves documenting patient care services so that others who treat the patient have a source of information to assist with additional care and treatment. a. continuity b. provision c. quality d. reimbursement ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.7 - Describe health care documentation methods.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 21. POR progress notes are documented for each problem assigned to the patient, using the SOAP format. When the patient states, “I have had a stuffy nose and sore throat for about one week,” the provider documents the statement in the __________ portion of the progress note. a. Subjective b. Objective c. Assessment d. Plan ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.7 - Describe health care documentation methods.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 22. Which is a systematic method of documentation that consists of four components: database, problem list, initial plan, and progress notes? a. electronic record Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care b. integrated record c. problem-oriented record d. source-oriented record ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.7 - Describe health care documentation methods.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 23. The eHealth exchange is a health information exchange network for a. mailing or faxing medical documentation to review contractors. b. promoting research and development to enhance competitiveness in the United States. c. reducing costs and time for review contractors when reviewing patient records. d. securely sharing clinical information over the Internet nationwide.

ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 24. Accountable care organizations a. amended the PPACA to implement health care reform initiatives, closing the Medicare “donut hole.” b. authorized an expenditure of $1.5 billion for grants for construction, renovation, and equipment, and for the acquisition of health information technology systems. c. focus on private health insurance reform to provide better coverage for individuals with pre-existing conditions. d. help physicians, hospitals, and other health care providers work together to improve care for people with Medicare.

ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 25. The Merit-based Incentive Payment System (MIPS) combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one single program that a. allows providers to earn a performance-based payment adjustment that considers quality, resource use, clinical Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care practice improvement, and meaningful use of certified EHR technology. b. conducts utilization and quality control review of health care furnished, or to be furnished, to Medicare beneficiaries in order to generate cost savings for health care provided. c. documents patient care services so that others who treat the patient have a source of information to assist with additional care and treatment. d. focuses on private health insurance reform to provide better coverage for individuals with pre-existing conditions, resulting in a nationwide health insurance exchange program ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.8 - Discuss the impact of the electronic health record (EHR) on health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 26. The Health Maintenance Organization (HMO) Assistance Act of 1973 authorized grants and loans to develop HMOs under private sponsorship. It defines a federally qualified HMO as being certified to provide health care services to __________ enrollees. a. anyone with U.S. citizenship as b. commercial and government c. Medicare and Medicaid d. TRICARE and CHAMPVA ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 27. The Healthcare Effectiveness Data and Information Set (HEDIS) was developed by the __________ and created standards to assess managed care systems in terms of membership, utilization of services, quality, access, health plan management and activities, and financial indicators. a. Centers for Medicare and Medicaid Services (CMS) b. Joint Commission c. National Committee for Quality Assurance (NCQA) d. Office of the Inspector General (OIG) ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care

DATE CREATED: DATE MODIFIED:

managed care.

11/1/2022 11:33 AM 11/1/2022 11:33 AM

28. With managed care’s capitation financing method, if the physician provides services that cost less than the capitation amount, there is a profit, which the physician ___________. a. distributes to all patients in the practice b. keeps to reinvest in the medical practice c. pays back to the managed care organization d. reimburses to government third-party payers ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 29. The primary care provider (PCP) is responsible for __________. a. being a gatekeeper to provide services at the highest possible cost b. denying all referrals to specialists and inpatient hospital admissions c. providing nonessential health care services to all patients d. supervising and coordinating health care services for enrollees ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 30. Managed care plans that are “federally qualified” and those that must comply with state quality review mandates, or __________, are required to establish quality assurance programs. a. laws b. procedures c. regulations d. standards ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 31. A quality assurance program includes activities that __________ the quality of care provided in a health care setting. a. assess b. deny c. provide d. quantify ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 32. Many states have enacted legislation requiring a(n) __________ to review health care provided by managed care organizations. a. external quality review organization b. group of community members c. subcommittee of state legislators d. task force of out-of-state providers ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 33. Medicare established the Quality Improvement System for Managed Care (QISMC) to ensure the accountability of managed care plans in terms of objective, measurable __________. a. laws b. mandates c. regulations d. standards ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 34. The National Committee for Quality Assurance (NCQA) reviews managed care plans and develops report cards to __________. a. allow health care consumers to make informed decisions when selecting a plan b. control the quality and utilization of health care services to patient populations c. establish punitive monetary penalties that are paid by poor quality providers d. guarantee the financial stability of managed care plans and their organizations ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 35. Which is a method of controlling health care costs and quality of care by reviewing the appropriateness and necessity of care provided to patients prior to the administration of care or after care has been provided? a. health information management b. risk management c. quality management d. utilization management ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 36. Some managed care plans contract out utilization management services to a utilization review organization (URO), which is an entity that __________. a. conducts a quality management program and completes focused review studies and medical audits b. establishes a utilization management program and performs external utilization review services c. performs risk management activities that result in appropriate in-service education for medical staff d. provides a service to the organization to ensure that physicians have met credentialing requirements ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 37. Prior to scheduling elective surgery, managed care plans often require a __________ during which another physician is asked to evaluate the necessity of surgery and recommend the most economical, appropriate facility in which to perform the surgery. a. preauthorization b. prospective review c. retrospective review d. second surgical opinion ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 38. Medicare and many states prohibit managed care contracts from containing __________, which prevent providers from discussing all treatment options with patients, whether or not the plan would provide reimbursement for services. a. credentialing statements b. gag clauses c. physician incentives d. profit margins ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 39. Physician incentives include payments made directly or indirectly to health care providers to __________ so as to save money for the managed care plan. Managed care plans that contract with Medicare or Medicaid must disclose information about physician incentive plans to CMS or state Medicaid agencies before a new or renewed contract receives final approval. a. contractually provide limits and quotas for services b. encourage them to reduce or limit patient services c. prevent physicians from receiving payment for services Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care d. underwrite exotic travel and other bonuses for services ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and managed care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 40. A physician-hospital organization (PHO) is owned by hospital(s) and physician groups that obtain managed care plan contracts. The physicians __________ and provide health care services to plan members. a. are employed by the PHO b. calculate what they want to earn c. maintain their own practices d. purchase the PHO building ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 41. An integrated provider organization (IPO) manages the delivery of health care services offered by hospitals, physicians, and other health care organizations. Physicians associated with an IPO are considered __________. a. employees b. independent contractors c. self-employed d. temporary staff ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 42. Which is associated with contracted health care services that are delivered to subscribers by participating physicians who are members of an independent multispecialty group practice? a. direct contract model HMO b. group model HMO Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care c. network model HMO d. staff model HMO ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 43. Health care services provided to subscribers by physicians employed by the HMO are associated with a __________. Premiums and other revenue are paid to the HMO, and usually all ambulatory services are provided within HMO corporate buildings. a. direct contract model HMO b. group model HMO c. network model HMO d. staff model HMO ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 44. Which type of HMO contracts health services that are delivered to subscribers by physicians who remain in their own office settings? a. independent practice association b. point-of-service plan c. preferred provider organization d. triple-option plan ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 45. To create flexibility in managed care plans, some HMOs and preferred provider organizations have implemented a(n) __________, under which patients have freedom to use the managed care panel of providers or to self-refer to out-ofCopyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care network providers. a. independent practice association b. point-of-service plan c. preferred provider organization d. triple option plan ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 46. A managed care network of physicians and hospitals that have joined together to contract with insurance companies, employers, or other organizations to provide health care to subscribers for a discounted fee is called a(n) __________. a. independent practice association b. point-of-service plan c. preferred provider organization d. triple option plan ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 47. Triple option plans are intended to prevent the problem of covering members who are sicker than the general population, which is called __________ selection. a. adverse b. indeterminate c. risk d. pool ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care DATE MODIFIED:

11/1/2022 11:33 AM

48. Which is created when a number of people are grouped for insurance purposes (e.g., employees of an organization), and the cost of health care coverage is determined by employees’ health status, age, sex, and occupation? a. cafeteria plan b. managed care c. risk pool d. self-referral ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 49. Which is a private, not-for-profit organization that assesses the quality of managed care plans in the United States and releases the data to the public for consideration when selecting a managed care plan? a. Centers for Medicare and Medicaid Services b. department of health in each state c. National Committee for Quality Assurance d. The Joint Commission ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 50. Which consumer-directed health plan provides tax-exempt accounts offered by employers to any number of employees; which individuals use to pay health care bills? The employees contribute funds through a salary reduction agreement and withdraw funds to pay medical bills. Funds are exempt from both income tax and Social Security tax (and employers may also contribute). a. customized sub-capitation plan b. flexible spending account c. health savings account d. health reimbursement arrangement ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care LEARNING OBJECTIVES: UHI_GREEN_24_2.6 - Describe consumer-directed health plans.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 51. Which consumer-directed health plan allows participants to enroll in a relatively inexpensive high-deductible insurance plan and open a tax-deductible savings account to cover current and future medical expenses? Money deposited (and earnings) is tax-deferred, and money withdrawn to cover qualified medical expenses is tax-free. Money can be withdrawn for purposes other than health care expenses after payment of income tax plus a 15 to 20 percent penalty.

Unused balances “roll over” from year to year, and if an employee changes jobs, he or she can continue to use the fund to pay for qualified health care expenses. a. customized sub-capitation plan b. flexible spending account c. health savings account d. health reimbursement arrangement ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.6 - Describe consumer-directed health plans.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 52. An effect that managed care has on a practice’s administrative procedures includes __________ for all hospitalizations and continued certification if the patient’s condition requires extension of the number of authorized days. a. audit b. inspection c. preauthorization and/or precertification d. survey ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.6 - Describe consumer-directed health plans.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 53. Risk adjustment is a method of adjusting __________ to health plans, accounting for differences in expected health costs of enrollees. a. capitation payments b. insurance payments c. overpayments d. underpayments ANSWER: a Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 54. Which legislation protects and compensates railroad workers who are injured on the job? a. Federal Civil Defense Act b. Federal Employees’ Compensation Act c. Federal Employers’ Liability Act d. Federal Unemployment Tax Act ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 55. Large employers who assume the financial risk for providing health care benefits to employees do not pay a fixed premium for a health insurance payer, but establish a trust fund (of employer and employee contributions) out of which claims are paid. This concept is called _________. a. capitation b. managed care c. self-insurance d. underwriting ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 56. Any health insurance company that provides coverage is known as a(n) ________________. a. revenue management b. third-party payer c. group health insurance d. public health insurance ANSWER: b POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and managed care concepts.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 57. A contract that protects the insured from loss and guarantees payment for the insured for an unforeseen event in return for a premium is referred to as _____________. a. insurance b. universal health insurance c. medical care d. public health insurance ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and managed care concepts.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 58. The Preferred Provider Health Care Act of 1985 _____________ restrictions on preferred provider organizations (PPOs) and allowed subscribers to seek health care from providers outside of the PPO. a. allowed b. eased c. eliminated d. increased ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/12/2022 7:19 AM 59. A group practice without walls (GPWW) establishes a contract that allows physicians to maintain their own offices and share services, such as ___________. a. admitting patients to the hospital b. appointment scheduling and billing c. performing surgical procedures d. providing office services to patients ANSWER: b Copyright Cengage Learning. Powered by Cognero.

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Chapter 02: Introduction to Health Insurance and Managed Care POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM 60. What is associated with contracted health care services that are delivered to subscribers by individual physicians in the community? a. direct contract model HMO b. group model HMO c. network model HMO d. staff model HMO ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed care in health care.

DATE CREATED: 11/1/2022 11:33 AM DATE MODIFIED: 11/1/2022 11:33 AM

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Chapter 03: Introduction to Revenue Management 1. Which means the provider agrees to accept what the insurance company allows or approves as payment in full for the claim? a. accept assignment b. assignment of benefits ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.5 - Describe the processing of an insurance claim from patient appointment through claims submission.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 2. Health insurance plans may include a(n) __________ provision, which means that when the patient has reached that limit for the year, appropriate patient reimbursement to the provider is determined. a. assignment of benefits b. coinsurance and copayment c. accept assignment d. out-of-pocket payment ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.5 - Describe the processing of an insurance claim from patient appointment through claims submission.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 3. Which person is responsible for paying the charges? a. enrollee b. guarantor c. patient d. payer ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 4. A participating provider (PAR) contracts with a health insurance plan and accepts whatever the plan pays for procedures or services performed. This means that PARs __________ allowed to bill patients for the difference between the contracted rate and their normal fee.

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Chapter 03: Introduction to Revenue Management a. are b. are not ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 5. A nonparticipating provider (nonPAR) is an out-of-network provider who does not contract with the insurance plan, and patients who elect to receive care from non-PARs will incur higher out-of-pocket expenses. The patient __________ expected to pay the difference between the insurance payment and the provider’s fee. a. is not b. is usually ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 6. Dr. Smith is a participating provider (PAR) for the ABC Health Insurance Plan. Mary Talley is treated by Dr. Smith in the office, for which a $100 fee is charged. Given the information in the table located below, calculate the PAR provider write-off amount.

PAR provider fee $100 PAR allowable charge $80 Patient copayment $20 Insurance payment $60 PAR provider write-off amount ______ a. $10 b. $20 c. $30 d. $40 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management 7. Dr. Jones is a nonparticipating provider (nonPAR) for the ABC Health Insurance Plan. Anne Smith is treated by Dr. Jones in the office, for which a $100 fee is charged. Given the information in the table located below, calculate the nonPAR provider write-off amount. nonPAR provider fee $100 nonPAR allowable charge $90 Patient copayment $18 Insurance payment $72 nonPAR provider write-off amount ____ a. $0 b. $10 c. $20 d. $30 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 8. Which is the insurance plan responsible for paying health care insurance claims first? a. primary insurance b. secondary insurance c. supplemental insurance d. tertiary insurance ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 9. Secondary insurance is the insurance plan that is billed after the primary insurance plan has paid its contracted amount and the provider’s office has received a(n) __________ from the primary payer. a. CMS-1500 claim b. encounter form c. explanation of benefits d. remittance advice ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 10. When a child lives with both parents, and each parent subscribes to a different health insurance plan, the primary and secondary policies are determined by applying the birthday rule. The individual who holds the primary policy for dependent children is the spouse whose birth __________. a. day occurs earlier in the month b. month and day occur earlier in the calendar year c. month, day, and year occur earlier d. year occurs earlier ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 11. When applying the birthday rule, if policyholders have identical birthdays, the policy in effect the __________ is considered primary. a. longest b. shortest ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 12. A child is listed as a dependent on both his father’s and his mother’s group insurance policies. The father’s birth date is March 20, 1977, and the mother’s birth date is March 6, 1979. Which policy is primary? a. father’s policy b. mother’s policy ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management 13. Which is the financial record source document used by health care providers and other personnel to record treated diagnoses and services rendered to the patient during the current visit? a. CMS-1500 claim b. encounter form c. explanation of benefits d. remittance advice ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.4 - Explain the use of an encounter form and a chargemaster.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 14. Which is the financial record source document used by health care providers and other personnel in a physician’s office setting to record treated diagnoses and services rendered to the patient during the current visit? a. CMS-1500 claim b. explanation of benefits c. remittance advice d. superbill ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.4 - Explain the use of an encounter form and a chargemaster.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 15. Which is the financial record source document used by health care providers and other personnel in a hospital outpatient setting to select codes for treated diagnoses and services rendered to the patient during the current visit? a. chargemaster b. explanation of benefits c. remittance advice d. superbill ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.4 - Explain the use of an encounter form and a chargemaster.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 16. Which is a manual permanent record of all financial transactions between the patient and the practice?

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Chapter 03: Introduction to Revenue Management a. health record b. insurance claim c. patient ledger d. remittance advice ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.6 - Explain how to post charges to patient accounts DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 17. Which is a computerized permanent record of all financial transactions between the patient and the practice? a. health record b. patient account record c. patient ledger d. remittance advice ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.6 - Explain how to post charges to patient accounts DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 18. The manual daily accounts receivable journal is also known as the __________, and it is a chronologic summary of all transactions posted to individual patient ledgers/accounts on a specific date. a. day sheet b. explanation of benefits c. patient ledger d. superbill ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.6 - Explain how to post charges to patient accounts DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 19. A policyholder or __________ is the person in whose name the insurance policy is issued. a. beneficiary b. employee c. patient Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management d. provider ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 20. Which is the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid? a. coinsurance b. copayment c. deductible d. premium ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.5 - Describe the processing of an insurance claim from patient appointment through claims submission.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 21. Which is the fixed amount the patient pays each time he or she receives health care services? a. coinsurance b. copayment c. deductible d. premium ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 22. Sally Simmons is a patient of Dr. Tyler’s. She received preventive services for her annual physical examination on May 17. The third-party payer determined the allowed charge for preventive services to be $100, for which the payer reimbursed the physician 80 percent of that amount. Sally is responsible for paying the remaining 20 percent directly to the physician. Thus, the physician will receive a check in the amount of __________ from the payer, and the patient will pay __________ to the physician. a. $20; $80 b. $50; $50 Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management c. $80; $20 d. $100; $20 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 23. The patient underwent office surgery on March 18, and the third-party payer determined the allowed charge to be $1,480. The patient paid the 20 percent coinsurance at the time of the office surgery. The physician and patient each received a check for $1,184, and the patient signed her check over to the physician. The overpayment was __________, and the physician must reimburse the third-party payer. a. $296 b. $1,184 c. $1,480 d. $2,368 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 24. Which is considered a financial source document from which an insurance claim is generated? a. CMS-1500 claim b. encounter form c. ledger card d. patient record ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.4 - Explain the use of an encounter form and a chargemaster.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 25. Which is a document that contains a computer-generated list of hospital-based outpatient procedures, services, and supplies with charges for each? a. charge description master b. electronic health record Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management c. physician fee schedule d. UB-04 or CMS-1500 claim ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.4 - Explain the use of an encounter form and a chargemaster.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 26. Chargemaster __________ is the process of updating and revising key elements of the chargemaster to ensure accurate reimbursement. a. computerization b. documentation c. maintenance d. revenue generation ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.4 - Explain the use of an encounter form and a chargemaster.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 27. A chargemaster team jointly shares the responsibility of updating and revising the chargemaster to ensure its __________. a. accuracy b. compliance c. encryption d. revenue ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.4 - Explain the use of an encounter form and a chargemaster.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 28. Which are preprinted on a facility’s chargemaster to indicate the location or type of service provided to an inpatient? a. CPT codes b. HCPCS level II codes c. ICD-10-CM/PCS codes d. Revenue codes Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.4 - Explain the use of an encounter form and a chargemaster.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 29. Revenue cycle management is the process by which health care facilities and providers ensure their financial viability by increasing __________, improving cash flow, and enhancing the patient’s experience. a. charges b. costs c. patient satisfaction d. reimbursement ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.2 - Explain the revenue management process.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 30. Revenue cycle monitoring assessment helps ensure __________ stability using standards of measurement (e.g., cash flow). a. data analytics b. financial viability c. resource allocation d. validation and verification ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.7 - Summarize methods of monitoring and auditing for revenue management.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 31. Which is an assessment process conducted as a follow-up to revenue cycle monitoring so that areas of poor performance can be identified and corrected? a. data analytics b. financial viability c. resource allocation d. revenue cycle auditing Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.7 - Summarize methods of monitoring and auditing for revenue management.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 32. Which is the distribution of financial resources among competing groups? a. data analytics b. financial viability c. resource allocation d. revenue cycle auditing ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.2 - Explain the management revenue process.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 33. Resource allocation monitoring uses data __________ to measure whether a health care provider or organization achieves operational goals and objectives within the confines of the distribution of financial resources. a. analytics b. encryption c. mining d. warehouses ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.7 - Summarize methods of monitoring and auditing for revenue management.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 34. Data analytics are tools and systems that are used to __________ clinical and financial data, conduct research, and evaluate the effectiveness of disease treatments. a. evaluate b. encrypt c. outsource d. reimburse Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.7 - Summarize methods of monitoring and auditing for revenue management.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 35. Which are databases that use reporting interfaces to consolidate multiple databases, allowing reports to be generated from a single request? a. data warehouses b. electronic health records c. resource allocations d. third-party administrators ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.7 - Summarize methods of monitoring and auditing for revenue management.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 36. The process of extracting and analyzing data to identify patterns, whether predictable or unpredictable, is called data __________. a. allocation b. auditing c. mining d. warehousing ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.7 - Summarize methods of monitoring and auditing for revenue management.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 37. Which is a method of controlling health care costs and quality of care by reviewing the appropriateness and necessity of care provided to patients prior to the administration of care or after care has been provided? a. health information management b. risk management c. quality management Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management d. utilization management ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.7 - Summarize methods of monitoring and auditing for revenue management.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 38. Which is a review for medical necessity of tests and procedures ordered during an inpatient hospitalization? a. concurrent review b. discharge planning c. preadmission certification d. preauthorization ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.2 - Explain the revenue management process.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 39. Which involves arranging appropriate health care services for the patient who is being released from an inpatient hospitalization? a. concurrent review b. discharge planning c. preadmission certification d. preauthorization ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.2 - Explain the revenue management process.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 40. Which involves the development of patient care plans for the coordination and provision of care for complicated cases in a cost-effective manner? a. case management b. risk management c. quality management d. utilization management Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.2 - Explain the revenue management process.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 41. The purpose of an integrated revenue cycle (IRC), which combines revenue cycle management with clinical, coding, and information management decisions, is to __________. a. destabilize health care b. impact financial management c. increase facility costs d. reduce payer reimbursement ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.2 - Explain the revenue management process.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 42. When a patient has two insurances, and they must be coordinated to determine which insurance is primary/secondary and how much each carrier will pay, that process is known as ___________________. a. explanation of benefits b. coordination of benefits c. adjudication of claims d. provider write-off amount ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 43. When a participating provider charges $120.00 for an office visit, and, the insurance allows $100.00, what will be the participating provider write-off amount for this service? a. $0.00 b. $40.00 c. $20.00 d. $10.00 ANSWER: c Copyright Cengage Learning. Powered by Cognero.

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Chapter 03: Introduction to Revenue Management POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.3 - Explain how new and established patients are managed.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 44. The revenue management process, when performed in the physician’s office setting, is also referred to as ___________________. a. accounts payable management b. accounts receivable management c. charge capturing d. data analytics ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.2 - Explain the revenue management process.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM 45. Process where all charges for service performed during an encounter are captured is referred to as _______________. a. data analytics b. accounts payable c. charge capturing d. financial viability ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_3.2 - Explain the revenue management process.

DATE CREATED: 11/1/2022 11:50 AM DATE MODIFIED: 11/1/2022 11:50 AM

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections 1. Which is the electronic or manual transmission of claims data to payers or clearinghouses for processing? a. claims adjudication b. claims payment c. claims processing d. claims submission ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

2. A clearinghouse that involves value-added vendors, such as banks, in the processing of claims is called a value-added __________ to improve efficiency and reduce expenses. a. network b. organization c. reseller d. system ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

3. When selecting a clearinghouse, providers may also want to determine whether it is accredited by the __________. a. Centers for Medicare and Medicaid Services b. Electronic Healthcare Network Accreditation Commission c. Joint Commission d. National Committee for Quality Assurance ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

4. Clearinghouses process claims in an electronic flat file format, which requires conversion of CMS-1500 claims data to a standard format. Providers can also use software to convert claims to an electronic flat file format, also known as a(n) __________, which is a series of fixed-length records (e.g., 25 spaces for patient’s name) submitted to payers as a bill for health care services. a. common data file b. electronic media claim c. patient ledger d. source document ANSWER: b POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

5. The computer-to-computer transfer of data between providers and third-party payers (or providers and health care clearinghouses) in a data format agreed upon by sending and receiving parties is called electronic __________. a. data interchange b. flat file format c. media claim d. remittance advice ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

6. Which is an electronic format supported for health care claims transactions? a. ANSI ASC X12 837 b. CMS-1500 claim c. national drug code format d. UB-04 claim ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

7. Covered entities are required to use mandated national standards when conducting any of the defined transactions covered under HIPAA. Which is an example of a covered entity? a. banks that handle medical office payroll b. companies that perform human resources c. ERISA-covered health benefit plans d. outsourced physical plant management ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

8. Electronic claims are submitted directly to the payer after being checked for accuracy by billing software or a health care clearinghouse, which results in a __________ claim that contains all required data elements needed to process and pay the claim. a. clean b. electronic Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections c. submitted d. unassigned ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

9. A claims attachment is __________ documentation associated with a health care claim or patient encounter. a. coding b. payment c. remittance d. supporting ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

10. Coordination of benefits (COB) is a provision in __________ health insurance policies intended to keep multiple insurers from paying benefits covered by other policies. a. all b. commercial c. group d. private ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

11. Which involves sorting claims upon submission to collect and verify information about the patient and provider? a. claims adjudication b. claims payment c. claims processing d. claims submission ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

12. Which involves comparing the claim to payer edits and the patient’s health plan benefits to verify that the required Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections information is available to process the claim, the claim is not a duplicate, payer rules and procedures have been followed, and procedures performed or services provided are covered benefits? a. claims adjudication b. claims payment c. claims processing d. claims submission ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

13. Any procedure or service reported on the claim that is not included on the master benefit list is a noncovered benefit and will result in claims __________. a. approval b. denial c. payment d. submission ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.3 - Describe how insurance claim files are maintained.

14. Procedures and services provided to a patient without proper authorization from the payer, or that were not covered by a current authorization, are called __________ services. a. approved b. denied c. submitted d. unauthorized ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

15. The claim is also checked against the __________, which is an abstract of all recent claims filed on each patient and helps determine whether the patient is receiving concurrent care for the same condition by more than one provider. a. chargemaster b. common data file c. encounter form d. list of pre-existing conditions ANSWER: b POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

16. Claims adjudication involves making a determination about __________ charges, which is the maximum amount the payer will permit for each procedure or service, according to the patient’s policy. a. allowed b. denied c. inconsistent d. irregular ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

17. Which is the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the insurance company is obligated to pay any benefits? a. coinsurance b. copayment c. deductible d. premium ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

18. A remittance advice submitted to the provider electronically is called an electronic remittance advice (ERA), and __________. a. different information is included as compared with a paper-based remittance advice b. it contains identical information to the information on a paper-based remittance advice c. payers are required to increase the amount of reimbursement paid to the provider d. similar information is included in the exact format as a paper-based remittance advice ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

19. Medicare calls its remittance advice a(n) __________. a. explanation of benefits b. electronic remittance advice c. Medicare summary notice Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections d. provider remittance notice ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

20. Providers have the option of arranging for __________, which means that payers deposit reimbursement for health care services to the provider’s account electronically. a. electronic data interchange b. electronic flat file formats c. electronic funds transfer d. electronic media claims ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

21. Which claims are organized by month and insurance company after submission to the payer, but for which processing is not complete? a. closed claims b. clean claims c. open claims d. unassigned claims ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.3 - Describe how insurance claim files are maintained.

22. Which claims are filed according to year and insurance company and include those for which all processing, including appeals, has been completed? a. clean claims b. closed claims c. open claims d. unassigned claims ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.3 - Describe how insurance claim files are maintained.

23. Which claims are organized by year and are generated for providers who do not accept assignment?

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections a. clean claims b. closed claims c. open claims d. unassigned claims ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.3 - Describe how insurance claim files are maintained.

24. An appeal is documented as a(n) __________ why a claim should be reconsidered for payment. a. addendum to the patient record to justify b. letter signed by the provider explaining c. patient release of information form describing d. resubmitted CMS-1500 insurance claim indicating ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.3 - Describe how insurance claim files are maintained.

25. A pre-existing condition is any medical condition that was diagnosed and/or treated within a specified period of time __________ the enrollee’s effective date of coverage. a. after b. before ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.3 - Describe how insurance claim files are maintained.

26. Which are the amounts owed to a business for services or goods provided? a. accounts payable b. accounts receivable c. allowed charges d. assignment of benefits ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections 27. Which requires providers to make certain written disclosures concerning all finance charges and related aspects of credit transactions (including disclosing finance charges expressed as an annual percentage rate)? a. Electronic Funds Transfer Act b. Equal Credit Opportunity Act c. Fair Credit Billing Act d. Truth in Lending Act ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

28. Which establishes the rights, liabilities, and responsibilities of participants in electronic fund transfer systems? a. Electronic Funds Transfer Act b. Equal Credit Opportunity Act c. Fair Credit and Charge Card Disclosure Act d. Fair Credit Billing Act ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

29. Which prohibits discrimination on the basis of race, color, religion, national origin, sex, marital status, age, receipt of public assistance, or good-faith exercise of any rights under the Consumer Credit Protection Act? a. Electronic Funds Transfer Act b. Equal Credit Opportunity Act c. Fair Debt Collection Practices Act d. Truth in Lending Act ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

30. Which amended the Truth in Lending Act and requires credit and charge card issuers to provide certain disclosures in direct mail, telephone, and other applications and solicitations for open-ended credit and charge accounts and under other circumstances? a. Fair Credit and Charge Card Disclosure Act b. Fair Credit Billing Act c. Fair Credit Reporting Act Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections d. Fair Debt Collection Practices Act ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

31. Which amended the Truth in Lending Act and requires prompt written acknowledgment of consumer billing complaints and investigation of billing errors by creditors? a. Fair Credit and Charge Card Disclosure Act b. Fair Credit Billing Act c. Fair Credit Reporting Act d. Fair Debt Collection Practices Act ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

32. Which protects information collected by consumer reporting agencies such as credit bureaus, medical information companies, and tenant screening services? a. Fair Credit and Charge Card Disclosure Act b. Fair Credit Billing Act c. Fair Credit Reporting Act d. Fair Debt Collection Practices Act ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

33. Which states that third-party debt collectors are prohibited from employing deceptive or abusive conduct in the collection of consumer debts incurred for personal, family, or household purposes? a. Fair Credit and Charge Card Disclosure Act b. Fair Credit Billing Act c. Fair Credit Reporting Act d. Fair Debt Collection Practices Act ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

34. A delinquent account is also called a __________ account, which means it is one that has not been paid within a certain time frame (e.g., 120 days). Following up on such delinquent accounts is crucial to the success of the business. a. deductible b. deficient c. past-due d. payable ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

35. The delinquent claim cycle advances through aging periods, and providers typically focus on __________ recovery efforts for older delinquent claims. a. external b. internal ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

36. Which is the assignment of lower-level codes than documented in the record? a. downcoding b. jamming c. unbundling d. upcoding ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

37. Which is the practice of submitting multiple CPT codes when just one code should have been submitted? a. downcoding b. jamming c. unbundling d. upcoding Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

38. One reason to track unpaid claims is due to the payment error in which a patient erroneously cashes a check made out to both patient and provider, which is called a __________. a. combination check b. credit check c. third-party payer check d. two-party check ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

39. When dealing with delinquent claims, it is important to review records to determine whether the claim was paid, was denied, or is pending. A pending claim is considered in __________. a. adjudication b. denial c. receipt d. suspense ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

40. An account receivable that cannot be collected by the provider or a collection agency is called a bad debt. To deduct a bad debt, the amount must have been __________. a. deposited in the bank via electronic funds transfer b. previously included in the provider’s income c. received from the third-party payer or patient d. turned over to a collections agency for processing ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections claims.

41. Which is a legal action that can be used to recover a debt and is usually a last resort for a medical practice? a. adjudication b. litigation c. mediation d. subrogation ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.5 - Explain the role of credit and collections in processing claims.

42. Denied and rejected claims are unpaid claims that have been returned to the provider by third-party payers. Which is an example of a reason for denied claims? a. absence of pre-existing condition b. coding error c. covered benefit d. procedure was medically necessary ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.3 - Describe how insurance claim files are maintained.

43. Which is the term for the reason for a denied or rejected claim as reported on the remittance advice or explanation of benefits? a. CARC b. EOB c. POS d. Remit ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.3 - Describe how insurance claim files are maintained.

44. An administrative denial is defined as _____________________________. a. denial when services have not been provided that are reported b. medical necessity has not been met c. a claim containing errors such as missing data d. All of the above ANSWER: c Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.4 - Outline the appeals process for denied claims.

45. The first stage of the insurance claim cycle is _______________________. a. payment b. claims adjudications c. claims processing d. claims submissions and electronic data interchange ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.2 - Explain the stages of the insurance claim cycle.

46. When a Medicare claim is appealed, the final, fifth level of the appeal process is the _________________. a. Medicare reconsideration notice b. Federal district court c. administrative law judge d. Medicare appeal council ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.4 - Outline the appeals process for denied claims.

47. Medicare appeals are now referred to as _____________________. a. reconsiderations b. appeals c. redeterminations d. appeals requests ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.4 - Outline the appeals process for denied claims.

48. In order to determine the issue(s) that resulted in denied or rejected claims, they are designated on the remittance advice or Explanation of Benefits as ______________________________. a. denial descriptions b. remittance advice remark codes c. rejection codes Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections d. explanation codes ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.4 - Outline the appeals process for denied claims.

49. When a claim is denied for procedure/service not medically necessary, what would be the first steps the provider’s office should take? a. call the patient b. call the insurance company c. bill the patient d. check the medical record documentation to determine if a diagnosis that would justify the medical necessity was not included on the claim, and, if so, resubmit ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.4 - Outline the appeals process for denied claims.

50. If services are denied for preexisting conditions, what would be the first action the provider’s office should take? a. call the patient b. bill the patient c. check the medical record documentation to determine if another diagnosis made during the coverage period would justify the services and resubmit d. call the insurance company ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.4 - Outline the appeals process for denied claims.

51. If a claim is denied for noncovered benefits, what action should be taken? a. bill the patient b. contact the insurance carrier to determine if the denial is appropriate c. file an appeal d. resubmit the claim ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.4 - Outline the appeals process for denied claims.

52. If a claim is denied for termination of coverage, what action should be taken by the provider’s office?

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections a. bill the patient b. contact the patient to determine the dates of coverage and whether the patient has another insurance for the date of service billed c. resubmit the claim d. file an appeal ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.4 - Outline the appeals process for denied claims.

53. If a claim is denied for “another insurance is primary,” what action should be taken by the provider’s office? a. bill the patient b. resubmit the claim c. check financial documents to determine if another insurance is listed as primary d. file an appeal ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.4 - Outline the appeals process for denied claims.

54. If services are denied on the Explanation of Benefits as “bundled in payment for another service,” the first action that should be taken by the provider’s office is: a. resubmit the claim b. bill the patient c. write-off the service d. consult bundling edits to determine if indeed, it should not have been billed separately, and, if so, write off the service ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.4 - Outline the appeals process for denied claims.

55. When incorrect codes are submitted on a claim that leads to denial, the provider’s office should __________________. a. contact the insurance carrier b. contact the patient c. refile a corrected claim with the correct codes to the carrier d. write off the service ANSWER: c POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 04: Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and Collections QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_4.4 - Outline the appeals process for denied claims.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement 1. Federal and state __________ are laws passed by legislative bodies, such as federal Congress and state legislatures. a. policies b. procedures c. regulations d. statutes ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/15/2022 11:50 PM 2. Laws that are implemented as guidelines written by administrative agencies, such as CMS, are called __________. a. policies b. procedures c. regulations d. statutes ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/15/2022 11:53 PM DATE MODIFIED: 11/15/2022 11:53 PM 3. Court decisions that establish a standard create __________ law. a. administrative b. admiralty c. case d. criminal ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/15/2022 11:48 PM DATE MODIFIED: 11/15/2022 11:48 PM 4. Court decisions establish standard use legal decisions that serve as authoritative rules or patterns in future similar cases.

The legal term for standard is __________. a. decision b. example Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement c. precedent d. statute ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/10/2022 12:09 AM 5. Civil law deals with all areas of the law that are not classified as __________ law. a. administrative b. case c. criminal d. standard ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/10/2022 12:11 AM 6. Criminal law is __________ law (statute or ordinance) that defines crimes and their prosecution. a. administrative b. case c. civil d. public ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/10/2022 12:12 AM 7. Which is an order of the court that requires a witness to appear at a particular time and place to testify? a. deposition b. interrogatory c. subpoena d. subpoena duces tecum ANSWER: c POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 8. Which requires documents, such as a patient record, to be produced in court? a. deposition b. interrogatory c. subpoena d. subpoena duces tecum ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 9. Which is testimony under oath taken outside of court, such as at the physician’s office? a. deposition b. interrogatory c. subpoena d. subpoena duces tecum ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 10. Which is a legal document containing a list of questions that must be answered in writing? a. deposition b. interrogatory c. subpoena d. subpoena duces tecum ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement DATE MODIFIED:

11/1/2022 11:45 AM

11. Which is an abbreviation for the Latin phrase qui tam pro domino rege quam pro sic ipso in hoc parte sequitur, meaning “who as well for the king as for himself sues in this matter”? a. qui tam b. res gestae c. respondeat superior d. subpoena duces tecum ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 12. Which is a legal newspaper published every business day by the National Archives and Records Administration (NARA), and is available in paper form, on microfiche, and online? a. Coding Clinic b. Code of Federal Regulations c. Federal Register d. Medicare Bulletin ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 13. Which is the official document that contains new and changed Medicare policies and/or procedures that are to be incorporated into a specific CMS program manual? a. bulletins b. companion guides c. face sheets d. transmittals ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement 14. Which authorizes CMS to enter into contracts with entities to perform cost report auditing, medical review, anti-fraud activities, and the Medicare Secondary Payer (MSP) program? a. COBRA b. MIP c. PEPP d. TEFRA ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 15. Which program was implemented to find and correct improper Medicare payments paid to health care providers participating in fee-for-service Medicare? a. Hospital Inpatient Quality Reporting (Hospital IQR) b. Medicaid Integrity Program (MIP) c. Recovery Audit Contractor (RAC) d. Zone Program Integrity Contractor (ZPIC) ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 16. Record retention is the __________ of documentation for an established period of time, usually mandated by federal and/or state law. a. destruction b. privacy and security c. release d. storage ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.4 - Explain how record retention is determined.

DATE CREATED: 11/16/2022 12:59 AM DATE MODIFIED: 11/16/2022 12:59 AM 17. HIPAA defines fraud as an __________ deception or misrepresentation that someone makes, knowing it is false, that could result in an unauthorized payment.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement a. accidental b. intentional ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/16/2022 12:40 AM DATE MODIFIED: 11/16/2022 1:35 AM 18. HIPAA defines abuse as involving actions that are __________ with accepted, sound medical, business, or fiscal practices, which directly or indirectly result in unnecessary costs to the program through improper payments. a. compatible b. inconsistent c. recurrent d. unvarying ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/16/2022 12:43 AM DATE MODIFIED: 11/16/2022 12:44 AM 19. Which of the following is an example of fraud? a. billing noncovered services as covered services b. falsifying certificates of medical necessity plans of treatment c. reporting duplicative charges on an insurance claim d. submitting claims for services not medically necessary ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 20. Which of the following is an example of abuse? a. billing noncovered services/procedures as covered services/procedures b. falsifying health care certificates of medical necessity plans of treatment c. misrepresenting ICD-10-CM and CPT/HCPCS codes to justify payment d. submitting claims for services and procedures knowingly not provided ANSWER: a Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 21. The Medicare Integrity Program includes medical review, which is defined by CMS as a review of claims to determine whether services provided are __________, as well as to follow up on the effectiveness of previous corrective actions. a. affordable by patient populations b. covered by the Medicare program c. effective for treatment of conditions d. medically reasonable and necessary ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.5 - Describe health care audit and compliance programs.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 22. The Patient Protection and Affordable Care Act established a Medicare shared savings program to facilitate the __________ to improve the quality of care for Medicare fee-for-service beneficiaries and to reduce unnecessary costs. a. coordination and cooperation among health care providers b. declining investment in infrastructure and redesigned care processes c. lack of coordinated care for services under Medicare fee-for-service d. reduction in accountability for the care of beneficiaries ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.3 - Summarize federal legislation and regulations affecting health care.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 23. Drew Baker is referred to a health care provider by an employer for treatment of a fracture that occurred during a fall at work. The physician billed Medicare and did not indicate on the claim that the injury was work-related.

Medicare benefits were paid to the provider for services rendered. This resulted in Medicare contacting the provider, who is liable for the __________ because of the provider’s failure to disclose that the injury was work-related. a. adjudication b. mediation Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement c. overpayment d. unbundling ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.5 - Describe health care audit and compliance programs.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 24. Which unique identifier was assigned to third-party payers and had its use rescinded by HHS in 2019? a. HPID b. PAYERID c. PlanID d. UPIN ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/16/2022 12:44 AM DATE MODIFIED: 11/16/2022 12:45 AM 25. Which unique identifier is assigned to health care providers as a 10-digit numeric identifier, including a check digit in the last position? a. EIN b. HPID c. NPI d. UPIN ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 26. Which is the format of the EIN? a. 000000000 b. 00-0000000 c. 000-00-0000 d. 000-000-000 ANSWER: b Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 27. Which was created by the Centers for Medicare and Medicaid Services for the purpose of assigning unique identifiers to health care providers and health plans? a. CMS b. DEEDS c. EDI d. NPPES ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/16/2022 12:47 AM DATE MODIFIED: 11/16/2022 12:48 AM 28. HIPAA requires payers to implement rules called electronic __________, which result in a uniform language for electronic data interchange. a. data interchanges b. health records c. medical records d. transaction standards ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 29. The proposed standard for an electronic signature is __________, which applies a mathematical function to the electronic document. a. decrypted b. digital c. manual d. standard ANSWER: b POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 30. An electronic signature will result in a unique bit string (or computer code) called a(n) __________, which is encrypted and appended to the electronic document. a. electronic transaction b. message digest c. message identifier d. unique identifier ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 31. Encoding or __________ a computer file makes it safe for electronic transmission so that unauthorized parties cannot read it. a. decrypting b. digesting c. encrypting d. interchanging ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/16/2022 12:49 AM DATE MODIFIED: 11/16/2022 12:49 AM 32. Which is a series of fixed-length records used to bill institutional services, such as services performed in hospitals? a. ANSI ASC X12N 837 b. CMS-1500 c. NSF d. UB-04 flat file ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 33. Which flat file is used to bill physician and noninstitutional services, such as services reported by a general practitioner, on the CMS-1500? a. CDT b. EDI c. NSF d. UB-04 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/16/2022 12:50 AM DATE MODIFIED: 11/16/2022 12:51 AM 34. Which is a variable-length file format used to bill institutional, professional, dental, and drug claims? a. ANSI ASC X12N 837 b. CMS-1500 c. NSF d. UB-04 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/16/2022 12:52 AM DATE MODIFIED: 11/16/2022 12:53 AM 35. Which code set is copyrighted by the American Dental Association? a. CDT b. CPT c. ICD-10-CM d. ICD-O-3 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/16/2022 12:53 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement DATE MODIFIED:

11/16/2022 12:54 AM

36. Which is maintained by the Food and Drug Administration (FDA) and identifies prescription drugs and some overthe-counter products? a. CDT b. ICD c. NDC d. NSF ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/16/2022 12:55 AM DATE MODIFIED: 11/16/2022 12:55 AM 37. Any information communicated by the __________ is considered privileged communication, and HIPAA provisions address the privacy and security of protected health information. a. patient to a health care provider b. patient to a third-party payer c. provider to a third-party payer d. third-party payer to a provider ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 38. Which specifically requires an individual’s authorization prior to disclosure and for which HIPAA has established specific requirements for an authorization form? a. covered entity data and information b. designated record set c. protected health information d. treatment, payment, and operations ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement 39. Which is the right of individuals to keep their information from being disclosed to others? a. authorization b. confidentiality c. privacy d. security ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 40. Which restricts patient information access to those with proper authorization and maintains the security of patient information? a. authorization b. confidentiality c. privacy d. security ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 41. Which involves the safekeeping of electronic patient information by controlling access to records, protecting patient information from alteration/destruction/tampering/loss, and providing employee training in HIPAA requirements, which includes the consequences of improper disclosure of patient information? a. authorization b. confidentiality c. privacy d. security ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/16/2022 1:38 AM 42. Breach of confidentiality involves the unauthorized release of patient information to a third party, such as health care employees who __________.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement a. access patient health care information with an appropriate job-related reason b. communicate patient information to family members with the patient’s consent c. discuss patient information outside an exam room where other patients are present d. ensure that patient information is not available on a computer screen display ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 43. The HIPAA Privacy Rule creates national standards to protect individuals’ medical records and other personal health information, and it also provides patients with __________. a. conveniences, like not signing an authorization b. greater access to their own medical records c. less control over how their PHI is used d. the ability to collect monetary penalties ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 44. The HIPAA Security Rule adopts standards and safeguards to protect health information that is collected, maintained, used, or transmitted __________. a. electronically b. manually c. personally d. physically ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 45. Release of information (ROI) by a covered entity about protected health information (PHI) requires the patient (or representative) to sign an authorization to release information, which is reviewed for authenticity and processed within a HIPAA-mandated __________ time limit.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement a. 10-day b. 30-day c. 60-day d. 90-day ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 46. Which documents patient information sent to authorized requestors and can be kept in manual or software formats? a. decryption and encryption b. electronic data interchange c. release of information log d. transmittals and manuals ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.6 - Explain the provisions of HIPAA legislation.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 47. CMS develops Conditions of Participation and Conditions for Coverage, which are requirements that health care organizations must meet in order to begin and continue participating in the __________ programs. a. BlueCross BlueShield b. Indian Health Service c. Medicare and Medicaid d. TRICARE and CHAMPVA ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 48. Accreditation organization standards are recognized by CMS through a process called deeming, which requires that standards meet or exceed __________ requirements. a. Conditions of Participation and Conditions for Coverage b. hospital rules and regulations Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement c. state department of health d. The Joint Commission ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 49. The Hospital Outpatient Quality Reporting (Hospital OQR) Program was created as a “pay for quality data reporting program” that was implemented by CMS for __________ hospital services. a. hospitalist b. inpatient c. outpatient d. physician ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.3 - Summarize federal legislation and regulations affecting health care.

DATE CREATED: 11/1/2022 11:45 AM DATE MODIFIED: 11/1/2022 11:45 AM 50. Which is a key component of the Health Care Fraud Prevention and Enforcement Action Team (HEAT)? a. Medicare Strike Force teams b. quality improvement organizations c. recovery audit contractors d. value-based purchasing programs ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.5 - Describe health care audit and compliance programs.

DATE CREATED: 11/16/2022 12:56 AM DATE MODIFIED: 11/16/2022 12:56 AM 51. Which contains program issuances, day-to-day operating instructions, policies, and procedures based on statutes, regulations, models, and directives, which are used by contractors to administer CMS programs? a. ANSI ASC X12N 837 b. CMS IOM c. eCQM Copyright Cengage Learning. Powered by Cognero.

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Chapter 05: Legal Aspects of Health Insurance and Reimbursement d. PEPPER ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_5.2 - Summarize health care laws and regulations.

DATE CREATED: 11/16/2022 12:57 AM DATE MODIFIED: 11/16/2022 12:58 AM

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Chapter 06: ICD-10-CM Coding 1. The International Classification of Diseases, published by the World Health Organization, is used to classify __________ data from death certificates. a. moratory b. morbidity c. morphology d. mortality ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 2. ICD-10-CM was developed in the United States and is used to classify __________ data from inpatient and outpatient records, including provider-based office records. a. moratory b. morbidity c. morphology d. mortality ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 3. ICD-9-CM is a(n) __________ classification system because of ICD-10-CM and ICD-10-PCS implementation. a. contemporary b. legacy c. optional d. updated ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding 4. COVID-19. Which ICD-10-CM code should be assigned? a. U07.1 b. U07.0 c. B34.2 d. J12.81 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 5. Which code cannot be used with code U07.1? a. U07.0 b. B34.2 c. J96.00 d. Z20.828 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 6. Lung injury due to e-cigarettes. Which ICD-10-CM code should be assigned? a. U07.0 b. T65.291 c. F17.29 d. J68.9 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 7. ICD-10-CM codes require up to __________ characters, are entirely alphanumeric, and have unique coding conventions, such as Excludes1 and Excludes2.

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Chapter 06: ICD-10-CM Coding a. five b. six c. seven d. eight ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 8. When coders have questions about documented diagnoses or procedures/services, they should use a __________ process to contact the responsible physician to request clarification about documentation and the code(s) to be assigned. a. medical coordination b. physician query c. quality assurance d. utilization management ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 9. ICD-10-PCS codes are reported for __________ settings only. a. inpatient hospital b. outpatient hospital c. provider office d. skilled nursing facility ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 10. ICD-10-PCS uses a __________ seven-character alphanumeric code structure (e.g., 047K04Z) that provides a Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding unique code for all substantially different procedures, and it allows new procedures to be easily incorporated as new codes. a. clinical b. logical c. multiaxial d. relational ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 11. The ICD-10-CM/PCS Coordination and Maintenance Committee is responsible for overseeing all changes and modifications to ICD-10-CM and ICD-10-PCS codes, including the creation and update of general equivalency mappings. ICD-10-CM codes are reported for __________, while ICD-10-PCS codes are reported for __________. a. diagnoses; procedures b. diagnoses; conditions c. procedures; diagnoses d. services; procedures ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 12. Matching ICD-10-CM diagnosis codes to CPT and HCPCS level II procedure and service codes on a claim submitted for a patient encounter ensures that services and procedures are reasonable and necessary for the diagnosis or treatment of an illness or injury. This concept is called __________. a. advance beneficiary notice of nonpayment b. medical necessity c. quality assurance d. utilization management ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding

DATE CREATED: DATE MODIFIED:

ICD-10-PCS coding systems.

11/1/2022 11:53 AM 11/1/2022 11:53 AM

13. According to Medicare, if it is possible that scheduled tests, services, or procedures may be found medically unnecessary, the patient must sign an advance beneficiary notice, which __________. a. acknowledges the patient’s responsibility for payment if Medicare denies the claim b. ensures that the provider will receive reimbursement from another third-party payer c. guarantees that Medicare will deny payment for the claim, and the patient must pay d. improves the chances that Medicare will approve the submitted claim for payment ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 14. Which are diseases or syndromes that are named for people and are listed in appropriate alphabetical sequence as main terms in the ICD-10-CM index? a. characters b. eponyms c. nouns d. persons ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 15. Which abbreviation means “other” or “other specified” and identifies codes that are assigned when documentation supports a condition for which a more specific code does not exist? a. NEC b. NOS c. nonessential d. other specified code ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/9/2022 2:18 AM 16. Which abbreviation means “unspecified” and identifies codes that are to be assigned when information needed to assign a more specific code cannot be obtained from the provider? a. NEC b. NOS c. nonessential d. other specified code ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/9/2022 2:19 AM 17. Which punctuation is used after an incomplete term or phrase in the ICD-10-CM index and tabular list when one or more modifiers (additional terms) is needed to assign a code? a. braces b. colons c. parentheses d. slanted brackets ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 18. Which punctuation is used in the ICD-10-CM index and tabular list to enclose nonessential modifiers; which are supplementary words that may be present in or absent from the physician’s statement of a disease or procedure without affecting the code number to which it is assigned? a. braces b. colons c. parentheses d. slanted brackets ANSWER: c POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 19. Which is a condition that occurs as the result of another condition and for which the codes are always reported as secondary codes? a. manifestation b. sign c. symptom d. syndrome ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 20. Which appears in the ICD-10-CM tabular list below certain categories to further define, clarify, or give examples of the content of a code category? a. excludes1 notes b. excludes2 notes c. includes notes d. inclusion terms ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 3:14 PM DATE MODIFIED: 11/1/2022 3:19 PM 21. Which is a pure excludes note and means not coded here to indicate mutually exclusive codes, which means the conditions cannot be reported together? a. excludes1 note b. excludes2 note ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 22. When patient record documentation is insufficient to assign a more specific code, __________ codes are assigned. a. etiology b. manifestation c. other and other specified d. unspecified ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 23. Which term describes the cause or origin of disease? a. consequence b. etiology c. manifestation d. syndrome ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 24. Which term describes symptoms or conditions that result from another disease? a. consequences b. etiology c. manifestation d. syndrome ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 25. Wherever an etiology and manifestation combination of codes exists, the ICD-10-CM tabular list etiology code contains a(n) __________ note. a. code first underlying disease b. in diseases classifiable elsewhere c. other and other specified codes d. use additional code ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 26. Wherever an etiology and manifestation combination of codes exists, the ICD-10-CM tabular list manifestation code contains a(n) __________ note. a. code first underlying disease b. in diseases classifiable elsewhere c. other and other specified codes d. use additional code ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 27. The __________ instruction requires the causal condition to be sequenced first if present. a. code, if applicable, any causal condition first b. in diseases classifiable elsewhere c. other and other specified codes d. use additional code ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 28. When the word and appears in ICD-10-CM tabular list category titles and code descriptions, it is interpreted as meaning __________. a. and b. and/or c. or d. instead of ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 29. The subterm due to is located in the ICD-10-CM index in alphabetical order below a main term to indicate the presence of a __________ relationship between two conditions. a. cause-and-effect b. either/or c. inclusionary d. mutually exclusive ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 30. When the word with appears in the ICD-10-CM index, it is located immediately below the main term, not in alphabetical order. To assign a code from the list of qualifiers below the word with, the physician must document the presence of __________ condition(s) in the patient record. a. both b. either c. one d. mutually exclusive ANSWER: a POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 31. Which instruction after a main term directs the coder to refer to another term in the ICD-10-CM index to locate the code, and the coder must go to the referenced main term to locate the correct code? a. See b. See also c. See category d. See condition ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 32. Which instruction is located after a main term or subterm in the ICD-10-CM index and directs the coder to another main term (or subterm) that may provide additional useful index entries? a. See b. See also c. See category d. See condition ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 33. Supplementary words located in parentheses after a main term in the ICD-10-CM index are called __________ modifiers, which means they do not have to be included in the diagnostic statement for the code to be assigned. a. mandatory b. nonessential c. qualifying d. unspecified ANSWER: b Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 34. Which are essential modifiers that qualify the main term in the ICD-10-CM index by listing alternative sites, etiology, or clinical status? a. neoplasms b. nonessential modifiers c. qualifiers d. subterms ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 35. The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications, organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies the original cancerous tumor site? a. malignant primary b. malignant secondary c. carcinoma in situ d. unspecified nature ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 36. The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications, organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies the metastasis of cancer? a. malignant primary b. malignant secondary Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding c. carcinoma in situ d. unspecified nature ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 37. The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications, organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies a malignant tumor that is localized, circumscribed, encapsulated, and noninvasive? a. malignant primary b. malignant secondary c. carcinoma in situ d. unspecified nature ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 38. The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications, organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies a noninvasive, nonspreading, nonmalignant tumor? a. malignant b. benign c. uncertain behavior d. unspecified nature ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 39. The ICD-10-CM Table of Neoplasms is indexed according to anatomic site and contains four cellular classifications, Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding organized in columns: malignant, benign, uncertain behavior, and unspecified nature. Which column classifies a neoplasm for which it is not possible to predict subsequent morphology or behavior from the submitted specimen? a. malignant b. benign c. uncertain behavior d. unspecified nature ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 40. Cancer described as metastatic to a site is considered __________. a. benign b. in situ c. secondary d. unspecified ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 41. If the primary site of malignancy is no longer present, assign a code for __________. a. personal history of malignant neoplasm b. primary cancer c. primary of unspecified site d. secondary of unspecified site ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 42. For carcinoma of breast with spread to the lungs, the primary site is __________.

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Chapter 06: ICD-10-CM Coding a. breast b. lungs c. undetermined d. unspecified ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 43. Which term describes the origin of a tumor (primary site) that involves two adjacent sites? a. benign tumor b. contiguous sites c. primary malignancy d. uncertain behavior ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 44. The re-excision of a tumor occurs when the pathology report recommends that the surgeon perform a second excision to widen the margins of the original tumor site. The re-excision is performed to ensure that all tumor cells have been removed and that a clear border (margin) of normal tissue surrounds the excised specimen. To code the reason for the re-excision, __________. a. assign a code based on a review of the current operative and pathology reports b. generate a physician query to ask for clarification about the patient’s condition c. refer to the diagnostic statement found in the report of the original excision d. use the pathology report that results from the re-excision of the tumor margins ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding 45. The ICD-10-CM Table of Drugs and Chemicals is an alphabetic index of medicinal, chemical, and biological substances that result in poisonings and adverse effects. The first column of the table lists generic names of drugs and chemicals with four columns for poisonings, one column for adverse effects, and one column for underdosing.

Which column is reviewed to locate a code for a poisoning that results from an inadvertent overdose, wrong substance administered/taken, or intoxication that includes combining prescription drugs with nonprescription drugs or alcohol? a. Poisoning: Accidental (Unintentional) b. Poisoning: Intentional Self-Harm c. Poisoning: Assault d. Poisoning: Undetermined ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 46. The ICD-10-CM Table of Drugs and Chemicals is an alphabetic index of medicinal, chemical, and biological substances that result in poisonings and adverse effects. The first column of the table lists generic names of drugs and chemicals with four columns for poisonings, one column for adverse effects, and one column for underdosing.

Which column is reviewed to locate a code for a poisoning that results from a deliberate overdose, such as a suicide attempt, of substance(s) administered/taken or intoxication that includes purposely combining prescription drugs with nonprescription drugs or alcohol? a. Poisoning: Accidental (Unintentional) b. Poisoning: Intentional Self-Harm c. Poisoning: Assault d. Poisoning: Undetermined ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 47. The ICD-10-CM Table of Drugs and Chemicals is an alphabetic index of medicinal, chemical, and biological substances that result in poisonings and adverse effects. The first column of the table lists generic names of drugs and chemicals with four columns for poisonings, one column for adverse effects, and one column for underdosing.

Which column is reviewed to locate a code for a poisoning inflicted by another person who intended to kill or injure the patient? a. Poisoning: Accidental (Unintentional) b. Poisoning: Intentional Self-Harm c. Poisoning: Assault Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding d. Poisoning: Undetermined ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 48. The ICD-10-CM Table of Drugs and Chemicals is an alphabetic index of medicinal, chemical, and biological substances that result in poisonings and adverse effects. The first column of the table lists generic names of drugs and chemicals with four columns for poisonings, one column for adverse effects, and one column for underdosing.

Which column is reviewed to locate a code when the patient develops a pathologic condition that results from a drug or chemical substance that was properly administered or taken? a. Poisoning b. Adverse Effect c. Underdosing d. Underdetermined ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 49. The ICD-10-CM Table of Drugs and Chemicals is an alphabetic index of medicinal, chemical, and biological substances that result in poisonings and adverse effects. The first column of the table lists generic names of drugs and chemicals with four columns for poisonings, one column for adverse effects, and one column for underdosing.

Which column is reviewed to locate a code when the patient takes less of a medication than is prescribed by a provider or a manufacturer’s instruction? a. Poisoning b. Adverse Effect c. Underdosing d. Underdetermined ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.4 - Interpret ICD-10-CM coding conventions for accurate code assignment.

DATE CREATED: 11/1/2022 11:53 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding DATE MODIFIED:

11/1/2022 11:53 AM

50. ICD-10-CM category codes contain __________ characters. a. 3 b. 4 c. 5 d. 6 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 51. Codes that have an applicable seventh character are considered __________ without the seventh character. a. codes b. complete c. invalid d. unspecified ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 52. Which character is used as a placeholder in ICD-10-CM? a. A b. M c. X d. Z ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding 53. Which indicates the tissue type of a neoplasm and is reported to state cancer registries? a. biology b. morphology c. oncology d. topography ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.3 - Describe the use and characteristics of the ICD-10-CM and ICD-10-PCS coding systems.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 54. The ICD-10-CM Official Guidelines for Coding and Reporting and the ICD-10-PCS Coding Guidelines are approved by the __________. a. Centers for Medicare and Medicaid Services b. Cooperating Parties for ICD-10-CM and ICD-10-PCS c. Department of Health and Human Services d. National Center for Health Statistics ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.6 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 55. Which is a concurrent condition that coexists with the first-listed diagnosis, has the potential to affect treatment of the first-listed diagnosis, and is an active condition for which the patient is treated and/or monitored? a. comorbidity b. complication c. qualified diagnosis d. sign/symptom ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.6 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding 56. Which is a condition that develops after outpatient care has been provided? a. comorbidity b. complication c. qualified diagnosis d. sign/symptom ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.6 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 57. Amebic cystitis is represented by which ICD-10-CM code? a. A06.0 b. A06.81 c. A06.89 d. A06.9 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 58. Malignant primary carcinoid tumor of the duodenum is represented by which ICD-10-CM code? a. C7A.0 b. C7A.01 c. C7A.010 d. C7A.019 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 59. Diabetes insipidus is represented by which ICD-10-CM code?

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Chapter 06: ICD-10-CM Coding a. E13.9 b. E15 c. E23.2 d. E23.7 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 60. Opioid abuse with intoxication delirium is represented by which ICD-10-CM code? a. F11.10 b. F11.120 c. F11.121 d. F11.129 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 61. Vascular parkinsonism is represented by which ICD-10-CM code? a. G21.2 b. G21.4 c. G21.8 d. G21.9 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 62. Vitiligo of the right lower eyelid and periocular area is represented by which ICD-10-CM code? a. H02.722 Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding b. H02.731 c. H02.732 d. H02.739 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 63. Atherosclerosis of native arteries of extremities with gangrene, bilateral legs is represented by which ICD-10-CM code? a. I70.261 b. I70.262 c. I70.263 d. I70.268 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 64. Obstructive rhinitis is represented by which ICD-10-CM code? a. J30.0 b. J30.9 c. J31.0 d. J31.2 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 65. Chronic hepatic failure with coma is represented by which ICD-10-CM code? a. K72.01 Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding b. K72.10 c. K72.11 d. K72.91 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 66. Postimmunization arthropathy, left elbow, is represented by which ICD-10-CM code? a. M02.20 b. M02.221 c. M02.222 d. M02.229 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 67. Late vomiting in pregnancy is represented by which ICD-10-CM code? a. O21.1 b. O21.2 c. O21.8 d. O21.9 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 68. Old age is represented by which ICD-10-CM code? a. R53.1 b. R53.83 Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding c. R54 d. R55 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 69. Sprain of thyroid cartilage, initial encounter, is represented by which ICD-10-CM code? a. S13.20XA b. S13.29XA c. S13.5XXA d. S13.8XXA ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 70. Tobacco use is represented by which ICD-10-CM code? a. F17.209 b. F17.219 c. Z87.891 d. Z72.0 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 71. A 35-year-old male patient was admitted to the hospital with pneumonia due to Pneumocystis carinii. The patient had been diagnosed with AIDS several years ago and has been undergoing treatment. Which ICD-10-CM codes should be assigned? a. B20, B59 b. B20, J15.9 Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding c. B59, B20 d. J15.9, B20 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 72. The final diagnosis for a 76-year-old woman is congestive heart failure, acute pulmonary edema, hypertension, and type 2 diabetes mellitus. Which ICD-10-CM codes should be assigned? a. I11.0, E11.9, J81.0 b. I11.0, J81.0, I10, E11.9 c. I50.1, I11.0, E11.9 d. J81.0, I10, E11.9 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 73. Renal heart disease due to hypertension. Which ICD-10-CM code(s) should be assigned? a. I11.9, I10 b. I13.10, N18.9 c. I13.10, I10 d. I13.10, I11.9, I12.9 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 74. Failed medical induction of labor at 43 weeks’ gestation. Which ICD-10-CM code(s) are assigned? a. O48.0 b. O61.0, O48.0 Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding c. O61.0, O48.0, T48.0x5A d. O61.9 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 75. Malunion of nondisplaced bimalleolar fracture, right ankle. Which ICD-10-CM code should be assigned? a. S82.844P b. S82.844S c. S82.899K d. S82.899P ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 76. Displacement of cardiac pacemaker electrode. Which ICD-10-CM codes should be assigned? a. I97.191, Y83.1 b. T82.110A, Y83.1 c. T82.120A, Y83.1 d. T85.79xA, Y83.1 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 77. Elective abortion (complete) due to suspected damage to single fetus from maternal rubella. Which ICD-10-CM codes should be assigned? a. O04.89, O35.3XX0 b. O04.89, O35.3XX1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 06: ICD-10-CM Coding c. Z33.2, O35.3XX0 d. Z33.2, O35.3XX1 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 78. Major stab wound to thoracic aorta. Patient fell on a pitchfork in hay that was stored in the barn. Which ICD-10-CM codes should be assigned? a. S21.139A, W27.1XXA, Y92.71 b. S21.309A, W27.1XXA, Y92.71 c. S21.339A, W27.1XXA, Y92.71 d. S25.02xA, W27.1XXA, Y92.71 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 79. Five-hour-old low birth weight infant, premature at 30 weeks, spontaneous vaginal birth, is transferred to a tertiary care hospital’s neonatal intensive care unit. Final diagnoses at the tertiary care hospital include male newborn suspected of having respiratory distress syndrome due to prematurity. Which ICD-10-CM codes are assigned for the tertiary care hospital care? a. P22.0, P07.10, P07.33 b. P22.0, P07.10, Z38.00 c. Z38.00, P07.10, P07.33 d. Z38.00, P22.0, P07.10 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 80. Arteriosclerotic cardiovascular disease (ASCVD). Which ICD-10-CM code is assigned?

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Chapter 06: ICD-10-CM Coding a. I25.10 b. I25.709 c. I25.83 d. I25.84 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 81. Patient treated for sepsis during subsequent encounter, following induced termination of pregnancy that was performed during a previous admission. Which ICD-10-CM code(s) should be assigned? a. O04.87 b. O04.80, Z33.2 c. O08.0 d. Z33.2, O08.0 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 82. Bronchogenic squamous cell carcinoma, left lung. Which ICD-10-CM code(s) should be assigned? a. C34.92 b. C34.92, C80.1 c. C78.02 d. C80.1 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM 83. Essential hypertension with congestive heart failure. Which ICD-10-CM code(s) should be assigned?

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Chapter 06: ICD-10-CM Coding a. I10, I50.9 b. I11.0 c. I11.0, I10 d. I11.0, I50.9 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_6.5 - Use the ICD-10-CM index, tabular list, and official coding guidelines to assign ICD-10-CM codes to diseases.

DATE CREATED: 11/1/2022 11:53 AM DATE MODIFIED: 11/1/2022 11:53 AM

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Chapter 07: CPT Coding 1. Procedures and services submitted on a claim must be linked to the __________ that justifies the need for the service or procedure. a. CPT code b. HCPCS code c. ICD-10-CM code d. HCPCS Level I code ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 2. With what type of codes are procedures/services identified by a five-digit CPT code and descriptor nomenclature (these are codes traditionally associated with the CPT and organized within six sections)? a. Category I codes b. Category II codes c. Category I and II codes d. Category III codes ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 3. Which are “performance measurements” tracking codes that are assigned an alphanumeric identifier with a letter in the last field? a. Category I codes b. Category II codes c. Category III codes d. Category IV codes ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 4. What type of codes contain “emerging technology,” are temporary codes assigned for data collection, and are still used by some third-party payers?

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Chapter 07: CPT Coding a. Category I codes b. Category II codes c. Category III codes d. Category IV codes ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 5. Most CPT procedures and services are classified as __________ codes, which include a complete description of the procedure or service. a. indented b. individual c. separate d. stand-alone ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 6. To save space in CPT, some descriptions are not printed in their entirety next to a code number, and a(n) __________ code appears below another code, requiring the coder to refer back to the common portion of the code description that is located before the semicolon. a. indented b. individual c. Separate d. stand-alone ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 7. A bullet located to the left of a code number identifies codes that were __________. a. added to CPT for new procedures and services Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding b. deleted from CPT since its last edition c. reinstated or recycled since the last edition d. revised since the last edition of CPT ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 8. A triangle located to the left of a code number identifies a code description that has been __________. a. added to CPT for new procedures and services b. deleted from CPT since its last edition c. reinstated or recycled since the last edition d. revised since the last edition of CPT ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 9. A semicolon is used to save space in CPT, which means __________. a. add-on codes are assigned procedures performed during another procedure b. modifiers are never assigned for described procedures and services c. revised procedures and services have been added to the code description d. some code descriptions are not printed in their entirety next to a code number ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 10. The plus symbol identifies __________ for procedures that are commonly, but not always, performed at the same time and by the same surgeon as the primary procedure. a. add-on codes b. indented codes c. modifiers d. parenthetical notes Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 11. The forbidden symbol identifies codes that are not to be used with modifier __________. a. -25 b. -26 c. -51 d. -59 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 12. The bull’s-eye symbol located next to a code number indicates that the procedure __________. a. has been revised since the last edition of the CPT manual b. includes moderate (conscious) sedation c. is being performed on a patient of extreme age d. was performed on both sides of the body ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 13. Moderate (conscious) sedation is the administration of moderate __________, which results in a drug-induced depression of consciousness. a. epidural injections b. general anesthesia c. local anesthetics d. sedation or analgesia ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.10 - Assign CPT codes from the medicine section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 14. The number symbol precedes CPT __________ codes, which appear out of numerical order. a. added b. deleted c. resequenced d. revised ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 15. Which define terms and explain the assignment of codes for procedures and services located in a particular section of the CPT manual? a. boldfaced terms b. guidelines c. symbols d. unlisted codes ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 16. Which type of procedure or service code is assigned when the provider performs a procedure or service for which there is no CPT code? a. add-on code b. indented code c. stand-alone code d. unlisted code ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding DATE CREATED: DATE MODIFIED:

11/1/2022 11:55 AM 11/1/2022 11:55 AM

17. When an unlisted procedure or service code is reported, a __________ must accompany the claim to describe the nature, extent, and need for the procedure or service along with the time, effort, and equipment necessary to provide the service. a. CMS-1500 claim b. copy of the record c. remittance advice d. special report ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 18. Which appear throughout CPT sections to clarify the assignment of codes? a. add-on codes b. guidelines c. instructional notes d. special reports ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 19. Main terms in the CPT index are printed in __________. a. all capitals b. boldface type c. italics d. underlined type ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.3 - Locate main terms, subterms, and cross-references in the CPT index.

DATE CREATED: 11/1/2022 11:55 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding DATE MODIFIED:

11/1/2022 11:55 AM

20. Which is a CPT cross-reference that directs coders to an index entry under which codes are listed? a. See b. See also c. See category d. See code ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.3 - Locate main terms, subterms, and cross-references in the CPT index.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 21. Which typeface is used for cross-reference terms in the CPT index? a. all capitals b. boldface c. italics d. underlining ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.3 - Locate main terms, subterms, and cross-references in the CPT index.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 22. To save space in the CPT index when referencing subterms, __________ words are used. a. add-on b. inferred c. presumptive d. speculative ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.3 - Locate main terms, subterms, and cross-references in the CPT index.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding 23. CPT modifiers __________ the meaning of services and procedures performed by providers. a. clarify and alter b. completely change c. delete d. revise ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.4 - Select appropriate modifiers to add to CPT codes.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 24. The Evaluation and Management section is located at the beginning of CPT because these codes describe __________. a. encounters that have unusual circumstances b. health care rendered by nonphysicians only c. procedures performed by anesthesiologists d. services most frequently provided by physicians ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 25. The Evaluation and Management __________ of service for office or other outpatient visits reflects the tasks that affect the management of a patient's condition which include medical decision-making or total time. a. complexity b. level c. place d. type ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 26. The __________ of an evaluation and management service refers to the kind of health care services provided to Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding patients. a. complexity b. level c. place d. type ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 27. A new patient is one who has not received any professional services from the physician, or from another physician of the same specialty who belongs to the same group practice, within the past __________ year(s). a. one b. two c. three d. four ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 28. Concurrent care is the provision of similar services, such as hospital inpatient visits, to __________ on the same day. a. different patients by more than one provider b. different patients by the same provider c. the same patient by more than one provider d. the same patient by the same provider ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding 29. Transfer of care occurs when a physician who is managing some or all of a patient’s problems releases the patient to the care of another physician who is __________. a. consulting on the case in the office b. not providing consultative services c. providing consultative services d. terminating all care provided ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 30. In 2021, CMS developed new Evaluation and Management Guidelines, which explain how CPT evaluation and management codes for office visits are assigned based on (a) __________ . a. documentation-based system b. medical necessity-based system c. office visits d. reimbursement ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 31. The __________ components of medical decision making and total time spent with the patient are required when selecting an evaluation and management level of service code for office visits. a. collaborative b. key ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 32. Beginning with CPT 2021 (except for 99211), _____________ alone may be used to select the appropriate code level Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding for office/other outpatient E/M service codes. a. time b. intensity of services c. number of body systems reviewed d. counseling ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 33. A history is an interview of the patient that includes which of the following elements? a. chief complaint, history of present illness, past/family/social history b. chief complaint, history of present illness, past/family/social history, physical examination c. chief complaint, history of present illness, past/family/social history, review of systems d. chief complaint, past/family/social history, physical examination, review of systems ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 34. The CPT problem-focused history includes the __________. a. chief complaint and brief history of present illness or problem b. chief complaint, brief history of present illness or problem, and problem-pertinent system review c. chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient’s problem d. chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding 35. The CPT detailed history includes the __________. a. chief complaint and brief history of present illness or problem b. chief complaint, brief history of present illness or problem, and problem-pertinent system review c. chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient’s problem d. chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 36. The CPT comprehensive history includes the __________. a. chief complaint and brief history of present illness or problem b. chief complaint, brief history of present illness or problem, and problem-pertinent system review c. chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient’s problem d. chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 37. Which is an assessment of the patient’s body areas and organ systems? a. physical examination b. review of systems ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding 38. The CPT __________ of examination is categorized according to four levels. a. extent b. level c. range d. type ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 39. The CPT problem-focused examination includes a(n) __________. a. extended examination of the affected body areas and other symptomatic or related organ systems b. general multisystem examination or a complete examination of a single organ system c. limited examination of the affected body area or organ system d. limited examination of the affected body areas or organ systems and other symptomatic or related organ systems ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 40. The CPT detailed examination includes a(n) __________. a. extended examination of the affected body areas and other symptomatic or related organ systems b. general multisystem examination or a complete examination of a single organ system c. limited examination of the affected body area or organ system d. limited examination of the affected body areas or organ systems and other symptomatic or related organ systems ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding 41. The CPT comprehensive examination includes a(n) __________. a. extended examination of the affected body areas and other symptomatic or related organ systems b. general multisystem examination or a complete examination of a single organ system c. limited examination of the affected body area or organ system d. limited examination of the affected body areas or organ systems and other symptomatic or related organ systems ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 42. CPT medical decision making refers to the complexity of __________ as measured by the number of diagnoses or management options, amount and/or complexity of data to be reviewed, and risk of complications and/or morbidity or mortality. a. assessing patient data in a group or single practice b. completing a comprehensive history and physical examination c. establishing a diagnosis and/or selecting a management option d. ordering ancillary tests and interpreting their results ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 43. CPT defines counseling as it relates to evaluation and management coding as a(n) __________ concerning areas that involve diagnostic results, impressions, recommended diagnostic studies, and so on. a. assessment that impacts patient care b. discussion with a patient and/or family c. order for further ancillary testing d. way to guarantee quality patient care ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM Copyright Cengage Learning. Powered by Cognero.

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44. When the physician makes arrangements with other providers or agencies for services to be provided to a patient, this is called __________ of care. a. coordination b. delivery c. quality d. transfer ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 45. Which is considered when determining the number of diagnoses or management options for medical decision-making complexity? It includes a disease, condition, illness, injury, symptom, sign, finding, complaint, or other reason for the encounter, with or without a diagnosis being established at the time of the encounter. a. chief complaint b. history of present illness c. nature of presenting problem d. review of systems ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 46. Which is the amount of time the office or outpatient care provider spends with the patient and/or family? a. face-to-face time b. unit/floor time ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding 47. Which is the amount of time the provider spends at the patient’s bedside and at management of the patient’s care on the inpatient unit or floor? a. face-to-face time b. unit/floor time ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 48. Observation services furnished in a hospital outpatient setting where the patient is considered an outpatient __________. a. are reimbursed when ordered by a physician b. include a bed but no monitoring procedures c. must be preauthorized by Medicare d. routinely convert to an inpatient admission ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 49. Subcategories of hospital inpatient evaluation and management services include subsequent hospital care, which includes the __________. a. admission and discharge from observation/inpatient status on the same day b. final examination of the patient, discussion of hospital stay with patient or caregiver, instructions for continued care, and preparation of discharge records, prescriptions, and referral forms c. inpatient’s first encounter d. review of the chart for changes in patient’s condition, results of diagnostic studies, and/or reassessment of patient’s condition since performance of last assessment ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM Copyright Cengage Learning. Powered by Cognero.

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50. Subcategories of hospital inpatient evaluation and management services include observation or inpatient care services, which include the __________. a. admission and discharge from observation/inpatient status on the same day b. final examination of the patient, discussion of hospital stay with patient or caregiver, instructions for continued care, and preparation of discharge records, prescriptions, and referral forms c. inpatient’s first encounter d. review of the chart for changes in patient’s condition, results of diagnostic studies, and/or reassessment of patient’s condition since performance of last assessment ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 51. Which describes the short-term, intensive treatment program where individuals who are experiencing an acute episode of an illness can receive medically supervised treatment during a significant number of daytime or nighttime hours? a. inpatient hospitalization b. outpatient hospitalization c. partial hospitalization d. skilled nursing facility hospitalization ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 52. Which is the evaluation and management of a patient by a health care provider, usually a specialist, for the purpose of advising the referring or attending physician in the evaluation and/or management of a specific problem with a known diagnosis? a. consultation b. discharge c. referral d. transfer ANSWER: a POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 53. Which occurs when a patient reports that another provider sent the patient to the provider, but the first provider did not schedule the appointment or document a request for services? a. consultation b. discharge c. referral d. transfer ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 54. Which occurs when a surgeon requests a specialist or other physician to examine a patient to determine if the patient can withstand the expected risks of a specific surgery? a. consultation b. preoperative clearance c. referral d. transfer ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 55. Which are provided in a hospital that is open 24 hours for the purpose of providing unscheduled episodic services to patients who require immediate medical attention? a. ambulatory services b. emergency department services c. inpatient services d. outpatient services ANSWER: b Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 56. Which are reported when a physician directly delivers medical care for a critically ill or critically injured patient? a. critical care services b. emergency department services c. inpatient services d. outpatient services ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 57. Which are provided at an intermediate care facility or mentally handicapped, long-term care facility, or psychiatric residential treatment facility? a. critical care services b. inpatient services c. nursing facility services d. outpatient services ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 58. Care plan oversight services cover the physician’s time __________ the complex and multidisciplinary care treatment program for a specific patient who is under the care of a domiciliary or rest home or who resides at home. a. auditing b. justifying c. operating d. supervising ANSWER: d Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 59. Home services are provided to individuals in __________ to promote, maintain, or restore health and/or to minimize the effects of disability and illness, including terminal illness. a. an inpatient hospice b. ambulatory care settings c. health care facilities d. their place of residence ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 60. Physicians’ services involving patient contact that are considered beyond the usual service in either an inpatient or outpatient setting may be reported as __________ services. a. case management b. critical care c. prolonged d. unlisted ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 61. Prolonged physician service with direct patient contact refers to __________ patient contact on an inpatient or outpatient basis. a. critical care b. face-to-face c. standby d. unusual Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 62. Which cover physicians who spend prolonged periods of time without direct patient contact? a. critical care services b. face-to-face services c. standby services d. unusual services ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 63. Which include processes in which a physician is responsible for direct care of a patient and for coordinating and controlling access to or initiating and/or supervising other health care services needed by the patient? a. case management services b. face-to-face services c. standby services d. unusual services ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 64. Which include routine examinations or risk management counseling for children and adults who exhibit no overt signs or symptoms of a disorder while presenting to the medical office for a preventive medical physical? a. case management services b. preventive medicine services c. prolonged services d. standby services Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 65. Newborn care includes services provided to newborns in a(n) __________. a. ambulatory care setting b. inpatient hospital c. nursing facility d. variety of health care settings ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 66. When anesthesia services are provided during situations or circumstances that make anesthesia administration more difficult, report a qualifying circumstances code from the CPT __________ section. a. Anesthesia b. Evaluation and Management c. Medicine d. Surgery ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.6 - Assign CPT codes from the anesthesia section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 67. A physical status modifier is added to each reported CPT Anesthesia section code to indicate the patient’s condition __________. a. at the time anesthesia was administered b. during the post-anesthesia recovery period c. for the purpose of increasing reimbursement d. to reduce the complexity of services provided Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.6 - Assign CPT codes from the anesthesia section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 68. Which service is included as part of the surgical package (or global surgery)? a. complicated postoperative care b. general anesthesia c. repeat surgery, if necessary d. surgical procedure performed ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 69. The global period is the number of days associated with the surgical package (or global surgery) and is designated by the payer as __________. a. a specific number of days for each surgery b. including the management of any complications c. requiring a repeat surgery, if indicated d. treating the patient until (s)he is healed ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 70. Which parenthetical note follows a code description to identify procedures that are an integral part of another procedure or service? a. add-on procedure b. routine procedure c. separate procedure d. unlisted procedure ANSWER: c POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 71. When billing multiple surgical procedures, the code __________ should be reported first on the claim. a. associated with topical anesthesia b. for the major surgical procedure c. in straight numerical order d. that justifies all of the diagnoses ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 72. The supervision of the radiologic procedure and the interpretation and writing of a report describing the examination and its findings are considered the __________ component of a radiologic examination. a. complete b. professional c. technical d. unusual ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.8 - Assign CPT codes from the radiology section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 73. In the Laboratory and Pathology section of CPT, single code numbers are assigned to __________ panels, which consist of a series of blood chemistry studies routinely ordered by providers at the same time for the purpose of investigating a specific organ or disorder. a. laboratory b. organ- or disease-oriented c. pathology d. surgical ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.9 - Assign CPT codes from the pathology and laboratory section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 74. Which code represents a new patient exam in which the physician documents a medically appropriate history and/or exam and a low level of medical decision-making or a total time spent of 30-44 minutes? a. 99203 b. 99204 c. 99213 d. 99214 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 75. Which code represents anesthesia for repairs in the upper abdomen of an omphalocele? a. 00700 b. 00730 c. 00750 d. 00754 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.6 - Assign CPT codes from the anesthesia section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 76. Which code represents fine needle aspiration with fluoroscopic guidance? a. 10005 b. 10006 c. 10009 d. 10021 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 77. Which code represents removal of foreign body, intranasal, by lateral rhinotomy? a. 30220 b. 30300 c. 30310 d. 30320 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 78. Which code represents direct ligation of esophageal varices? a. 43330 b. 43400 c. 43410 d. 43425 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 79. Which code represents repair of the anomalous coronary artery from pulmonary artery origin (Takeuchi procedure)? a. 33500 b. 33502 c. 33505 d. 33506 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding 80. Which code represents electroencephalogram, cerebral death evaluation only? a. 95812 b. 95824 c. 95705 d. 95927 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.10 - Assign CPT codes from the medicine section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 81. Which code represents ultrasonic guidance for amniocentesis, imaging supervision and interpretation? a. 76941 b. 76942 c. 76945 d. 76946 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 82. Which code represents suture of lumbar plexus? a. 64858 b. 64861 c. 64862 d. 64864 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 83. Which code represents deoxyribonucleic acid antibody, native or double stranded? a. 86215 b. 86235 c. 86236 Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding d. 88271 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.9 - Assign CPT codes from the pathology and laboratory section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 84. Which code represents hemodialysis procedure with physician evaluation? a. 90935 b. 90937 c. 90940 d. 90945 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.10 - Assign CPT codes from the medicine section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 85. Which code represents simple incision and drainage of pilonidal cyst? a. 10060 b. 10080 c. 11770 d. 11772 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 86. Which code represents intrathoracic tracheoplasty? a. 31750 b. 31760 c. 31766 d. 31770 ANSWER: b POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 87. Which code represents laparoscopy, surgical with vaginal hysterectomy, for uterus weighing 300 g? a. 58546 b. 58550 c. 58552 d. 58553 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 88. Which code represents computed tomography, head or brain, without contrast material, followed by contrast material and further sections? a. 70450 b. 70460 c. 70470 d. 76376 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.8 - Assign CPT codes from the radiology section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 89. Which code represents excision of 6.2 cm malignant lesion including margins, face? a. 11606 b. 11640 c. 11644 d. 11646 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

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Chapter 07: CPT Coding DATE CREATED: DATE MODIFIED:

11/1/2022 11:55 AM 11/1/2022 11:55 AM

90. Which code represents immunoassay presumptive drug test, single drug class, capable of being read by direct optical observation only? a. 80081 b. 80305 c. 80306 d. 80307 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.9 - Assign CPT codes from the pathology and laboratory section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 91. Which codes represent decompression of spinal cord using transpedicular approach, three lumbar segments? a. 63056, 63057 b. 63056, 63057 x2 c. 63064, 63066 d. 63064, 63066 x2 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 92. The patient underwent intramuscular injection of influenza virus vaccine. The trivalent vaccine was derived from cell cultures, subunit, preservative, and antibiotic free. Which CPT codes are assigned? a. 90661, 90472 b. 90660, 90472 c. 90661, 90471 d. 90662, 90473 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.10 - Assign CPT codes from the medicine section.

DATE CREATED: 11/1/2022 11:55 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding DATE MODIFIED:

11/1/2022 11:55 AM

93. Which codes represent critical care evaluation and management of the critically injured patient for 90 minutes? a. 99285, 99288 b. 99288, 99291 c. 99291, 99292 d. 99292, 99292, 99292 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 94. Which codes represent dermal xenograft for temporary closure on small child’s neck, 2 percent of body area? a. 15271, 15272 b. 15273, 15274 c. 15275, 15276 d. 15277, 15278 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 95. Which code represents removal of lung, extrapleural pneumonectomy? a. 32440 b. 32445 c. 32480 d. 32488 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 96. Which code represents mitral valve replacement with cardiopulmonary bypass?

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Chapter 07: CPT Coding a. 33420 b. 33423 c. 33430 d. 33460 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 97. Which code represents an established patient home visit evaluation and management service (problem-focused history and examination, and straightforward medical decision making)? a. 99347 b. 99348 c. 99349 d. 99350 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.5 - Assign CPT codes from the evaluation and management section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 98. Which code represents an intermediate closure of a heavily contaminated hand wound that required extensive cleaning, 14.3 cm? a. 12001 b. 12005 c. 12035 d. 12045 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 99. Which code represents complicated LeFort III open treatment of craniofacial separation that required the use of multiple surgical approaches?

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Chapter 07: CPT Coding a. 21431 b. 21432 c. 21433 d. 21435 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 100. Which code represents implantation of patient-activated event recorder including programming? a. 33216 b. 33217 c. 33249 d. 33285 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 101. Which codes represent diagnostic amniocentesis with ultrasonic guidance? a. 59000 b. 59000, 76946 c. 59001 d. 59001, 76946 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 102. Which code represents transcatheter placement of two intracoronary stents, percutaneous, with or without other therapeutic intervention, any method, single vessel? a. 92920 b. 92928 c. 92933 Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding d. 92943 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.10 - Assign CPT codes from the medicine section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 103. Which codes represent the administration of anesthesia for second- and third-degree burn excision, 12 percent of total body surface? a. 01951, 01952 b. 01952, 01953 c. 01953, 01951 d. 01953, 01953 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.6 - Assign CPT codes from the anesthesia section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 104. Which code represents syndactylization, toes (Kelikian-type procedure)? a. 28280 b. 28285 c. 28286 d. 28289 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 105. Which code represents percutaneous ablation of renal tumors, bilateral, using radiofrequency? a. 50590 b. 50592-50 c. 50593 d. 50593-50 ANSWER: b POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 106. Which code(s) represent(s) venous catheterization for selective organ blood sampling with venous sampling through catheter (radiologic supervision and interpretation)? a. 36481 b. 36500, 75893 c. 36500, 75894 d. 36500-51 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 107. Which code represents closure of cystostomy? a. 51860 b. 51880 c. 51920 d. 51940 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 108. Which code represents bilateral excision of hydrocele? a. 55040 b. 55040-50 c. 55041 d. 54901 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

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Chapter 07: CPT Coding DATE CREATED: DATE MODIFIED:

11/1/2022 11:55 AM 11/1/2022 11:55 AM

109. Which code represents lysis of labial adhesions? a. 53060 b. 56405 c. 56441 d. 56442 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 110. Which code represents exploratory supratentorial craniectomy? a. 61304 b. 61305 c. 61314 d. 61320 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 111. Which code represents drainage of lacrimal gland via incision? a. 68020 b. 68400 c. 68440 d. 68500 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 112. Which code represents modified radical mastoidectomy?

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Chapter 07: CPT Coding a. 69502 b. 69505 c. 69511 d. 69540 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 113. Which code represents pelvimetry with placental localization? a. 74470 b. 74710 c. 74742 d. 74775 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.8 - Assign CPT codes from the radiology section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 114. Which code represents ligation of thoracic duct, abdominal approach? a. 38300 b. 38380 c. 38381 d. 38382 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 115. Which code represents biopsy of vestibule of mouth? a. 40490 b. 40799 c. 40808 d. 40812 Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 116. Which code represents needle biopsy of salivary gland? a. 42100 b. 42300 c. 42400 d. 42405 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 117. Which code represents closure of gastrocolic fistula? a. 43860 b. 43870 c. 43880 d. 43881 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 118. Which code represents cholecystectomy with exploration of common duct? a. 47600 b. 47605 c. 47610 d. 47612 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 07: CPT Coding LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 119. Which code represents insertion of tunneled intraperitoneal catheter for dialysis, open? a. 49419 b. 49421 c. 49423 d. 49425 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.7 - Assign CPT codes from the surgery section.

DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM 120. Telemedicine is a provision of remote medical care using a secure two-way video connection when the patient and provider are located at a. different locations b. hospitals c. the same location d. their homes only ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_7.2 - Describe the organization of CPT. DATE CREATED: 11/1/2022 11:55 AM DATE MODIFIED: 11/1/2022 11:55 AM

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Chapter 08: HCPCS Level II Coding 1. Medicare defines __________ as equipment that can withstand repeated use in the patient’s home and not in the absence of illness or injury. a. durable medical equipment b. durable medical equipment and supplies c. durable medical equipment, prosthetics, and orthotics d. durable medical equipment, prosthetics, orthotics, and supplies ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.2 - Describe the purpose of HCPCS Level II codes.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 2. Which includes artificial limbs, braces, medications, surgical dressings, and wheelchairs? a. durable medical equipment b. durable medical equipment and supplies c. durable medical equipment, prosthetics, and orthotics d. durable medical equipment, prosthetics, orthotics, and supplies ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.2 - Describe the purpose of HCPCS Level II codes.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 3. Which supply patients with durable medical equipment? a. carriers b. fiscal intermediaries c. DMEPOS dealers d. Medicare administrative contractors ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.2 - Describe the purpose of HCPCS Level II codes.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 4. DMEPOS claims are submitted to DME __________. a. CMS HCPCS Workgroups b. fiscal intermediaries Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding c. DMEPOS dealers d. Medicare administrative contractors ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.2 - Describe the purpose of HCPCS Level II codes.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 5. The CMS HCPCS Workgroup maintains __________, permanent national codes, miscellaneous codes, temporary codes, and modifiers. a. HCPCS Level I codes b. HCPCS Level II codes c. HCPCS Level III codes d. HCPCS Level IV codes ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.3 - Explain the organization of HCPCS Level II codes.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 6. HCPCS Level II __________ codes are reported when a DMEPOS dealer submits a claim for a product or service for which there is no existing HCPCS Level II code. a. miscellaneous b. permanent c. temporary d. unlisted ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.3 - Explain the organization of HCPCS Level II codes.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/12/2022 7:23 AM 7. When claims are to be submitted to one of the four regional DME MACs, DMEPOS dealers that have coding questions should check with the __________, which is responsible for providing suppliers and manufacturers with assistance in determining HCPCS codes to be used. a. Centers for Medicare and Medicaid Services b. Department of Health and Human Services Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding c. Medicare Administrative Contractor d. Medicare Pricing, Data Analysis and Coding Contractor ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.2 - Describe the purpose of HCPCS Level II codes.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 8. HCPCS Level II temporary codes are maintained by the __________ and other members of the HCPCS National Panel, independent of permanent national codes. a. CMS b. DHS c. PDAC d. MAC ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.3 - Explain the organization of HCPCS Level II codes.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 9. HCPCS Level II C codes identify items that may qualify for __________ under the hospital outpatient prospective payment system. a. medical review coverage b. professional health care services c. transitional pass-through payments d. unlisted procedures and services ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.3 - Explain the organization of HCPCS Level II codes.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 10. HCPCS Level II modifiers are attached to any CPT and/or HCPCS Level II codes to __________ performed by providers. a. clarify services and procedures b. guarantee payment for services c. justify the procedure Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding d. validate codes submitted on claims ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.3 - Explain the organization of HCPCS Level II codes.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 11. For certain items or services reported on a claim submitted to the DME MAC, the DMEPOS dealer must receive a signed certificate of medical necessity from the __________ before submitting a claim to Medicare. a. administrative contractor b. patient or guarantor c. third-party payer d. treating physician ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.4 - Identify documentation and submission requirements for reporting HCPCS Level II codes.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 12. Which code represents pillow for decubitus care? a. E0190 b. E0193 c. E0196 d. E0198 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 13. Which code represents IV pole? a. E0776 b. E0779 c. E0783 d. E0856 ANSWER: a Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 14. Which code represents Ohio Willow stump sock, below knee? a. L8465 b. L8470 c. L8480 d. L8499 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 15. Which code represents baseball splint, finger? a. A4570 b. A4580 c. A4590 d. Q4050 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 16. Which code represents ambulance service, outside state per mile, transport (Medicaid only)? a. A0021 b. A0080 c. A0090 d. A0120 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

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Chapter 08: HCPCS Level II Coding DATE CREATED: DATE MODIFIED:

11/1/2022 11:56 AM 11/1/2022 11:56 AM

17. Which code represents replacement tubing for breast pump? a. A4280 b. A4281 c. A4283 d. A4286 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 18. Which code represents heel wedge, SACH? a. L3320 b. L3332 c. L3340 d. L3350 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 19. Which code represents calorically dense enteral nutrition? a. B4152 b. B4153 c. B4155 d. B4157 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 20. Which code represents an Easy Care folding walker?

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Chapter 08: HCPCS Level II Coding a. E0105 b. E0143 c. E0144 d. E0148 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 21. Which code represents Dilaudid? a. J0500 b. J1165 c. J1170 d. J1200 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 22. Which code represents a OneTouch® blood glucose meter? a. A4253 b. E0607 c. E0616 d. E0618 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 23. Which code represents telephone calls by a registered nurse to a disease management program member for monitoring purposes, per month? a. S0274 b. S0315 c. S0320 Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding d. S0342 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 24. Which code represents diazepam? a. J0470 b. J0500 c. J1436 d. J3360 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 25. Which code represents an IV tubing extension set? a. S0630 b. S1001 c. S1015 d. S1030 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 26. Which code represents hemipelvectomy, Canadian type, hip joint? a. L5280 b. L5321 c. L5331 d. L5341 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 27. Which code represents splint, prefabricated, ankle? a. S8450 b. S8451 c. S8452 d. S8460 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 28. Which code represents 15 minutes of sign language or oral interpretative services? a. T1005 b. T1006 c. T1013 d. T1014 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 29. Which code represents injection, sermorelin acetate, 1 mcg? a. Q0515 b. Q2004 c. Q2009 d. Q2017 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding 30. Which code represents cast supplies, long arm splint, pediatric (0–10 years), plaster? a. Q4017 b. Q4019 c. Q4021 d. Q4023 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 31. Which code represents scratch-resistant coating, per lens? a. V2760 b. V2762 c. V2781 d. V2799 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 32. Which code represents dysphagia screening? a. V5336 b. V5362 c. V5363 d. V5364 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 33. Which code represents a replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt? a. K0462 b. K0601 Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding c. K0604 d. K0605 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 34. Which code represents cervical, multipost collar, occipital/mandibular supports, adjustable? a. L0140 b. L0174 c. L0180 d. L0200 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 35. Which code represents injection, paclitaxel, 1 mg? a. J9267 b. J9266 c. J9268 d. J9270 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 36. Which code represents a traction stand, freestanding, cervical traction? a. E0840 b. E0849 c. E0850 d. E0855 ANSWER: c POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 37. Which code represents MRI without contrast followed with contrast, breast; unilateral? a. C8902 b. C8905 c. C8906 d. C8911 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 38. Which code represents the halo procedure, cervical halo incorporated into jacket vest? a. L0810 b. L0820 c. L0859 d. L0861 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 39. Which code represents cyclophosphamide, 100 mg? a. J9070 b. J9098 c. J9100 d. J9120 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding DATE MODIFIED:

11/1/2022 11:56 AM

40. Which code represents male external catheter, with or without adhesive, disposable? a. A4349 b. A4351 c. A4353 d. A4355 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 41. Which code represents the shock absorber for a power wheelchair? a. E1016 b. E1014 c. E1017 d. E1018 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 42. Which code represents the fitting, orientation, and check of a hearing aid? a. V5008 b. V5010 c. V5011 d. V5014 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 43. Which code represents prosthetic sheath, upper limb? a. L8410 Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding b. L8415 c. L8435 d. L8465 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 44. Which code represents adjustable chair, for ESRD patients? a. E1570 b. E1590 c. E1615 d. E1699 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/12/2022 7:24 AM 45. Which code represents contact lens, gas permeable, bifocal? a. V2510 b. V2511 c. V2512 d. V2513 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 46. Which code represents services of home health/hospice aide in home health or hospice settings, 30 minutes? a. G0155, G0155 b. G0156, G0156 c. G0157, G0157 d. G0158, G0158 ANSWER: b Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 47. Which code represents intrauterine copper contraceptive? a. J7300 b. J7303 c. J7304 d. J7306 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 48. Which code represents replacement of transmitter cable for use with cochlear implant device? a. L8617 b. L8618 c. L8622 d. L8623 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 49. Which code represents a replacement battery for external infusion pump owned by patient, lithium, 3.6 volt? a. K0603 b. K0604 c. K0605 d. K0607 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

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Chapter 08: HCPCS Level II Coding DATE CREATED: DATE MODIFIED:

11/1/2022 11:56 AM 11/1/2022 11:56 AM

50. Which code represents foot, abduction rotation bar, without shoes? a. L3140 b. L3150 c. L3160 d. L3170 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 51. Which code represents clubfoot wedge? a. L3400 b. L3340 c. L3350 d. L3380 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 52. Which code represents injection, Clolar, 1 mg? a. J9020 b. J9025 c. J9027 d. J9030 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 53. Which code represents influenza vaccine, any route of administration?

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Chapter 08: HCPCS Level II Coding a. G0008 b. G0009 c. G8482 d. Q2034 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 54. Which code represents 20-mg injection of Humira (generic name Adalimumab)? a. J0130 b. J0135 c. J0153 d. J0178 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 55. Which code represents an extra heavy-duty wheelchair? a. K0001 b. K0002 c. K0004 d. K0007 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 56. Which code represents a cervical semi-rigid adjustable plastic collar? a. L0120 b. L0130 c. L0140 d. L0150 Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 57. Which code represents replace pretibial shell? a. L4110 b. L4130 c. L4205 d. L4210 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 58. Which code represents blood, split unit? a. P9010 b. P9011 c. P9012 d. P9016 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 59. Which code represents pinworm examination? a. Q0113 b. Q0114 c. Q0139 d. Q0163 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 08: HCPCS Level II Coding LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 60. Which code represents comprehensive contact lens evaluation? a. S0514 b. S0590 c. S0592 d. S0595 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_8.5 - Assign HCPCS Level II codes, modifiers, and quantities.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM

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Chapter 09: CMS Reimbursement Methodologies 1. Reimbursement according to a __________ means that providers reported actual charges for care to payers after each encounter. a. prospective cost-based rate b. prospective price-based rate c. retrospective reasonable cost system d. site-of-service differential ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.2 - Compare cost-based and price-based prospective payment systems to retrospective reasonable cost systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 2. Which is established in advance and based on reported health care charges from which a predetermined per diem rate is determined? a. prospective cost-based rate b. prospective price-based rate c. retrospective reasonable cost system d. site-of-service differential ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.2 - Compare cost-based and price-based prospective payment systems to retrospective reasonable cost systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 3. Which is associated with a particular category of patient and is established by the payer prior to the provision of health care services? a. per diem b. prospective price-based rate c. retrospective reasonable cost system d. site-of-service differential ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.2 - Compare cost-based and price-based prospective payment systems to retrospective reasonable cost systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies 4. The federal government administers several health care programs, some of which require services to be reimbursed according to predetermined reimbursement methodologies, which are established as __________. a. cost-based rates b. price-based rates c. payment systems d. reasonable cost systems ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.2 - Compare cost-based and price-based prospective payment systems to retrospective reasonable cost systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 5. The ambulance fee schedule payment system replaced a __________ for providers and suppliers of ambulance services. a. prospective cost-based system b. prospective price-based system c. retrospective reasonable cost payment system d. site-of-service differential system ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 6. An ambulatory surgical center (ASC) is a state-licensed, Medicare-certified supplier (not provider) of surgical health care services that must __________ on Medicare claims. a. accept assignment b. assign benefits ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies 7. In 1980 Medicare authorized implementation of ambulatory surgical center (ASC) __________ rates as a fee to ASCs for facility services furnished in connection with performing certain surgical procedures. a. differential b. payment c. per diem d. retrospective ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 8. The MMA of 2003 mandated implementation of a(n) __________ payment amount as a substitute for the ambulatory surgical center (ASC) standard overhead amount for surgical procedures performed at an ASC. a. fee schedule b. inpatient prospective payment system c. outpatient prospective payment system d. resource-based relative value scale system ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 9. Medicare reimburses laboratory services according to a(n) __________, which is based on the submitted charge, national limitation amount, or local fee schedule amount, whichever is lowest. a. ambulatory outpatient center rate b. clinical laboratory fee schedule c. outpatient prospective payment system d. pathology diagnostic fee schedule ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies 10. The Medicare durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) fee schedule reimburses DMEPOS either __________ percent of the actual charge for the item or the fee schedule amount, whichever is lower. a. 20 b. 50 c. 80 d. 100 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 11. The end-stage renal disease (ESRD) composite payment rate system is __________ adjusted to provide a mechanism to account for differences in patients’ utilization of health care resources. a. case-mix b. cost-basis c. discharge-status d. resource-utilization ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 12. Which is a facility’s measure of the types of patients treated and reflects patient utilization of varying levels of health care resources? a. case mix b. cost basis c. discharge status d. resource utilization ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.2 - Compare cost-based and price-based prospective payment systems to retrospective reasonable cost systems.

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Chapter 09: CMS Reimbursement Methodologies DATE CREATED: DATE MODIFIED:

11/1/2022 11:56 AM 11/1/2022 11:56 AM

13. Each home health resource group (HHRG) has an associated __________ that increases or decreases Medicare’s payment for an episode of home health care. a. case mix b. cost basis c. resource utilization d. weight value ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 14. Home health resource groups are reported to Medicare on UB-04 using the __________ code set, which represents case-mix groups about which payment determinations are made for the home health prospective payment system. a. CPT b. HCPCS level II c. HIPPS d. ICD-10-CM ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 15. HIPPS codes are determined after home health care patient assessments are completed using the __________ . a. MEDPAR limited data set (LDS) b. minimum data set (MDS) c. outcomes and assessment information set (OASIS) d. uniform hospital discharge data set (UHDDS) ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

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Chapter 09: CMS Reimbursement Methodologies DATE CREATED: DATE MODIFIED:

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16. Which type of software is used to determine the appropriate HHRG after OASIS data is input on each patient (to measure the outcome of all adult patients receiving home health services)? a. calculator b. editing c. encrypting d. grouper ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 17. Home Assessment Validation and Entry (HAVEN) __________ software is then used to collect OASIS assessment data for transmission to state databases. a. data entry b. editing c. encrypting d. grouper ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 18. The inpatient prospective payment system (IPPS) resulted in Medicare reimbursing hospitals for inpatient hospital services according to a __________ rate for each discharge. a. cost-based b. per diem c. predetermined d. retrospective ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies

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payment systems.

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19. MS-DRGs are organized into mutually exclusive categories called __________, which are loosely based on body systems. a. intensity of resources b. major diagnostic categories c. risk of mortality d. severity of illness ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 20. MS-DRG reimbursement rates are recalculated according to a(n) __________ adjustment, which results in increased Medicare payments for hospitals that treat a high percentage of low-income patients. a. disproportionate share hospital b. indirect medical education c. risk of inpatient patient mortality d. severity of inpatient illness ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 21. Approved teaching hospitals receive increased Medicare payments according to a(n) __________ adjustment. a. disproportionate share hospital b. indirect medical education c. risk of inpatient patient mortality d. severity of inpatient illness ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 22. Hospitals that treat unusually costly cases receive increased __________ payments that are designed to protect hospitals from large financial losses due to unusually expensive cases. a. disproportionate b. indirect c. outlier d. severity ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 23. Which is the relative volume and types of diagnostic, therapeutic, and inpatient bed services used to manage an inpatient disease? a. case-mix management b. intensity of resources c. risk of mortality d. severity of illness ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 24. Which is the original DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to non-Medicare beneficiaries (e.g., BlueCross BlueShield) and is based on intensity of resources? a. DRGs b. AP-DRGs c. APR-DRGs d. MS-DRGs ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 25. Which was adopted for one year by Medicare in 2007 to reimburse hospitals for inpatient care provided to Medicare beneficiaries? a. DRGs b. AP-DRGs c. APR-DRGs d. MS-DRGs ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 26. Which is the extent of physiological decompensation or organ system loss of function? a. case-mix management b. intensity of resources c. risk of mortality d. severity of illness ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 27. Which is the likelihood of dying? a. case-mix management b. intensity of resources c. risk of mortality d. severity of illness ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 28. Which was adopted by Medicare in 2008 to improve recognition of severity of illness and resource consumption and reduce cost variation among DRGs? a. DRGs b. AP-DRGs c. APR-DRGs d. MS-DRGs ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 29. When outpatient preadmission services are provided by a hospital on the day of or during the three days prior to a patient’s inpatient admission and the inpatient principal diagnosis code exactly matches that for preadmission services, the IPPS __________ rule applies. a. 3-day payment window b. intensity of resources c. severity of illness d. transfer ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 30. Which rule applies when patients are discharged from the hospital directly to a postacute provider? a. 3-day payment window rule b. intensity of resources rule c. severity of illness rule d. transfer rule ANSWER: d POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 31. The outpatient prospective payment system reimburses services according to ambulatory payment classifications (APCs); which group services according to similar __________ and in terms of resources are required? a. clinical characteristics b. intensity of resources c. risk of mortality d. severity of illness ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 32. Which includes all outpatient procedures and services provided during one day to the same patient? a. limited data set b. diagnosis-related group c. outpatient encounter d. relative value unit ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 33. Which adjusts payments to account for geographic variations in hospitals’ labor costs? a. case index b. disease index c. morbidity index d. wage index ANSWER: d POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 34. Provisions of the inpatient psychiatric facility prospective payment system resulted in a __________ patient classification system that reflects differences in patient resource use and costs. a. cost-based b. price-based c. per diem d. prospective ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 35. Providers that use the Diagnostic and Statistical Manual refer to diagnostic assessment criteria that are used as tools to identify __________ disorders. a. ambulatory b. inpatient c. medical d. psychiatric ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 36. Which classifies patients into inpatient rehabilitation facility prospective payment system groups that are based on clinical characteristics and expected resource needs? a. charge description master b. fee schedule c. HIPPS code set d. patient assessment instrument ANSWER: d Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 37. Inpatient rehabilitation facilities use __________ software for computerized data entry to create a file in a standard format that can be electronically transmitted to a national database. a. HAVEN b. IRVEN c. OASIS d. RAVEN ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 38. Which replaced the reasonable cost-based payment system for long-term (acute) care hospitals? a. cost-based system b. per diem system c. prospective payment system d. retrospective payment system ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 39. Long-term acute care hospitals are defined by Medicare as having an average inpatient length of stay greater than __________ days. a. 10 b. 15 c. 25 d. 30 ANSWER: c Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 40. Which reimburses providers according to predetermined rates assigned to services and is revised by CMS each year? a. Medicare physician fee schedule b. Medicare relative value units c. Medicare resource-based fee schedule d. Medicare value fee schedule ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 41. Physician services standardized to measure the value of a service as compared with other services provided are called __________, and they consist of physician work, practice expense, and malpractice expense payment components. a. allowed charges b. physician fee schedules c. price-based rates d. relative value units ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 42. Medicare physician fee schedule payment limits were established by adjusting relative value units (RVUs) for each locality using geographic adjustment factors, and an annual dollar multiplier called a __________ changes RVUs into payments using a formula. a. case mix b. conversion factor c. fee schedule Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies d. grouper ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 43. The nonparticipating provider __________ charge is calculated by multiplying the Medicare physician fee schedule by 95 percent. a. allowed b. limiting c. prospective d. retrospective ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 44. Nonparticipating provider limiting charge information appears on the Medicare __________, which notifies Medicare beneficiaries of actions taken on claims. a. chargemaster b. explanation of benefits c. remittance advice d. summary notice ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 45. Charging write-off or adjustment amounts to beneficiaries is called __________, and it is prohibited by Medicare regulations. a. accepting assignment b. allowed charges Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies c. assigning benefits d. balance billing ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 46. When the Medicare program does not have primary responsibility for paying a beneficiary’s medical expenses, the Medicare __________ concept applies. a. balance billing b. conversion factor c. limiting charge d. secondary payer ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 47. Services provided by nonphysician practitioners may also be reported to Medicare as __________ to the supervising physician’s service, and as a result, services are reimbursed at 100 percent of the Medicare physician fee schedule and Medicare pays 80 percent of that amount directly to the physician. a. allowed charges b. incident c. limiting charges d. price-based costs ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 48. When office-based services are performed in a facility, such as a hospital or outpatient setting, payments are reduced because the doctor did not provide supplies, utilities, or the costs of running the facility. This is known as the Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies __________ differential. a. fee schedule b. limiting charge c. resource utilization d. site of service ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 49. Which communicates new or changed policies and/or procedures that are being incorporated into a specific CMS Internet-only program manual? a. explanation of benefits b. transmittals c. remittance advice d. summary notice ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 50. The CMS Quarterly Provider Update (QPU) is an online CMS publication that contains information about __________ currently under development or completed/canceled and new/revised manual instructions. a. classification and coding systems b. electronic data interchange methods c. physician fee schedules d. regulations and major policies ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies 51. Medical conditions or complications that patients develop during inpatient hospital stays and that were not present at admission are called __________. a. case-mix index relative weights b. hospital-acquired conditions c. medical diagnostic categories d. comorbidities ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 52. A condition that exists at the time an order for inpatient admission occurs is categorized according to __________. a. case management b. data analysis c. present on admission d. revenue cycle auditing ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 53. A patient is admitted as a hospital inpatient with a diagnosis of possible cerebrovascular accident. During admission, the patient falls out of bed, fractures her right arm. Which present on admission (POA) indicator applies to the right arm fracture diagnosis? a. Y (present at the time of inpatient admission) b. N (not present at the time of inpatient admission) c. U (documentation is insufficient to determine if condition is present on admission) d. W (provider is unable to clinically determine whether condition was present on admission or not) ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies 54. A patient is admitted as a hospital inpatient for treatment of acute asthma. The patient also has hypertension, which was medically managed during the inpatient admission. Which present on admission (POA) indicator applies to the acute asthma? a. Y (present at the time of inpatient admission) b. N (not present at the time of inpatient admission) c. U (documentation is insufficient to determine if condition is present on admission) d. W (provider is unable to clinically determine whether condition was present on admission or not) ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 55. A patient is admitted as a hospital inpatient and undergoes appendectomy surgery. The responsible physician documents acute appendicitis. Upon discharge, the patient is provided with instructions for follow up and care postoperatively as well as for hyperthyroidism. Which present on admission (POA) indicator applies to the hyperthyroidism? a. Y (present at the time of inpatient admission) b. N (not present at the time of inpatient admission) c. U (documentation is insufficient to determine if condition is present on admission) d. W (provider is unable to clinically determine whether condition was present on admission or not) ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 56. A hospital has 100 inpatient cases that are assigned to DRG 54, which has a relative weight of 1.540. What is the total relative weight for the cases? a. 83 b. 154 c. 5,400 d. 8,316 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies LEARNING OBJECTIVES: UHI_GREEN_24_9.2 - Compare cost-based and price-based prospective payment systems to retrospective reasonable cost systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 57. Which determines whether provided services are appropriate for patient’s current or proposed level of care? a. intensity of services (IS) b. severity of illness (SI) c. quality management (QM) d. utilization management (UM) ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.4 - Summarize processes and regulations established for CMS payment systems.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 58. Federally Qualified Health Centers (FQHCs) are safety net providers that primarily provide services typically furnished in which type of setting? a. home health agency b. inpatient hospital c. outpatient clinic d. skilled nursing facility ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 59. The Affordable Care Act established which of the following payment systems in 2014? a. ESRD Composite Payment Rate System b. FQHC PPS c. HOPPS d. SNF PPS ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 09: CMS Reimbursement Methodologies LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM 60. Which is an umbrella term for initiatives that link reimbursement to health care performance criteria? a. pay-for-performance b. quality management c. risk management d. utilization management ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_9.3 - Explain the components, rules, and differences among CMS fee schedules.

DATE CREATED: 11/1/2022 11:56 AM DATE MODIFIED: 11/1/2022 11:56 AM

Copyright Cengage Learning. Powered by Cognero.

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Chapter 10: Coding Compliance Programs, Clinical Documentation Improvement, and Coding for Medical Necessity 1. A provider often considers diagnoses that do not receive direct treatment during an encounter because they impact treatment of other conditions. It is appropriate to report codes for such diagnoses on the CMS-1500 claim because they have been __________. a. discounted by the payer b. included in coverage c. medically managed d. treated during the visit ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.4 - Apply coding for medical necessity guidance when reporting ICD-10-CM, CPT, and HCPCS Level II codes on claims.

2. The procedure or service provided is linked with the _________ that provided medical necessity for performing the procedure or service. a. diagnosis b. procedure c. service d. supply ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.4 - Apply coding for medical necessity guidance when reporting ICD-10-CM, CPT, and HCPCS Level II codes on claims.

3. Which are linked to procedure and service codes to prove medical necessity? a. CPT codes b. HCPCS Level II codes c. ICD-10-CM codes d. ICD-10-PCS codes ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.4 - Apply coding for medical necessity guidance when reporting ICD-10-CM, CPT, and HCPCS Level II codes on claims.

4. Which is a form required by Medicare for all outpatient and physician office procedures/services that are not covered by the Medicare program? a. advance beneficiary notice b. assignment of benefits Copyright Cengage Learning. Powered by Cognero.

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Chapter 10: Coding Compliance Programs, Clinical Documentation Improvement, and Coding for Medical Necessity c. fee-rendered schedule d. patient waiver form ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.4 - Apply coding for medical necessity guidance when reporting ICD-10-CM, CPT, and HCPCS Level II codes on claims.

5. Medical practices and health care facilities should routinely participate in an auditing process, which involves reviewing patient records and CMS-1500 or UB-04 claims to __________. a. assess coding accuracy and completeness of documentation b. calculate the amount of money that must be sent to the payer c. determine whether procedures and services were covered d. follow up on payer reimbursement of the submitted claims ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.4 - Apply coding for medical necessity guidance when reporting ICD-10-CM, CPT, and HCPCS Level II codes on claims.

6. The Medicare coverage database (MCD) is used by Medicare administrative contractors, providers, and other health care industry professionals to determine whether a procedure or service is __________ for the diagnosis or treatment of an illness or injury. a. billed at the appropriate level b. preauthorized by the contractor c. reasonable and necessary d. usual, customary, and reasonable ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.4 - Apply coding for medical necessity guidance when reporting ICD-10-CM, CPT, and HCPCS Level II codes on claims.

7. CMS develops national coverage determinations on an ongoing basis, and __________ create(s) edits for NCD rules, which are local coverage determinations. a. BlueCross BlueShield b. Medicaid c. Medicare administrative contractors d. third-party payers ANSWER: c Copyright Cengage Learning. Powered by Cognero.

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Chapter 10: Coding Compliance Programs, Clinical Documentation Improvement, and Coding for Medical Necessity POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.4 - Apply coding for medical necessity guidance when reporting ICD-10-CM, CPT, and HCPCS Level II codes on claims.

8. Local coverage determinations specify under which __________ a service is covered and coded correctly. a. clinical circumstances b. health care settings c. medical necessity d. service conditions ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.4 - Apply coding for medical necessity guidance when reporting ICD-10-CM, CPT, and HCPCS Level II codes on claims.

9. The outpatient code editor (OCE) is software that edits outpatient __________ by hospitals, community mental health centers, comprehensive outpatient rehabilitation facilities, and home health agencies. a. claims submitted b. payments received c. records maintained d. treatments provided ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.2 - Describe the components of a coding compliance program.

10. A narrative clinic note is written in a(n) __________ format. a. catalogue b. itemized c. list d. paragraph ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.5 - Review case scenarios and patient records to determine the appropriate assignment of codes to diagnoses, procedures, and services.

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Chapter 10: Coding Compliance Programs, Clinical Documentation Improvement, and Coding for Medical Necessity 11. Which part of the SOAP note contains the chief complaint and the patient’s description of the presenting problem? a. Subjective b. Objective c. Assessment d. Plan ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.5 - Review case scenarios and patient records to determine the appropriate assignment of codes to diagnoses, procedures, and services.

12. Which part of the SOAP note contains the diagnostic statement and may include the physician’s rationale for the diagnosis? a. Subjective b. Objective c. Assessment d. Plan ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.5 - Review case scenarios and patient records to determine the appropriate assignment of codes to diagnoses, procedures, and services.

13. Which part of the SOAP note contains documentation of measurable observations made by a health care provider during the physical examination and diagnostic testing? a. Subjective b. Objective c. Assessment d. Plan ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.5 - Review case scenarios and patient records to determine the appropriate assignment of codes to diagnoses, procedures, and services.

14. Which part of the SOAP note is the statement of the physician’s intended medical management of the case? a. Subjective b. Objective c. Assessment d. Plan Copyright Cengage Learning. Powered by Cognero.

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Chapter 10: Coding Compliance Programs, Clinical Documentation Improvement, and Coding for Medical Necessity ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.5 - Review case scenarios and patient records to determine the appropriate assignment of codes to diagnoses, procedures, and services.

15. Although it may vary from a short narrative description of a minor procedure to a more formal report dictated by surgeons, all operative reports contain __________. a. pathology diagnosis b. patient complete address c. preauthorization number d. procedure performed ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.5 - Review case scenarios and patient records to determine the appropriate assignment of codes to diagnoses, procedures, and services.

16. The National Correct Coding Initiative has resulted in numerous __________ that cannot be reported on the same claim for the same date of service. a. code pairs b. coding conventions c. guidelines d. instructional notes ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.2 - Describe the components of a coding compliance program.

17. Which were incorporated into the National Correct Coding Initiative to compare units of service (UOS) with CPT and HCPCS level II codes reported on claims for the purpose of indicating the maximum number of UOS allowable by the same provider for the same beneficiary on the same date of service under most circumstances? a. comprehensive code edits b. edit pairs (or code pairs) c. medically unlikely edits d. mutually exclusive code edits ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 10: Coding Compliance Programs, Clinical Documentation Improvement, and Coding for Medical Necessity HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.2 - Describe the components of a coding compliance program.

18. Voluntary compliance program guidance documents were developed by the Department of HHS OIG for the health care industry to __________ the development and use of internal controls to __________ adherence to applicable regulations, statutes, and program requirements. a. assess; justify b. enforce; mandate c. encourage; monitor d. evaluate; regulate ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.2 - Describe the components of a coding compliance program.

19. Coding compliance is the conformity to established coding __________. a. guidelines and regulations b. laws and mandates c. methods and systems d. nomenclatures and classifications ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.2 - Describe the components of a coding compliance program.

20. Coding compliance programs include written policies and procedures, routine coding audits and monitoring and compliance-based education and training. As a minimum, how often should written policies and procedures be updated? a. annually b. monthly c. semi-annually d. weekly ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.2 - Describe the components of a coding compliance program.

21. Which is a helpful practice that allows the coding manager to establish criteria for coding assessment purposes?

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Chapter 10: Coding Compliance Programs, Clinical Documentation Improvement, and Coding for Medical Necessity a. auditing b. benchmarking c. clinical documentation improvement d. education and training ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.2 - Describe the components of a coding compliance program.

22. Which is part of an effective coding compliance program because it helps ensure accurate and thorough patient record documentation? a. CAC b. CDI c. CERT d. CMS ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.3 - Apply clinical documentation improvement to ensure coding accuracy.

23. As part of clinical documentation improvement, a physician query is generated by the __________ when there is an issue with incomplete or inconsistent provider documentation. a. coder b. health care provider c. patient billing office d. third-party payer ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.3 - Apply clinical documentation improvement to ensure coding accuracy.

24. As part of clinical documentation improvement, DRG coding validation assists in the recovery of otherwise lost __________ to the health care facility. a. charges b. costs c. expenditures d. revenue Copyright Cengage Learning. Powered by Cognero.

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Chapter 10: Coding Compliance Programs, Clinical Documentation Improvement, and Coding for Medical Necessity ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.3 - Apply clinical documentation improvement to ensure coding accuracy.

25. As part of clinical documentation improvement, the review of a patient case who was discharged home when he should have been transferred to home health care is part of a __________ audit. a. coding b. level of care c. readmission d. transfer ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_10.3 - Apply clinical documentation improvement to ensure coding accuracy.

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Chapter 11: CMS-1500 and UB-04 Claims 1. Block 33 of the CMS-1500 claim requires entry of the name, address, and telephone number of the billing entity, which is the __________. a. last name of the provider who applied for an EIN b. legal business name of the practice c. name of the provider who started the practice d. provider who treats the most patients ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 2. Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS-1500 claim to allow for entry of __________ codes, and they are reported in Block 24E. a. CPT b. HCPCS level II c. ICD-10-CM d. ICD-10-PCS ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 3. The CMS-1500 paper claim was designed to accommodate optical scanning of __________ claims. a. electronic b. encrypted c. manual d. paper ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.2 - Explain general purposes and completion processes for CMS-1500 and UB-04 claims.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 11: CMS-1500 and UB-04 Claims 4. The optical scanning process uses a device that converts __________ characters into text that can be viewed by an optical character reader (OCR). a. electronic b. encrypted c. manual d. printed ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.2 - Explain general purposes and completion processes for CMS-1500 and UB-04 claims.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 5. Supplemental plans usually cover the deductible and copay or coinsurance of a primary health insurance policy. Which is the best known supplemental plan? a. Medicaid b. Medigap c. Medicare d. TRICARE ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.4 - Explain how CMS-1500 secondary claims are processed.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 6. Provider services for inpatient care are billed on a fee-for-service basis, and service results in a unique and separate charge designated by a __________ or HCPCS level II service/procedure code. a. CPT b. ICD-9-CM c. ICD-10-CM d. ICD-10-PCS ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 11: CMS-1500 and UB-04 Claims 7. Hospital inpatient charges are reported on the __________ claim. a. CMS-1500 b. UB-92 c. UB-02 d. UB-04 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.2 - Explain general purposes and completion processes for CMS-1500 and UB-04 claims.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 8. HIPAA administrative simplification regulations require all payers to accept __________ claims attachments. a. electronic b. encrypted c. manual d. paper ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.2 - Explain general purposes and completion processes for CMS-1500 and UB-04 claims.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 9. When completing the CMS-1500, enter a __________ between the CPT or HCPCS level II code and any modifiers. a. dash b. hyphen c. period d. space ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 10. When reporting procedures and services on the CMS-1500, list one procedure per line, starting with line one of Block 24. To report more than six procedures or services for the same date of service, __________.

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Chapter 11: CMS-1500 and UB-04 Claims a. enter multiple codes on the same line in Block 24 b. generate a new claim to enter more procedures/services c. increase the number of units entered in Block 24G d. use the shaded lines in Block 24 of the first CMS-1500 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 11. When a person uses a title such as Sr., Jr., II, or III, __________. a. always include it after entry of the person’s last name on the CMS-1500 claim b. do not enter it on the claim unless printed on the patient’s insurance ID card c. enter the title on the claim if instructed to do so by the patient or beneficiary d. verify the use of the title with the patient or guarantor before entering on the claim ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 12. A nonphysician practitioner bills __________ a physician? a. appealed claims for b. clinical trials provided by c. incident to d. noncovered services with ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 13. Which of the following health care professionals are permitted to bill under a physician’s name when that physician provides direct supervision of procedures/services?

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Chapter 11: CMS-1500 and UB-04 Claims a. medical assistant b. nonphysician practitioner c. nurse d. pharmacist ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 14. Which is a licensed physician in good standing who, according to state regulations, engages in the direct management of nonphysician practitioners whose duties are encompassed by that physician’s scope of practice? a. attending physician b. managing physician c. primary care physician d. supervising physician ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 15. Patients sign Block 13 of the CMS-1500 claim to instruct the payer to directly reimburse the provider. This concept is called __________. a. accept assignment b. assignment of benefits ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 16. When the YES box in Block 27 of the CMS-1500 claims contains an X, the provider agrees to receive as payment in full whatever the payer reimburses. This concept is called __________. a. accept assignment Copyright Cengage Learning. Powered by Cognero.

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Chapter 11: CMS-1500 and UB-04 Claims b. assignment of benefits ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 17. ICD-10-CM diagnosis codes are entered in Block 21 of the CMS-1500 claim. A maximum of __________ ICD-10CM codes may be entered on a single claim. a. 4 b. 8 c. 12 d. 16 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 18. Diagnoses must be entered in the patient’s record to validate __________ of procedures or services billed. a. documentation b. frequency c. medical necessity d. submission ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 19. The code reported in Block 21A of the CMS-1500 claim is the major reason the patient was treated by the health care provider. It is called the __________ diagnosis. a. comorbid b. first-listed c. primary Copyright Cengage Learning. Powered by Cognero.

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Chapter 11: CMS-1500 and UB-04 Claims d. principal ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 20. When entering codes for diagnoses on a CMS-1500 claim, uncertain diagnosis codes (e.g., possible, probable) are never reported. Instead, codes for the patient’s __________ are entered. a. acute conditions b. chronic diagnoses c. laboratory tests d. signs or symptoms ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 21. The MUE project was implemented by CMS as part of the NCCI to improve the accuracy of Medicare payments by __________. a. comparing units of service with payment requested on submitted claims b. detecting and denying unlikely Medicare claims on a prepayment basis c. reimbursing submitted claims within 30 days of receipt and adjudication d. reporting errors due to inappropriate units of service, reducing overpayments ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 22. Institutional and other selected providers submit __________ claim data to payers for reimbursement of patient services. a. CMS-1500 b. UB-92 Copyright Cengage Learning. Powered by Cognero.

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Chapter 11: CMS-1500 and UB-04 Claims c. UB-02 d. UB-04 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.8 - Complete a UB-04 claim for outpatient care.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 23. Which is an example of an ICD-10-CM code as entered on the CMS-1500 claim? a. E11 9 b. E119 c. E11.9 d. E11-9 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.3 - Describe data entry requirements for the CMS-1500 claim.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 24. Which is a common error that delays CMS-1500 claims processing? a. Dates of service for physician office encounters b. Incomplete patient names c. Prior treatment authorization numbers d. Units of service ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.5 - Describe common errors that delay CMS-1500 claims processing.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 25. The Federal Privacy Act of 1974 prohibits a payer from notifying the provider about payment or rejection of unassigned claims or payments sent directly to the patient/policyholder. Thus, for providers to properly assist patients with appealing denied claims, the patient must provide a copy of the __________ received from the payer. a. CMS-1500 claim b. explanation of benefits Copyright Cengage Learning. Powered by Cognero.

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Chapter 11: CMS-1500 and UB-04 Claims c. remittance advice d. UB-04 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_11.7 - Explain how CMS-1500 claims are maintained for a medical practice.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM

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Chapter 12: Commercial Insurance 1. Which type of health insurance covers the medical expenses of individuals (e.g., private health insurance) and groups (e.g., employer group health insurance)? a. commercial b. disability c. liability d. workers’ compensation ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.2 - Explain the characteristics of commercial insurance plans.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 2. Which is associated with “last resort” health insurance for individuals who cannot obtain coverage due to a serious medical condition? a. association health insurance b. high-risk pool c. indemnity insurance d. managed care ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.2 - Explain the characteristics of commercial insurance plans.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 3. Which is traditional fee-for-service health insurance that covers a portion of services, such as inpatient hospitalizations or physician office visits, with the patient paying the remaining costs? a. association health insurance b. high-risk pool c. indemnity insurance d. managed care ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.2 - Explain the characteristics of commercial insurance plans.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 4. Which includes health maintenance organizations and preferred provider organizations?

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Chapter 12: Commercial Insurance a. association health insurance b. high-risk pool c. indemnity insurance d. managed care ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.2 - Explain the characteristics of commercial insurance plans.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 5. Which is offered to members and marketed to small business owners as a way to provide coverage to employees? a. association health insurance b. high-risk pool c. indemnity insurance d. managed care ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.2 - Explain the characteristics of commercial insurance plans.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 6. Group health insurance is available through employers and other organizations, and all or part of the premium costs are paid by employers. Employer-based group health insurance __________. a. covers all employees, regardless of health status, and cannot be canceled if an employee becomes ill b. excludes COBRA continuation coverage upon employee resignation or another qualifying event and lasts for 18 to 36 months, depending on the employee’s situation c. prohibits employer-limited plan options, such as a prescription drug plan that covers a certain list of medications, which is called a formulary d. requires exclusions for pre-existing conditions, which means the payer excludes all employees from coverage for pre-existing conditions ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.2 - Explain the characteristics of commercial insurance plans.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM Copyright Cengage Learning. Powered by Cognero.

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Chapter 12: Commercial Insurance 7. Which type of insurance is a contract between an individual and an insurance company whereby the individual pays a premium and, in exchange, the insurance company agrees to pay for specific vehicle-related financial losses during the term of the policy? a. automobile b. commercial c. liability d. workers’ compensation ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.3 - Differentiate among automobile, disability, and liability insurance.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 8. Which type of automobile insurance pays for damage to a covered vehicle caused by hitting an object or being hit during an automobile accident? a. collision b. comprehensive c. liability d. personal injury protection ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.3 - Differentiate among automobile, disability, and liability insurance.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 9. Which type of automobile insurance pays for loss of or damage to a covered vehicle, such as that caused by fire, flood, hail, impact with an animal, theft, vandalism, or wind? a. collision b. comprehensive c. liability d. personal injury protection ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.3 - Differentiate among automobile, disability, and liability insurance.

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Chapter 12: Commercial Insurance DATE CREATED: DATE MODIFIED:

11/1/2022 11:59 AM 11/1/2022 11:59 AM

10. Which type of automobile insurance pays for accidental bodily injury and property damage to others, including medical expenses, pain and suffering, lost wages, and other special damages? a. collision b. comprehensive c. liability d. personal injury protection ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.3 - Differentiate among automobile, disability, and liability insurance.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 11. Which type of automobile insurance reimburses medical expenses for covered individuals, regardless of fault, for treatment due to an automobile accident? a. collision b. comprehensive c. liability d. personal injury protection ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.3 - Differentiate among automobile, disability, and liability insurance.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 12. Which type of insurance is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury? a. commercial b. disability c. liability d. workers’ compensation ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 12: Commercial Insurance LEARNING OBJECTIVES: UHI_GREEN_24_12.3 - Differentiate among automobile, disability, and liability insurance.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 13. The base period of a disability policy usually covers 12 months and is divided into four __________ quarters. a. concurrent b. consecutive c. equal d. fiscal ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.3 - Differentiate among automobile, disability, and liability insurance.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 14. Which type of insurance covers losses to a third party caused by the insured, by an object owned by the insured, or on premises owned by the insured? a. commercial b. health c. liability d. workers’ compensation ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.3 - Differentiate among automobile, disability, and liability insurance.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 15. Which refers to the contractual right of a third-party payer to recover health care expenses from a liable party? a. adjudication b. arbitration c. mediation d. subrogation ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 12: Commercial Insurance LEARNING OBJECTIVES: UHI_GREEN_24_12.3 - Differentiate among automobile, disability, and liability insurance.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 16. Third-party recovery standards for investigation of liability coverage and the process for filing a lien in a potential liability case vary on a federal and state basis. A lien is defined as __________. a. arbitrating requested payments from owners of liability insurance b. mediating between parties involved in a liability case to resolution c. processing submitted liability claims to remunerate injured parties d. securing a debtor’s property as security or payment for a debt ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.3 - Differentiate among automobile, disability, and liability insurance.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 17. When the same payer issues the primary, secondary, or supplemental policies, the correct procedure for submitting the claim would be to submit __________. a. a separate claim for each policy b. one claim for all policies c. primary first, followed by secondary and supplemental d. three separate claims ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.5 - Complete commercial insurance secondary claims.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 18. If a patient is covered by two different policies, the usual procedure for submitting a claim would be __________. a. a separate claim to each payer for each policy, submitted at the same time b. one claim; the primary payer will submit a claim to the secondary payer c. to submit to the primary payer first, followed by submitting to the secondary after primary payment is received d. to submit all claims to all payers at the same time ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 12: Commercial Insurance LEARNING OBJECTIVES: UHI_GREEN_24_12.5 - Complete commercial insurance secondary claims.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 19. One CMS-1500 claim is submitted to just the primary health plan when the patient is covered by

__________. a. a single different commercial health plan b. an EGHP and Medicare c. each parent on two different EGHPs d. two different EHGPs ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.4 - Complete commercial insurance primary claims.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM 20. Mike Smith is employed by a college, which provides individual and family group health plan coverage. His

employer pays 80 percent of the annual premium. He selected family coverage for his group health plan, which means the employer pays $15,000 per year (of the $18,000 annual premium). Mike is responsible for 20 percent of the annual premium (or $3,000). How much is deducted from each of Mike’s 26 biweekly paychecks? a. $23.07 b. $115.38 c. $576.92 d. $692.31 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_12.6 - Complete commercial group health plan claims.

DATE CREATED: 11/1/2022 11:59 AM DATE MODIFIED: 11/1/2022 11:59 AM

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Chapter 13: BlueCross BlueShield 1. The forerunner of what is known today as the BlueCross plan began in 1929 when Baylor University Hospital in Dallas, Texas, approached teachers in the Dallas school district with a plan that would guarantee up to 21 days of hospitalization per year for subscribers and each of their dependents, in exchange for a $6 annual premium. This was considered a __________ plan. a. postpaid b. prepaid c. retrospective d. traditional ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.2 - Explain the purpose, origin, and features of BlueCross BlueShield.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 2. By 1932 some plans modified the prepaid plan concept and organized community-wide programs that allowed the subscriber to be hospitalized in one of several member hospitals in accordance with signed contracts to provide services __________. a. at no charge to the patient b. for negotiated special rates c. on an emergency basis only d. when the patient needed surgery ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.2 - Explain the purpose, origin, and features of BlueCross BlueShield.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 3. BlueShield plans were created as the result of a resolution passed by the House of Delegates at an American Medical Association meeting in 1938. This resolution supported the concept of __________ health insurance that would encourage physicians to cooperate with prepaid health care plans. a. commercial b. mandatory c. profit d. voluntary ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 13: BlueCross BlueShield LEARNING OBJECTIVES: UHI_GREEN_24_13.2 - Explain the purpose, origin, and features of BlueCross BlueShield.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 4. BlueCross plans originally covered only hospital bills, and BlueShield plans covered fees for physician services, and there was close cooperation between the plans that resulted in joint ventures where the two corporations were housed in one building. In these joint ventures, BlueCross BlueShield (BCBS) __________. a. contracted with providers to offer hospital and physician services, regardless of plan b. merged as a single corporate entity and was able to significantly reduce premium costs c. provided health care services and procedures to subscribed patients in the building d. shared one building and computer services but maintained separate corporate identities ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.2 - Explain the purpose, origin, and features of BlueCross BlueShield.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 5. Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are __________. a. distributed to shareholders and officers b. paid to the federal government as taxes c. returned to the nonprofit corporation d. sent to beneficiaries who paid premiums ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.2 - Explain the purpose, origin, and features of BlueCross BlueShield.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 6. Participating providers contract to participate in a BCBS plan’s preferred provider network (PPN), which is a program that requires providers to adhere to __________ care provisions. a. hospital b. managed c. prospective d. retrospective ANSWER: b POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 13: BlueCross BlueShield QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.2 - Explain the purpose, origin, and features of BlueCross BlueShield.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 7. BCBS fee-for-service __________ coverage includes additional benefits, such as office visits, physical and occupational therapy, and mental health encounters. a. basic b. contractual c. major medical d. traditional ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 8. Some BCBS contracts also include one or more riders, which are special clauses that stipulate additional coverage __________ the standard contract. a. combined into b. instead of c. over and above d. that is part of ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 9. The BCBS special accidental injury rider covers nonsurgical care sought and rendered within 24 to 72 hours of the accidental injury, depending on plan benefits. Surgical care is subject to any established contract __________ plan deductibles and copayments. a. basic b. major medical ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 13: BlueCross BlueShield LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 10. The medical emergency care rider covers __________ treatment sought and received for sudden, severe, and unexpected conditions that if not treated would place the patient’s health in permanent jeopardy or cause permanent impairment or dysfunction of an organ or body part. a. continuous b. immediate c. protracted d. recurring ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 11. BCBS indemnity coverage offers choice and flexibility to subscribers who want to receive a full range of benefits along with the __________. a. freedom to use any licensed health care provider b. option to use network-based health care providers c. requirement of obtaining referrals to providers d. restriction of selecting a primary care provider ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 12. The BCBS coordinated home health and hospice care program allows patients with this option to elect an alternative to __________ or long-term care settings. a. acute b. emergency c. outpatient d. rehabilitation ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 13: BlueCross BlueShield LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 13. The BCBS outpatient pretreatment authorization plan (OPAP) requires preauthorization of outpatient physical, occupational, and speech therapy services. Other terms for OPAP include precertification and __________ authorization. a. point-of-service b. preferred c. prospective d. retrospective ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 14. The BCBS PPO plan is sometimes described as a subscriber-driven program, and BCBS substitutes the term subscriber or __________ for policyholder. a. member b. patient c. payer d. provider ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 15. BCBS has a mandatory second surgical opinion (SSO) requirement necessary when a patient is considering elective, nonemergency surgical care. The initial surgical recommendation must be made by a physician qualified to perform the anticipated surgery. If a second surgical opinion is not obtained prior to surgery, the patient’s out-of-pocket expenses may be __________. a. eliminated b. increased c. reduced d. waived ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 13: BlueCross BlueShield HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 16. The BlueCross BlueShield Federal Employee Program (FEP) is a(n) __________ health benefits program established by an Act of Congress in 1959. a. employer-sponsored b. government-sponsored c. payer-sponsored d. state-sponsored ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 17. FEP cards contain the phrase __________ under the BCBS trademark. a. BCBS Supplemental Plan b. Federal Employee Program c. Government-Wide Service Benefit Plan d. Health Care Anywhere ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 18. BCBS corporations offer several federally designed and regulated Medicare supplemental plans that augment the Medicare program by paying for Medicare deductibles and copayments. These plans are usually identified by the word __________ on the patient’s plan ID card. a. Medicaid b. Medicare c. Medigap d. MediSupp ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 13: BlueCross BlueShield LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 19. Health care anywhere coverage allows members of the independently owned and operated BCBS plans to have access to health care benefits throughout the __________, depending on their home plan benefits. a. preferred provider network b. state in which they reside c. United States only d. United States and world ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 20. The BlueCard® program enables members to obtain health care services while traveling or living in another BCBS plan’s service area, which means they can receive __________. a. benefits of their home plan contract and access to local provider networks b. health care services from out-of-network providers where they are traveling c. optional services and procedures not in their contract, if they are traveling d. reimbursement if they have to receive services from nonparticipating providers ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/12/2022 7:30 AM 21. The Away From Home Care Program® allows participating BCBS plan members who are temporarily residing outside of their home HMO service area for at least 90 days to temporarily enroll with a local __________. a. health maintenance organization b. managed care company c. nonparticipating provider d. out-of-network provider ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

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Chapter 13: BlueCross BlueShield DATE CREATED: DATE MODIFIED:

11/1/2022 12:00 PM 11/1/2022 12:00 PM

22. GeoBlue(R) provides __________ health care coverage for United States based individuals who also live, travel, and work outside of the United States. a. county-wide b. international c. national d. state-wide ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.3 - Differentiate among BlueCross BlueShield plans.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 23. The usual, customary, and reasonable (UCR) basis is the amount providers commonly charge for a

particular service within a particular geographic region; the UCR amount is used by BCBS to establish __________. a. allowable rates b. copayment amounts c. limiting charges d. policy premiums ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.4 - Describe BlueCross BlueShield billing notes when completing CMS-1500 claims.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 24. When a patient is covered by a BCBS employer group health plan (EGHP) and Medicaid, which is

considered primary? a. BCBS plan b. Medicaid c. Neither the BCBS plan nor Medicaid is considered primary. d. The BCBS plan and Medicaid split health care cost 50/50.

ANSWER: POINTS: QUESTION TYPE: HAS VARIABLES:

a 1 Multiple Choice False

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Chapter 13: BlueCross BlueShield LEARNING OBJECTIVES: UHI_GREEN_24_13.5 - Complete BlueCross BlueShield primary claims.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 25. When a patient has different BCBS plan, the CMS-1500 claim is first submitted to the primary BCBS payer,

and after that payer processes the claim and second CMS-1500 claim is submitted to the secondary or supplemental payer along with a copy of the primary payer’s __________. a. allowable charges b. explanation of benefits c. fee schedule d. remittance advice ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_13.6 - Complete BlueCross BlueShield secondary claims.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM

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Chapter 14: Medicare 1. Which program pays for inpatient hospital critical care access, skilled nursing facility stays, hospice care, and some home health care? a. Medicare Part A b. Medicare Part B c. Medicare Part B d. Medicare Part D ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 2. Which program pays for physician services, outpatient hospital care, and durable medical equipment? a. Medicare Part A b. Medicare Part B c. Medicare Part C d. Medicare Part D ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 3. Which program includes managed care and private fee-for-service plans that provide contracted care to Medicare patients? a. Medicare Part A b. Medicare Part B c. Medicare Part C d. Medicare Part D ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

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Chapter 14: Medicare DATE CREATED: DATE MODIFIED:

11/1/2022 12:00 PM 11/1/2022 12:00 PM

4. Which program added prescription medication coverage to the original Medicare plan, some Medicare cost plans, some Medicare private fee-for-service plans, and Medicare medical Savings Account Plans? a. Medicare Part A b. Medicare Part B c. Medicare Part C d. Medicare Part D ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 5. Which insurance claim is submitted to receive reimbursement under Medicare Part A? a. CMS-1500 b. CMS-1500 or UB-04 c. CMS-1500 and UB-04 d. UB-04 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 6. The Medicare Summary Notice (MSN) is mailed to Medicare patients as a type of monthly __________. a. advance beneficiary notice b. explanation of benefits c. insurance claim d. remittance advice ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.7 - Describe the purpose of a Medicare Summary Notice.

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Chapter 14: Medicare DATE CREATED: DATE MODIFIED:

11/1/2022 12:00 PM 11/1/2022 12:00 PM

7. Which applies when the physician and a qualified nonphysician provider each personally perform a substantive portion of a medical necessary evaluation and management service for the same patient on the same date of service? a. durable medical equipment claims processing b. Medicare split/shared visit payment policy c. special handling of Medicare claims d. telehealth evaluation and management services ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.8 - Describe Medicare Billing notes when completing CMS1500 claims.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 8. Medicare beneficiaries can also obtain supplemental insurance to help cover costs not reimbursed by the original Medicare plan. This type of coverage is called __________. a. Medicaid b. Medicare PLUS c. Medigap d. PACE ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 9. An initial enrollment period (IEP) that provides an opportunity for the individual to enroll in Medicare Part A and/or Part B is for a period of __________ months. a. 3 b. 6 c. 7 d. 9 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False Copyright Cengage Learning. Powered by Cognero.

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Chapter 14: Medicare LEARNING OBJECTIVES: UHI_GREEN_24_14.2 - Explain Medicare eligibility and enrollment guidelines.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 10. Individuals who wait until they turn 65 to apply for Medicare will cause a delay in the start of Part B coverage, because they will have to wait until the next __________ enrollment period, which is held January 1 through March 31 of each year, with Part B coverage starting on July 1 of that year. a. beneficiary b. general c. initial d. special ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.2 - Explain Medicare eligibility and enrollment guidelines.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 11. Mary Smith is working full time and enrolled in Medicare Part A at age 65. She decided not to enroll in Medicare Part B at that time because her employer group health insurance coverage reimburses for physician and other outpatient encounters. Mary is eligible to enroll in Medicare Part B anytime during a(n) __________ enrollment period, which is a set time when individuals can sign up for Medicare Part B if they did not enroll when they applied for Medicare Part A. a. beneficiary b. general c. initial d. special ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.2 - Explain Medicare eligibility and enrollment guidelines.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 12. Which program helps individuals whose assets are not low enough to qualify them for Medicaid by requiring states to pay their Medicare Part A and B premiums, deductibles, and coinsurance amounts? a. qualified Medicare beneficiary program b. qualified disabled working individual c. qualifying individual d. specified low-income Medicare beneficiary ANSWER: a POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 14: Medicare QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.2 - Explain Medicare eligibility and enrollment guidelines.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 13. Which program helps low-income individuals by requiring states to pay their Medicare Part B premiums? a. qualified Medicare beneficiary program b. qualified disabled working individual c. Programs of All-Inclusive Care for the Elderly d. specified low-income Medicare beneficiary ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.2 - Explain Medicare eligibility and enrollment guidelines.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 14. Which program helps individuals who received Social Security and Medicare because of disability, but who lost their Social Security benefits and free Medicare Part A because they returned to work and their earnings exceed the limit allowed, by requiring states to pay their Medicare Part A premiums? a. qualified Medicare beneficiary program b. qualified disabled working individual c. qualifying individual d. specified low-income Medicare beneficiary ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.2 - Explain Medicare eligibility and enrollment guidelines.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 15. A Medicare benefit period begins with the first day of hospitalization and ends when the patient has been out of the hospital for __________ consecutive days. a. 10 b. 30 c. 60 d. 90 ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 14: Medicare HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 16. Medicare lifetime reserve days, which total __________ days, are used once during a patient’s lifetime and are usually reserved for use during the patient’s final, terminal hospital stay. a. 30 b. 60 c. 90 d. 120 ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 17. Which is an autonomous, centrally administered program of coordinated inpatient and outpatient palliative (relief of symptoms) services for terminally ill patients and their families? a. home health b. hospice c. hospital d. respite ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 18. Which is the term for short-term care provided by another caregiver, so the usual caregiver can rest? a. home health care b. hospice care c. hospital care d. respite care Copyright Cengage Learning. Powered by Cognero.

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Chapter 14: Medicare ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 19. Private fee-for-service (PFFS) plans are offered by private insurance companies in some regions of the country, and Medicare pays a pre-established amount of money each month to the insurance company, which decides how much it will pay for services. Such plans reimburse providers on a fee-for-service basis and are authorized to charge enrollees up to __________ percent of the plan’s payment schedule. a. 50 b. 80 c. 100 d. 115 ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 20. Medicare special needs plans cover all Medicare __________ health care services for individuals who can benefit the most from special care for chronic illnesses, care management of multiple diseases, and focused care management. a. Part A only b. Part B only c. Parts A and B d. Parts A, B, and D ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM Copyright Cengage Learning. Powered by Cognero.

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Chapter 14: Medicare 21. Which is a type of HMO that works in much the same way and has some of the same rules as a Medicare Advantage Plan, except that the individual receives health care from a non-network provider, and the original Medicare plan covers the services? The individual pays Medicare Part A and Part B coinsurance and deductibles. a. Medicare Advantage b. Medicare Cost Plan c. Medicare Supplementary Insurance d. Medicare SELECT ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 22. Which is a combination Medicare and Medicaid option that combines medical, social, and long-term care services for frail people who live and receive health care in the community? a. Medicare SELECT b. PACE c. QMBP d. SLMB ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare coverage, including calculation of coinsurance/copayments for hospital outpatient services.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 23. Medicare __________ is a type of Medigap insurance that requires enrollees to use a network of providers to receive full benefits, which may result in lower premiums for enrollees. a. PACE b. PLUS c. SELECT d. SUPPLEMENT ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.3 - Explain the characteristics of different types of Medicare Copyright Cengage Learning. Powered by Cognero.

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Chapter 14: Medicare

DATE CREATED: DATE MODIFIED:

coverage, including calculation of coinsurance/copayments for hospital outpatient services.

11/1/2022 12:00 PM 11/1/2022 12:00 PM

24. The Balanced Budget Act of 1997 allows certain health care providers to withdraw from Medicare and enter into private contracts with their Medicare patients, which requires “opting out” of Medicare for at least __________ years for all covered items and services furnished to Medicare beneficiaries. a. 2 b. 4 c. 6 d. 8 ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.4 - Differentiate among participating, nonparticipating, and opt-out providers.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 25. An advance beneficiary notice of noncoverage (ABN) is a written document provided to a Medicare beneficiary by a supplier, physician, or provider, and the ABN must be presented to the patient __________. a. after Medicare has denied payment for the service b. at least one month before providing the service c. on the day the service or treatment is provided d. prior to providing the service or treatment ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.5 - Recognize when a Medicare advance beneficiary notice of noncoverage is required.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 26. A Medicare medical necessity denial is a denial of otherwise covered services that were found to be not __________. a. cost effective and necessary b. in compliance with critical pathways c. necessary and frequent d. reasonable and necessary ANSWER: d POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 14: Medicare QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.5 - Recognize when a Medicare advance beneficiary notice of noncoverage is required.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 27. Medicare will award an assigned claim conditional primary payer status and process the claim when a __________. a. patient who is physically or mentally impaired files a claim with the primary payer b. plan considered primary to Medicare issues a denial of payment that is under appeal c. liability payer responds by processing a submitted claim within 120 days of filing d. workers’ compensation claim has been approved and the provider reimbursed ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.6 - Distinguish between Medicare as primary payer and Medicare as secondary payer.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 28. A Medicare-Medicaid (Medi-Medi) crossover plan provides both Medicare and Medicaid coverage to __________ beneficiaries with low incomes. a. Medicaid b. Medicare c. Medigap d. TRICARE ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.11 - Complete Medicare-Medicaid (Medi-Medi) crossover claims.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 29. A simplified roster billing process was developed to enable Medicare beneficiaries to participate in mass __________ programs offered by public health clinics and other entities that bill Medicare payers. a. durable medical equipment b. PPV and influenza virus vaccination c. preventive care and screening d. well baby and well child care ANSWER: b POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 14: Medicare QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.13 - Complete Medicare roster billing claims.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM 30. A physician who does not accept Medicare and has signed an agreement to be excluded from the Medicare

program is referred to as a(n) __________ provider. a. nonparticipating b. opt-out c. participating d. private ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_14.4 - Differentiate among participating, nonparticipating, and opt-out providers.

DATE CREATED: 11/1/2022 12:00 PM DATE MODIFIED: 11/1/2022 12:00 PM

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Chapter 15: Medicaid 1. In 1965 Congress passed Title 19 of the Social Security Act of 1965, establishing a federally mandated, __________ administered medical assistance program for individuals with incomes below the federal poverty level. a. federal b. county c. municipal d. state ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.2 - Explain Medicaid eligibility guidelines.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/12/2022 7:33 AM 2. The federal name for the Title 19 medical assistance program is __________. a. CHAMPUS b. Medicaid c. Medicare d. TRICARE ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.2 - Explain Medicaid eligibility guidelines.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 3. Which describes annual income guidelines established by the federal government? a. federal poverty level b. medically needy Medicaid program c. Supplemental Security Income d. Temporary Assistance for Needy Families ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.2 - Explain Medicaid eligibility guidelines.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 4. Which is the current program that makes cash assistance available, for a limited time, for children deprived of support because of a parent’s absence, death, incapacity, or unemployment? a. Aid to Families with Dependent Children Copyright Cengage Learning. Powered by Cognero.

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Chapter 15: Medicaid b. Federal Medical Assistance Percentage c. Qualified Working Disabled Individuals d. Temporary Assistance for Needy Families ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.2 - Explain Medicaid eligibility guidelines.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 5. Which is the special group that requires states to pay Medicare premiums, deductibles, and coinsurance amounts for individuals whose income is at or below 100 percent of the federal poverty level and whose resources are at or below twice the standard allowed under SSI? a. qualified Medicare beneficiaries b. qualifying individuals c. qualified working disabled individuals d. specified low-income Medicare beneficiaries ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.2 - Explain Medicaid eligibility guidelines.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 6. Which is the special group that requires states to pay Medicare Part A premiums for certain disabled individuals who lose Medicare coverage because of work? a. qualified Medicare beneficiaries b. qualifying individuals c. qualified working disabled individuals d. specified low-income Medicare beneficiaries ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.2 - Explain Medicaid eligibility guidelines.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 7. Which is the special group that requires states to pay Medicare Part B premiums for individuals with incomes between 100 and 120 percent of the federal poverty level? a. qualified Medicare beneficiaries Copyright Cengage Learning. Powered by Cognero.

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Chapter 15: Medicaid b. qualifying individuals c. qualified working disabled individuals d. specified low-income Medicare beneficiaries ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.2 - Explain Medicaid eligibility guidelines.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 8. The Children’s Health Insurance Program (CHIP) was implemented in accordance with the Balanced Budget Act (BBA) to allow states to create or expand existing insurance programs, providing more federal funds to states for the purpose of expanding __________ eligibility to include a greater number of currently uninsured children. a. commercial insurance b. group health insurance c. Medicaid d. Medicare ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.2 - Explain Medicaid eligibility guidelines.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 9. Programs of All-inclusive Care for the Elderly (PACE) use a capitated payment system to provide a comprehensive package of community-based services as an alternative to institutional care for persons age 55 or older who require a(n) __________ level of care. a. acute inpatient b. nursing facility c. outpatient basis d. subacute hospital ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.2 - Explain Medicaid eligibility guidelines.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 10. The Medicare Catastrophic Coverage Act of 1988 implemented Spousal Impoverishment Protection Legislation in 1989 to prevent married couples from being required to spend down income and other liquid assets (cash and property) before one of the partners could be declared eligible for Medicaid coverage for nursing facility care. The Copyright Cengage Learning. Powered by Cognero.

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Chapter 15: Medicaid spouse residing at home is called the __________ spouse. a. community b. eligible c. partner d. surviving ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.2 - Explain Medicaid eligibility guidelines.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 11. Any time patients state that they receive Medicaid, they must present a valid Medicaid identification card because eligibility, in many cases, will depend on the patient’s __________ income. a. daily b. monthly c. weekly d. yearly ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.2 - Explain Medicaid eligibility guidelines.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 12. Which consists of routine pediatric checkups provided to all children enrolled in Medicaid, including dental, hearing, vision, and other screening services to detect potential problems? a. early and periodic screening, diagnostic, and treatment b. health care immunization and vaccination program c. preventive and maintenance care and screening d. well baby and well child encounters at provider offices ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.3 - Describe mandatory services included with Medicaid coverage.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 13. The portion of the Medicaid program paid by the federal government is called the Federal Medical Assistance Percentage (FMAP) and is determined annually for each state using a formula that compares __________ average Copyright Cengage Learning. Powered by Cognero.

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Chapter 15: Medicaid per capita income level with the national average. a. patient b. payer c. provider d. state ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.4 - Describe Medicaid reimbursement policies.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 14. When the patient is covered by other medical or liability policies, Medicaid reimburses providers __________. a. first b. last ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.4 - Describe Medicaid reimbursement policies.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 15. Any provider who accepts a Medicaid patient must accept the Medicaid-determined payment as __________. a. partial payment b. payment in full ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.4 - Describe Medicaid reimbursement policies.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 16. Which allows providers to electronically access the state’s eligibility file to verify Medicaid eligibility? a. CMS b. DEEDS c. DMV d. MEVS ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice Copyright Cengage Learning. Powered by Cognero.

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Chapter 15: Medicaid HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.4 - Describe Medicaid reimbursement policies.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 17. A(n) __________ claim has a payment correction, resulting in additional payment(s) to the provider. a. adjusted b. appealed c. filed d. voided ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.4 - Describe Medicaid reimbursement policies.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 18. A(n) __________ claim is one that Medicaid should not have originally paid, and results in a deduction from the lump-sum payment made to the provider. a. adjusted b. appealed c. filed d. voided ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.4 - Describe Medicaid reimbursement policies.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 19. Federal regulations require Medicaid to establish and maintain a(n) __________ program, which safeguards against unnecessary or inappropriate use of Medicaid services or excess payments and assesses the quality of those services. a. early and periodic screening, diagnostic, and treatment b. eligibility verification c. recipient eligibility verification d. surveillance and utilization review ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.4 - Describe Medicaid reimbursement policies.

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Chapter 15: Medicaid DATE CREATED: DATE MODIFIED:

11/1/2022 12:01 PM 11/1/2022 12:01 PM

20. A Medicaid card issued for the “Unborn child of ...,” includes the __________ on the card. a. birth father’s last name b. given name of the child c. name as BABY BOY or GIRL d. pregnant woman’s name ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_15.5 - Apply Medicaid billing notes when completing CMS-1500 claims.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM

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Chapter 16: TRICARE 1. Which is a health care program for active duty members of the military and their qualified family members? a. CHAMPUS b. CHAMPVA c. MEDICARE d. TRICARE ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.2 - Summarize major developments in the history of TRICARE. DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 2. The new name for TRICARE Standard is __________. a. CHAMPUS b. For Live c. Prime d. TRICARE Select ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.5 - Explain the TRICARE coverage options, special programs, and supplemental plans.

DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 3. Which term is used to describe the Army, Navy, Air Force, Marines, and Coast Guard, Public Health Service Commissioned Corps, and the National Oceanic and Atmospheric Administration (NOAA) Commissioned Corps? a. executive branches b. government agencies c. law enforcement d. uniformed services ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.2 - Summarize major developments in the history of TRICARE. DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 4. Commanders of selected military treatment facilities are called __________ for TRICARE regions.

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Chapter 16: TRICARE a. beneficiary services representatives b. health care finders c. lead agents d. primary care managers ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.2 - Summarize major developments in the history of TRICARE. DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 5. Which is the name of the entire health care system of the U.S. uniformed services and includes military treatment facilities as well as various programs in the civilian health care market, such as TRICARE? a. Defense Enrollment Eligibility Reporting System b. Military Services System c. TRICARE Program Management Organization d. TRICARE Service Center ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.2 - Summarize major developments in the history of TRICARE. DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 6. Health Affairs (HA) refers to the Office of the Assistant Secretary of Defense for Health Affairs, which is responsible for __________. a. military readiness and peacetime health care b. the military health care system in their region c. various programs in the civilian health care market d. working with uniformed service headquarters’ staffs ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.2 - Summarize major developments in the history of TRICARE. DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 7. The TRICARE Management Activity (TMA) coordinates and administers the TRICARE program and is accountable Copyright Cengage Learning. Powered by Cognero.

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Chapter 16: TRICARE for __________ health care provided to members of the uniformed services and their families. a. affordable b. efficient c. pathway d. quality ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 8. TRICARE __________ are uniformed service personnel who are either active duty, retired, or deceased. a. beneficiaries b. patients c. providers d. sponsors ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 9. When a patient seeks health care under the TRICARE program, sponsor information is verified in the __________ computer system, which contains up-to-date workforce personnel information. a. CMS b. DEERS c. DOD d. MTF ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 10. Which include sponsors and dependents of sponsors?

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Chapter 16: TRICARE a. beneficiaries b. coordinators c. finders d. representatives ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 11. TRICARE regions are served by one or more __________ who assist TRICARE sponsors with health care needs and answer questions about the program. a. military treatment facilities b. nurse advisors c. primary care managers d. service centers ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 12. A TRICARE __________ provides information about using TRICARE and assists with other matters affecting access to health care (e.g., appointment scheduling). a. customer service representative b. health care finder c. nurse advisor d. primary care manager ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:01 PM DATE MODIFIED: 11/1/2022 12:01 PM 13. A TRICARE __________ assists primary care providers with preauthorizations and referrals to health care services Copyright Cengage Learning. Powered by Cognero.

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Chapter 16: TRICARE in a military treatment facility or civilian provider network. a. customer service representative b. health care finder c. nurse advisor d. primary care manager ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 14. TRICARE __________ are available 24/7 for advice and assistance with treatment alternatives and to discuss whether a sponsor should see a provider based on a discussion of symptoms, and they will also discuss preventive care and ways to improve a family’s health. a. customer service representatives b. health care finders c. nurse advisors d. primary care managers ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 15. Which is the entire health care system of the U.S. uniformed services and includes military treatment facilities as well as various programs in the civilian health care market, such as TRICARE? a. acute care hospital stay Health Affairs (HA) b. Military Health System (MHS) c. TRICARE d. Veterans Health Administration (VHA) ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM Copyright Cengage Learning. Powered by Cognero.

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Chapter 16: TRICARE 16. Which are located at military treatment facilities and are available to answer questions, help solve health care–related problems, and assist beneficiaries in obtaining medical care through TRICARE? a. beneficiary counseling and assistance coordinators b. debt collection assistance officers c. health care finders d. nurse advisors ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 17. Which are located at military treatment facilities to assist beneficiaries in resolving health care collection–related issues? a. beneficiary counseling and assistance coordinators b. debt collection assistance officers c. health care finders d. nurse advisors ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 18. Which is the sequence of activities that can normally be expected to result in the most cost-effective clinical course of treatment? a. critical pathway b. discharge planning c. pre-certification d. utilization management ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:02 PM Copyright Cengage Learning. Powered by Cognero.

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19. Which are decision-making tools used by providers to determine appropriate health care for specific clinical circumstances? a. critical pathways b. living wills c. practice guidelines d. revenue management ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 20. Which is responsible for the surveillance of fraud and abuse activities worldwide involving purchased care for beneficiaries in the Military Health Care System? a. Department of Defense b. Office of Inspector General c. Program Integrity Office d. TRICARE management activity ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.3 - Summarize the parties and processes involved in the administration of TRICARE. DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 21. Which is a comprehensive health care program for which the Department of Veterans Affairs shares costs of covered health care services and supplies with eligible beneficiaries? a. CHAMPUS b. CHAMPVA c. Medicare d. TRICARE ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.4 - Define CHAMPVA. DATE CREATED: 11/1/2022 12:02 PM Copyright Cengage Learning. Powered by Cognero.

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22. Which is the TRICARE managed care option similar to a civilian health maintenance organization? a. CHAMPUS b. TRICARE c. TRICARE Prime d. TRICARE Select ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.5 - Explain the TRICARE coverage options, special programs, and supplemental plans.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 23. Which is assigned to a TRICARE Prime sponsor and is part of the TRICARE provider network? a. beneficiary services representative b. health care finder c. nurse advisor d. primary care manager ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.5 - Explain the TRICARE coverage options, special programs, and supplemental plans.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 24. TRICARE Prime beneficiaries can receive care if they reside and work outside a military treatment facility __________ area, which is the region defined by code boundaries within a 40-mile radius of a military treatment facility. a. catchment b. local c. regional d. state ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.5 - Explain the TRICARE coverage options, special programs, and supplemental plans.

DATE CREATED: 11/1/2022 12:02 PM Copyright Cengage Learning. Powered by Cognero.

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25. The TRICARE benefit that protects beneficiaries from devastating financial loss due to serious illness or long-term treatment by establishing limits over which payment is not required is called the __________ cap benefit. a. calamitous b. cataclysmic c. catastrophic d. catchment ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.5 - Explain the TRICARE coverage options, special programs, and supplemental plans.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 26. Enrollees show their military ID card as proof of coverage when receiving health care that is covered by a. TRICARE b. TRICARE Select c. TRICARE Prime d. TRICARE Plus ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.5 - Explain the TRICARE coverage options, special programs, and supplemental plans.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 27. TRICARE Prime enrollees use their __________, which can be scanned each time they receive health care services. a. common access card b. driver’s license c. insurance ID d. military badge ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.5 - Explain the TRICARE coverage options, special programs, and supplemental plans.

DATE CREATED: 11/1/2022 12:02 PM Copyright Cengage Learning. Powered by Cognero.

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28. Which protects TRICARE beneficiaries from devastating financial loss due to serious illness or long-term

treatment by establishing limits over which payment is not required? a. common access card b. insurance certificate c. catastrophic cap benefit d. TRICARE select letter ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.5 - Explain the TRICARE coverage options, special programs, and supplemental plans.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 29. Which tests and establishes the feasibility of implementing a new program during a trial period, after which the program is evaluated, modified, and/or abandoned? a. catchment area b. demonstration project c. protocol plan d. research study ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.5 - Explain the TRICARE coverage options, special programs, and supplemental plans.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 30. TRICARE deductibles are applied to the government’s __________ year, which runs from October 1 of one year to September 30 of the next. a. calendar b. consecutive c. fiscal d. sequential ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_16.6 - Apply TRICARE billing notes when completing CMS-1500 claims.

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Chapter 17: Workers' Compensation 1. The Office of Workers’ Compensation Programs (OWCP) administers programs that provide wage-replacement benefits, medical treatment, vocational rehabilitation, and other benefits to federal workers (or eligible dependents) who are injured at work or acquire an occupational disease. In which federal department is the OWCP located? a. Department of Commerce b. Department of Health and Human Services c. Department of Labor d. Department of Veterans Affairs ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation programs.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 2. Which is an Office of Workers’ Compensation Programs (OWCP) program? a. Coal Mine Workers’ Compensation Program b. Federal Employment Liability Act c. Mine Safety and Health Administration d. Occupational Safety and Health Administration ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation programs.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 3. Effective July 31, 2001, the Energy Employees Occupational Illness Compensation Program (EEOICP) started providing benefits to eligible employees and former employees of the Department of Energy, its contractors and subcontractors, or to certain survivors of such individuals, and to certain beneficiaries of the Radiation Exposure Compensation Act. Which is responsible for adjudicating and administering claims filed by employees, former employees, or certain qualified survivors? a. Centers for Medicare and Medicaid Services (CMS) b. Division of Coal Mine Workers’ Compensation c. State Insurance Fund (or State Compensation Fund) d. Office of Workers’ Compensation Programs (OWCP) ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation Copyright Cengage Learning. Powered by Cognero.

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Chapter 17: Workers' Compensation

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programs.

11/1/2022 12:02 PM 11/1/2022 12:02 PM

4. The Coal Mine Workers’ Compensation Program provides medical treatment and other benefits for __________ conditions related to former employment in the nation’s coal mines. a. cardiovascular b. integumentary c. respiratory d. work injuries and ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation programs.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 5. The Longshore and Harbor Workers’ Compensation Program, administered by the U.S. Department of Labor, provides medical benefits, compensation for lost wages, and rehabilitation services to longshoremen, harbor workers, and other maritime workers who are __________. a. injured during employment only b. injured from or suffer diseases during employment c. injured and suffer diseases during employment, both of which must occur d. suffer diseases from employment only ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation programs.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 6. The U.S. Labor Department’s Mine Safety and Health Administration (MSHA) helps reduce deaths, injuries, and illnesses in U.S. mines through a variety of activities and programs. Which is an example of such an activity or program? a. Develops and enforces safety and health rules that apply to all U.S. mines b. Imprisons any mine operators who experience special compliance problems c. Mandates and charges for technical, educational, and other types of assistance d. Works in conflict with industry, labor, and other federal and state agencies ANSWER: a POINTS: 1 Copyright Cengage Learning. Powered by Cognero.

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Chapter 17: Workers' Compensation QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation programs.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 7. The Occupational Safety and Health Act of 1970 created the Occupational Safety and Health Administration (OSHA) to protect employees against injuries from occupational hazards in the workplace. OSHA and its state partners (of approximately 2,100 inspectors) establish protective __________, which are enforced. OSHA also reaches out to employers and employees by providing technical assistance and consultation programs. a. laws b. mandates c. regulations d. standards ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation programs.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 8. OSHA has special significance for those employed in health care because employers are required to obtain and retain manufacturers’ Material Safety Data Sheets (MSDS), which contain information about __________ used on site.

Training employees in the safe handling of these substances is also required. a. chemical and hazardous substances b. oral, IM, and IV medications c. possibly harmful agents only d. vaccinations and drugs ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation programs.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 9. The Merchant Marine Act (or Jones Act) provides seamen with the same protection from employer __________ as the Federal Employment Liability Act (FELA) provides railroad workers. a. assiduousness b. maintenance Copyright Cengage Learning. Powered by Cognero.

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Chapter 17: Workers' Compensation c. negligence d. oversight ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation programs.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 10. Workers’ compensation insurance provides weekly cash payments and reimburses health care costs for covered employees who develop a work-related illness or sustain an injury while on the job. It also provides payments to qualified dependents of a worker who dies from a compensable illness or injury. Each state establishes a workers’ compensation __________, which is responsible for administering workers’ compensation laws and handling appeals for denied claims or cases in which a worker feels compensation was too low. a. board b. fund c. plan d. program ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation programs.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 11. Which is a quasi-public agency that provides workers’ compensation insurance coverage to private and public employers and acts as an agent in state workers’ compensation cases involving state employees? a. combination program b. self-insurance plan c. state insurance fund d. workers’ compensation board ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation programs.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM Copyright Cengage Learning. Powered by Cognero.

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Chapter 17: Workers' Compensation 12. To qualify for workers’ compensation benefits, an employee must be injured while working within the scope of the job description, be injured while performing a service required by the employer, or develop a disorder that can be directly linked to employment, such as asbestosis or mercury poisoning. The worker does not have to be physically on company property to qualify for workers’ compensation. Which is an example of an on-the-job injury that would qualify the employee for workers’ compensation benefits? a. Employee develops pneumonia after working at the medical office all week. b. Employee faints at the grocery store and believes it is due to stress at work. c. Employee is injured when picking up reports for the office at the local hospital. d. Employee is injured in an accident during a trip to the bank to deposit personal checks.

ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.3 - Determine eligibility requirements for workers’ compensation coverage.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 13. Temporary disability claims cover health care treatment for illness and injuries as well as payment for __________. a. employer benefits b. lost wages c. medical services d. pain and suffering ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.4 - Explain how workers’ compensation cases are classified and billed.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 14. Permanent disability refers to an ill or injured employee’s __________ capacity to return to work. a. augmented b. diminished c. enhanced d. heightened ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.4 - Explain how workers’ compensation cases are classified and billed.

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Chapter 17: Workers' Compensation DATE CREATED: DATE MODIFIED:

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15. Vocational rehabilitation claims cover expenses for vocational retraining for both temporary and permanent disability cases. Vocational rehabilitation retrains an ill or injured employee so he or she can return to the workforce. The employee __________ of resuming the position held prior to the illness or injury. a. may be incapable b. must be capable ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.4 - Explain how workers’ compensation cases are classified and billed.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 16. Survivor benefits claims provide death benefits to eligible dependents. These benefit amounts are calculated according to the employee’s earning capacity __________. a. at the time of the illness or injury b. during the person’s expected lifetime ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.4 - Explain how workers’ compensation cases are classified and billed.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 17. First Report of Injury forms are completed by the __________ when treatment for a work-related illness or injury is sought. a. patient or patient’s representative b. physician or other health care provider c. state insurance fund or compensation board d. workers’ compensation board ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.6 - Describe documentation requirements for workers' compensation forms and reports.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM Copyright Cengage Learning. Powered by Cognero.

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Chapter 17: Workers' Compensation 18. When a workers’ compensation claim is denied, the employee (or eligible dependents) can appeal the denial to the state workers’ compensation board and undergo a process called __________, which is a judicial dispute resolution process in which an appeals board makes a final determination. a. adjudication b. arbitration c. mediation d. negotiation ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.7 - Define appeal and adjudication as they relate to workers’ compensation.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 19. Which is filed with the workers’ compensation board to document any significant change in the worker’s medical or disability status? a. copy of the entire patient’s medical record b. detailed narrative progress/supplemental report c. financial records, including encounter forms d. other documents that are not related to a disability ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.6 - Describe documentation requirements for workers' compensation forms and reports.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 20. Who is required to personally sign the original and all photocopies of reports submitted to the workers’ compensation board? a. attorney representing the patient b. both the patient and physician c. patient or legal representative d. physician or other health care provider ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.6 - Describe documentation requirements for workers' compensation forms and reports.

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Chapter 17: Workers' Compensation DATE CREATED: DATE MODIFIED:

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21. Which was created in 1946 to hear appeals for determinations and awards under the Federal Employees' Compensation Act (FECA) with respect to claims of federal employees injured in the course of their employment? a. ECAB b. FELA c. MSHA d. OSHA ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.2 - Describe federal and state workers’ compensation programs.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 22. Internal grievance and dispute resolution procedures involve the care and treatment provided by the

workers’ compensation program, along with an __________ process to the state workers’ compensation agency. a. adjudication b. adverse selection c. appeals d. assessment ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.5 - Explain how managed care applies to workers’ compensation coverage.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 23. Which is an example of workers’ compensation fraud? a. employee who provides a false statement about an on-the-job injury b. employer that submits employee classifications to the payer c. provider who collects copayments associated with a policy d. third-party payer that reimburses the provider directly ANSWER: a POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.8 - State examples of workers’ compensation fraud and Copyright Cengage Learning. Powered by Cognero.

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Chapter 17: Workers' Compensation

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abuse.

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24. Which pays workers’ compensation insurance premiums? a. employee b. employer c. provider d. third-party payer ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.9 - Describe workers’ compensation billing notes when completing CMS-1500 claims.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM 25. Which can occur when a patient fails to initially inform a provider that an illness or injury is work-related? a. The employer of the patient processes the insurance claim for payment of services provided. b. The patient’s primary payer may be mistakenly billed for services or procedures rendered. c. The provider’s liability insurance company coordinates payment with workers’ compensation. d. The workers’ compensation insurance company contacts the patient’s employer for resolution.

ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVES: UHI_GREEN_24_17.9 - Describe workers’ compensation billing notes when completing CMS-1500 claims.

DATE CREATED: 11/1/2022 12:02 PM DATE MODIFIED: 11/1/2022 12:02 PM

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