Ch 1: Content Review

Question 1

T/F: Nationally, unit values have been assigned for each service by Medicare (CPT and HCPCS) and determined on the basis of the resources necessary for the physician’s performance of the service.

Answer 1

True

Question 2

In the role as a medical coder, it is your responsibility to ensure that you code _____ and _____ to optimize reimbursement for services provided.

Answer 2

Accurately, Completely

Question 3

CMS

Answer 3

Centers for Medicare and Medicaid Services

Question 4

MAAC

Answer 4

Maximum Actual Allowable Charge

Question 5

What edition of the “Federal Register” would hospital facilities be especially interested in?

Answer 5

October

Question 6

The ____ program was developed by Congress to monitor the necessity of hospital admissions and review the treatment costs and medical records of hospitals.

Answer 6

?? PRO (Peer Review Organization)

Question 7

This program is also known as Medicare Advantage.

Answer 7

Part C

Question 8

What edition of the “Federal Register” would outpatient facilities be especially interested in?

Answer 8

November or December

Question 9

What are the incentives to Medicare participating providers?

Answer 9

• Direct payment on all claims
• A 5% higher fee schedule
• Faster processing

Question 10

The physician fee schedule is updated each April 15 and is composed of what?

Answer 10

• The relative value units for each service
• A geographic adjustment factor to adjust for regional variations in the cost of operations
• A national conversion factor

Question 11

RBRVS

Answer 11

Resource Based Relative Value Scale

Question 12

RBRVS

Answer 12

Resource Based Relative Value Scale

Question 13

CMS handles the daily operation of the Medicare program through the use of ____ ____ ____, formerly Fiscal Intermediaries

Answer 13

Medicare Administrative Contractors

Question 14

T/F: The “Federal Register” is the official publication for all “Presidential Documents,” “Rules and Regulations,” “Proposed Rules,” and “Notices.”

Answer 14

True

Question 15

OBRA

Answer 15

Omnibus Budget Reconciliation Act

Question 16

T/F: Kickbacks from patients are allowed under certain circumstances according to Medicare guidelines.

Answer 16

False

Question 17

QIO

Answer 17

Quality Improvement Organization

Question 18

Who handles the day-to-day operation of the Medicare program for the CMS?

Answer 18

MACs

Question 19

Part B services are billed using what?

Answer 19

• ICD-10-CM
• CPT
• HCPCS

Question 20

Medicare pays for what percentage of covered charges?

Answer 20

80%

Question 21

Medicare sets the payment level for assistant surgeons at a percentage of the fee schedule amount for the _____ surgical service.

Answer 21

Global

Question 22

Medicare Part B pays for what?

Answer 22

• Physician services

- Durable medical equipment

Question 23

Under the RBRVS, the unit value is termed ____ Value Unit.

Answer 23

Relative

Question 24

What are the three items that the Medicare beneficiaries are responsible to pay before Medicare will begin to pay for services?

Answer 24

• Deductibles
• Premiums
• Coinsurance

Question 25

RVU

Answer 25

Relative Value Unit

Question 26

The _____ is a national dollar amount that is applied to all services paid on the basis of the MFS.

Answer 26

Conversion Factor (CF)

Question 27

Medicare Part A pays for what?

Answer 27

Hospital/facility care

Question 28

For endoscopic procedures Medicare allows the full value of the highest valued endoscopy, plus the difference between the next highest endoscopy and the _____ endoscopy.

Answer 28

Highest

Question 29

T/F: The coder’s responsibility is to ensure that the data are as accurate as possible not only for classification and study purposes but also to obtain appropriate reimbursement.

Answer 29

True

Question 30

DHHS

Answer 30

Department of Health and Human Services

Question 31

The Medicare program was established in what year?

Answer 31

1965

Question 32

The amount determined by multiplying the RVU weight by the geographic index and the conversion factor is called the _____ amount.

Answer 32

Limiting

Question 33

OIG

Answer 33

Office of the Inspector General

Question 34

If a surgeon performs more than one procedure on the same patient on the same day, and discounts were made on all subsequent procedures, Medicare would pay what percentage for the first, second, third, fourth, and fifth procedures?

Answer 34

• 100%, 50%, 50%, 25%, 25%