EOS EXAM ANSWERS

Question 1

Medicare’s allowed charge for an in-office procedure is $200.00. Dr Smith is a PAR physician and Dr. Jones is a nonPAR physician who does not accept assignment. How much will Dr. Smith and Dr. Jones, respectively, receive from CMS?

Answer 1

$200.00 x 80% = $160.00

CMS does not reimburse nonPAR physicians not accepting assignment, they reimburse the patient.

Question 2

Which appendix in CPT describes the vascular families, detailing the first, second, third, and beyond the third order branches of each family?

Answer 2

Appendix L of the CPT codebook describes the vascular families and details the first, second, third, and beyond the third order branches of each family.

Question 3

The directional term “contralateral” means:

Answer 3

located or occurring in (on) the opposite side.

Question 4

Arterial catheterization relative to interventional radiology has specific rules that must be followed in order to correctly capture all services provided. Which of the following rules in INCORRECT?

Answer 4

Access to different vascular families during the same procedure will be reported with one code.

Question 5

A physician who agrees to accept payment in full of the allowed charge from the Medicare Physician Fee Schedule is called a:

Answer 5

Participating provider (PAR)

Question 6

If the Medicare non-PAR approved amount is $128.00 for a proctoscopy, what is the total Medicare approved amount for a doctor who does not accept assignment, applying the limiting charge for this procedure?

Answer 6

$147.20

Question 7

When mesh is used for a hernia repair, it can be reported separately with an add-on code when performing which type of repair?

Answer 7

incisional and ventral

Question 8

In which type of fracture treatment is the fracture not open to view, but fixation is utilized?

Answer 8

Percutaneous treatment

Question 9

Which type of laboratory study is being performed to measure the exact amount of a drug that has previously been identified as being present?

Answer 9

quantitative

Question 10

A radiologist is asked to review a patient’s CT scan that was taken at another facility. The modifier -26 attached to the code indicates that the physician is billing for what component of the procedure?

Answer 10

Professional

Question 11

A pulmonologist performs a diagnostic bronchoscopy with biopsy. The endoscope was introduced into the bronchus, and attachments were used to perforate the bronchial wall. Tissue was obtained and submitted to the pathologist, who identified it as “lung parenchyma.” What type of biopsy was performed?

Answer 11

transbronchial biopsy

Question 12

The standard claim form used by physicians to request reimbursement for procedures performed or services provided is called the

Answer 12

CMS 1500

Question 13

Which of the following refers to a statement sent to the Medicare beneficiary and the facility to notify all parties of what was billed by the provider, the amounts approved by Medicare, how much Medicare reimbursed the provider, and what the patient must pay the provider by way of deductible and copayments?

Answer 13

MSN

Question 14

In coding arterial catheterizations, when the tip of the catheter is manipulated from the insertion point into the aorta and then removed after completion of the procedure, this is called:

Answer 14

nonselective catheterization

Question 15

Regarding the reporting of treatment for an open fracture, when the physician manipulates the bone fragments into anatomical alignment without surgical exposure, this is referred to as:

Answer 15

closed treatment.

Question 16

Codes in the Cardiovascular System subsection of CPT are divided first by body part and then by:

Answer 16

procedure performed.

Question 17

The transmission of claims data to payers or clearinghouses occurs in which area of the revenue cycle?

Answer 17

Claims processing

Question 18

What instrument is used to notify the provider with information about claim rejections, denials, and payments?

Answer 18

Remittance Advice

Question 19

Medicare’s allowed charge for an in-office procedure is $200.00. Dr Smith is a PAR physician and Dr. Jones is a nonPAR physician who does not accept assignment. How much will Dr. Smith and Dr. Jones, respectively, receive in total for this procedure?

Answer 19

The PAR physician will receive in total the allowed charge of $200.00.
The nonPAR will apply the Limiting Charge (115%) to the nonPAR Fee Schedule amount (MPFS - 5%) of $190.00 ($190.00 x 115%) and will receive in total $218.50.

Question 20

In the hospital setting, what computer program is used to automate the billing of pathology and laboratory services?

Answer 20

chargemaster

Question 21

When should an Integumentary subsection abscess incision code be used instead of a Musculoskeletal subsection abscess incision code?

Answer 21

For superficial incisions.

Question 22

The amount that a nonparticipating (nonPAR) physician who does not accept assignment can bill a Medicare beneficiary is called the:

Answer 22

Limiting charge

Question 23

Assume that the patient has already met the yearly deductible and that the physician is a nonPAR provider not accepting assignment with Medicare on this claim. The provider’s usual charge for the service provided is $400.00. Medicare’s PAR allowed charge is $100.00 and the nonPAR allowed charge is $95.00. How much reimbursement will the physician receive from Medicare?

Answer 23

The physician will not receive any money from Medicare. Medicare will reimburse the patient 80% of the nonPAR MPFS amount.