Medicare & Coding

Question 1

As a coder you are to stay abreast of current and changing: (2)

Answer 1

Reimbursement policies
Coding guidelines

Question 2

Medicare was originally established for those…
When was it implemented?

Answer 2

65 and older
In 1966

Question 3

Persons who are covered are called…

Answer 3

“Beneficiaries”

Question 4

Medicare Part A

Answer 4

Hospital and Institutional Care Coverage

Question 5

Which Medicare Part will most inpatient coders work with?

Answer 5

Part A

Question 6

Medicare Part B

Answer 6

Supplemental-Nonhospital

Question 7

Which Medicare Part will most outpatient coders will work with?

Answer 7

Part B

Question 8

Medicare Part C

Answer 8

Medicare Advantage Organizations plans-combine Parts A & B

Question 9

Medicare Part D

Answer 9

Prescription Drug Plan (PDP)

Question 10

Medicare Part A Pays:

Answer 10

All covered costs except deductible

Question 11

Medicare Part B Pays:

Answer 11

80% of Medicare-allowed amount of covered services after deductible is met

Question 12

Medicare also pays…

Answer 12

Preventive Services

Question 13

What is covered in Medicare Part A In-Hospital Expenses? (3)

Answer 13

Semiprivate room
Meals and special diets in hospital
All medically necessary services

Question 14

What is not covered In-Hospital Expenses? (2)

Answer 14

Personal convenience items
Any service or procedure determined to be “not medically necessary”

Question 15

Medicare Part A Types of Covered Expenses (6)

Answer 15

Rehabilitation
Skilled nursing
Some personal convenience items for long-term illness or disabilities
Home health visits
Hospice care
Not automatically covered

Question 16

Part B pays…

Answer 16

Services and supplies not covered under Part A

Question 17

Types of Items Covered in Part B (5)

Answer 17

Physician services
Outpatient hospital services
Ambulatory surgical services
Home health care
Medically necessary supplies and equipment

Question 18

Coding for Medicare Part B Services (3)

Answer 18

CPT (procedures and service)
HCPCS (drugs, supplies, equipment, and special services)
ICD-10-CM (diagnosis codes)

Question 19

2 Types of QIOs

Answer 19

Beneficiary and Family Centered Care (BFCC)
Quality Innovation Network (QIN)

Question 20

BFCC

Answer 20

Beneficiary and Family Centered Care

Question 21

QIN

Answer 21

Quality Innovation Network

Question 22

Beneficiary and Family Centered Care (BFCC) (3)

Answer 22

Assists beneficiaries directly
Quality of care reviews
Filing complaints or appeals

Question 23

Quality Innovation Network (QIN) (3)

Answer 23

Organizes beneficiaries, providers, and community members for improvement initiatives
Data-driven approach
Focus on safety, health quality, and care coordination

Question 24

Fraud

Answer 24

Intentional deception to benefit

Question 25

Intentional deception to benefit

Answer 25

Fraud

Question 26

Fraud can be…(6)

Answer 26

Billing for services not provided
Misrepresenting diagnosis or CPT/HCPCS codes
Kickbacks
Unbundling services
Falsifying medical necessity
Systematic waiver of copayment or deductible