1. You're an outpatient coder in Dr. Smith's office. When you code procedures, you're probably using _______ codes.
A. ICD-10-CM
B. ICD-9-CM
C. HCPCS
D. CPT ANSWER
2. You're a coder who's reviewing the record of a 62-year-old woman who was admitted to the hospital with shortness of breath and minor chest pain. The doctor diagnosed the patient with Staphylococcus aureus pneumonia and you assigned a code of 482.41. Additionally, you coded decompensated chronic systolic congestive heart failure (as documented by the physician) as 428.22 and 428.0. The coding system grouped the information into MS-DRG 178 (RW: 1.4860). The hospital has a base rate of $4,500.
What is the hospital's reimbursement for this patient under the PPS?
A. $3,028.26
B. $6,687
C. $4,500
D. $10,360 ANSWER
3. Which of the following would be the best to use to help plan home health care outcomes and assessments?
A. RAVEN
B. OASIS
C. MAC ANSWER
D. HAVEN
4. A health care plan wants to measure their quality and performance. They could use
A. HAVEN.
B. HEDIS. ANSWER
C. MSDRG.
D. RAVEN.
5. Dr. M is receiving reimbursement based on actual charges after the patient has been treated. She's being reimbursed on a I DON’T KNOW THIS ONE.
A. prospective payment system.
B. usual, customary, and reasonable charges system.
C. retrospective, fee-for-service payment system.
D. indemnity system.
6. Mr. B is an 82-year-old retired railroad worker who is having a mole removed at his physician's office.
The physician's office is probably billing which of the following?
A. Medicare Part D
B. Medicare Part C
C. Medicare Part B
D. Medicare Part A
7. New Medicare payments systems and implementation of SCHIP both came out of the I DON’T KNOW THIS ONE.
A. Balanced Budget Act.
B. health maintenance organization.
C. Federal Act 33-2.
D. retrospective payment system.
8. Which of the following may lead to claim denials or improper service reimbursement?
A. Updated ICD-9-CM codes
B. Inaccurate physician documentation ANSWER
C. HCPCS codes on outpatient surgeries
D. Reporting of multiple APGs
9. You're switching jobs on Monday. Which one of the following acts was developed, in part, to ensure that you have ongoing insurance coverage during the change?
A. HIPAA ANSWER
B. HP2010
C. OCIIO
D. BBA
10. Before she can receive insurance benefits, Sally must pay the first $500 out of her own finances. The $500 is called a/an
A. co-pay. ANSWER
B. co-insurance.
C. deductible.
D. indemnity.
11. You're grandmother has a question about her Medicare reimbursement, but it's 10:30 P.M. What organization will answer her questions at this time of night?
A. HCPCS
B. CMS
C. OIG ANSWER
D. SCHIP
12. When a physician is billing under the RBRVS system, he or she is using
A. HCPCS/CPT codes.
B. APCs.
C. MS-DRGs.
D. ICD-9 procedure codes.
13. Dr. Smith's medical office group and the hospital in which he's affiliated are both examples of
A. suppliers.
B. resources.
C. payers.
D. providers. ANSWER
14. Which of the following was created to allow coverage for options that aren't covered under Medicare A or B?
A. Medigap ANSWER
B. Medicare Part D
C. Medicare+Choice
D. Medicare Part C
15. If you're in an 80-20 policy, it means
A. you pay 80% of the expenses and the insurer pays 20%.
B. the insured pays 80% of the expenses and you pay 20%.
C. the insurer pays 80% of the expenses and you pay 20%. ANSWER
D. you pay 80% of the expenses and the insured pays 20%.
16. Dr. S. is working within a reimbursement system where the insurance is billed after all the treatment has been given to the patients. The main reason that he orders more tests, exams, and procedures under this system is
A. because no one has to pay for it.
B. to increase resource utilization.
C. fear of being sued.
D. to make a profit.
17. It's January 2, 2011, and you're a hospital coder who just assigned three diagnosis codes to a patient's record. You probably used _______ codes.
A. HCPCS
B. CPT
C. ICD-10-CM
D. ICD-9-CM ANSWER
18. Mrs. F is a 72-year-old retired school teacher who is hospitalized for pneumonia. Which of the End of exam following is most likely covering her inpatient hospital stay? I DON’T KNOW THIS ONE.
A. Medicare Part D
B. Medicare Part B
C. Medicare Part C
D. Medicare Part A
19. Paul Patient is trying to get new insurance, but he fears he'll be denied due to his cancer diagnosis and ongoing treatment. Which of the following was put in place to help patients like Paul avoid insurance denial due to their current conditions?
A. Healthy People 2010
B. Social Security Title XVIII
C. Affordable Care Act
D. Balanced Budget Act
20. You're a coder who's reviewing the record of a 62-year-old woman who was admitted to the hospital with shortness of breath and minor chest pain. The doctor diagnosed the patient with Staphylococcus aureus pneumonia and you assigned a code of 482.41. Additionally, you coded decompensated chronic systolic congestive heart failure (as documented by the physician) as 428.22 and 428.0.
The coding system grouped the information into MS-DRG 178 (RW: 1.4860).
The hospital has a base rate of $4,500.
Which of the following is the principal diagnosis? I DON’T KNOW THIS ONE.
A. 482.
B. 178
C. 428.22
D. 428.0
Well, the first answer is wrong. The answer should have been a combination of two of the given choices.
On question number 2 how did you come up with the answer D. $10,360
what did you choose for number 12?
what was your answer for number 6?
11 is CMS.
1. The correct answer is D. CPT codes. When coding procedures as an outpatient coder, you will generally use the Current Procedural Terminology (CPT) codes. These codes describe medical procedures, services, and supplies provided to patients.
2. The correct answer is B. $6,687. The reimbursement for this patient under the Prospective Payment System (PPS) would be $6,687. This calculation is based on the Medicare Severity Diagnosis-Related Group (MS-DRG) assigned to the patient, the relative weight (RW) of the MS-DRG, and the hospital's base rate of $4,500.
3. The correct answer is B. OASIS. OASIS (Outcome and Assessment Information Set) is a standardized assessment tool that is used in home health care to help plan outcomes and assessments. It collects data on patients' physical, mental, and social conditions to create an individualized plan of care.
4. The correct answer is B. HEDIS. The Health Plan Employer Data and Information Set (HEDIS) is a set of performance measures used by health care plans to assess quality and performance. It measures various aspects of care, such as preventive services, chronic disease management, and patient satisfaction.
5. The correct answer is C. retrospective, fee-for-service payment system. In a retrospective, fee-for-service payment system, reimbursement is based on the actual charges incurred by the provider for the services rendered to the patient. The provider submits a claim after the services have been provided and is reimbursed based on the charges billed.
6. The correct answer is C. Medicare Part B. Medicare Part B provides coverage for outpatient services, including physician services and procedures such as the removal of a mole at a physician's office.
7. The correct answer is A. Balanced Budget Act. The New Medicare payment systems and the implementation of the State Children's Health Insurance Program (SCHIP) were both initiatives that came out of the Balanced Budget Act, which was enacted in 1997.
8. The correct answer is B. Inaccurate physician documentation. Inaccurate physician documentation can lead to claim denials or improper service reimbursement. Accurate and detailed documentation is essential for proper coding and billing.
9. The correct answer is A. HIPAA. The Health Insurance Portability and Accountability Act (HIPAA) was developed, in part, to ensure ongoing insurance coverage during job changes. It provides protection for individuals who change jobs by allowing them to maintain continuous health insurance coverage.
10. The correct answer is C. deductible. The first $500 that Sally must pay out of her own finances before receiving insurance benefits is called a deductible. This is the initial amount that the insured individual must pay before the insurance coverage starts.
11. The correct answer is C. OIG. The Office of Inspector General (OIG) is an organization that provides answers to questions about Medicare at any time of the day or night. They are responsible for investigating fraud, waste, and abuse in Medicare programs.
12. The correct answer is A. HCPCS/CPT codes. When billing under the Resource-Based Relative Value Scale (RBRVS) system, physicians use HCPCS (Healthcare Common Procedure Coding System) or CPT (Current Procedural Terminology) codes to describe the services they provided.
13. The correct answer is D. providers. Both Dr. Smith's medical office group and the hospital in which he is affiliated are examples of healthcare providers. Providers deliver medical services to patients.
14. The correct answer is A. Medigap. Medigap is private health insurance that is designed to fill "gaps" in coverage for services that are not covered under Medicare Part A or Part B. It provides additional coverage to help pay for out-of-pocket expenses.
15. The correct answer is C. the insurer pays 80% of the expenses and you pay 20%. In an 80-20 policy, the insurer pays 80% of the expenses, and the insured individual is responsible for paying the remaining 20%.
16. The correct answer is B. to increase resource utilization. Under a retrospective payment system where the insurance is billed after all the treatment has been given, ordering more tests, exams, and procedures can increase resource utilization, which may result in higher reimbursement.
17. The correct answer is D. ICD-9-CM codes. If it is January 2, 2011, and you have just assigned three diagnosis codes to a patient's record, you probably used ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes. However, it is important to note that ICD-10-CM has since been implemented.
18. The correct answer is D. Medicare Part A. Medicare Part A covers inpatient hospital stays. It provides coverage for hospitalization, skilled nursing facility care, hospice care, and some home health care services.
19. The correct answer is C. Affordable Care Act. The Affordable Care Act (ACA) was put in place to help patients like Paul avoid insurance denial due to pre-existing conditions. It prohibits insurance companies from denying coverage or charging higher premiums based on pre-existing conditions.
20. The correct answer is B. 178. In the given scenario, the principal diagnosis is the diagnosis that is chiefly responsible for the patient's admission to the hospital. Based on the information provided, MS-DRG 178 is the MS-DRG assigned to the patient, indicating that the code 178 is the principal diagnosis.