Medical Billing and Coding

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 ANSWER

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. ANSWER
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 ANSWER.
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 ANSWER
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

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  1. The answer to number 7 is the Balanced Budget Act. I'm sure you've figured that out already but I'm not sure if fellow readers with the same question are able to read other responses.

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    2. 👎
  2. The answer to number 18 is Medicare Part A. Part A covers hospitals. Part B covers medical. Part C was implemented so that those with part a and part b could have more options. Part D is for prescription drug plans.

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  3. 5)c

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  4. You're switching jobs on Monday. Which act was developed, in part, to ensure that you have ongoing insurance coverage during the change?

    1. 👍
    2. 👎
  5. 5. If a physician is charging for a mole removal procedure based on what other physicians generally charge for this procedure, the physician is probably using

    A. UCR.
    B. PPS.

    C. ABG.
    D. DRG.

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    2. 👎
  6. csza

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    2. 👎

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