Exam 3

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Question #1

Special groups that may be eligible for Medicaid include all the following EXCEPT:

A children with disabilities

B families that need temporary assistance.

C disabled adults.

D immigrants.

Question #2

The abbreviation PCCM used in regard to Medicaid managed care plans stands for:

A primary care case management.

B primary coverage and care management.

C preventive care case management.

D per case care management.

Question #3

States may pay for Medicaid services on a fee-for-service basis or:

A using a scale based on the beneficiary’s annual income.

B through contracts with managed care organizations.

C based on the Medicare fee schedule.

D through a per-diem rate.

Question #4

A copayment may NOT be collected from a Medicaid patient for:

A hospital services.

B family planning services.

C preventive care services.

D physician office visits.

Question #5

Medicaid participating hospitals and other inpatient facilities file claims electronically using the:

A CMS-1500 claim form.

B Medicaid claim form.

C Title XIX claim form.

D UB-04 claim form.

Question #6

Optional Medicaid services that are eligible for federal matching funds include all of the following EXCEPT:

A acupuncture for pain relief.

B rehabilitation services.

C transportation services.

D optometrist services and eyeglasses.

Question #7

Which types of nominal cost sharing can states require of most Medicaid beneficiaries?

A Coinsurance

B All of these

C Deductibles

D Copayments

Question #8

Eligibility for Temporary Assistance for Needy Families (TANF) is determined by the:

A state.

B county.

C nation.

D city.

Question #9

To qualify for federal matching funds for the medically needy, states must include coverage for

A the disabled.

B pregnant women.

C the blind.

D the elderly.

Question #10

In some states, a spend-down program requires that individuals must spend a portion of their income or resources each month on medical expenses before:

A Medicaid begins paying for services.

B a coinsurance amount applies.

C a deductible is paid.

D Medicare begins paying for services.

Question #11

Groups included as eligible for Medicaid include:

A All of these

B the medically needy.

C special groups.

D the categorically needy.

Question #12

The largest funding for healthcare for America’s low-income individuals comes from:

A Medicare.

B Medicaid.

C individuals.

D private insurance.

Question #13

The types of Medicare Advantage plans include HMOs.

A FALSE

B TRUE

Question #14

Hearing aids are NOT routinely covered by Medicare.

A TRUE

B FALSE

Question #15

All Medicare beneficiaries are automatically enrolled in Medicare Part D.

A TRUE

B FALSE

Question #16

Part C is the Medicare option that allows beneficiaries to enroll in their choice of managed care plan, known as a Medicare Advantage plan.

A TRUE

B FALSE

Question #17

In which of the following cases involving a patient who is age 65 or older is Medicare considered the primary payer?

A The patient’s injury or condition is covered by workers’ compensation.

B The patient works for an employer with 20 or fewer employees.

C The patient’s condition is the result of an automobile accident.

D The patient has group health insurance through a working spouse.

Question #18

Which of the following is true of nonparticipating providers who accept assignment?

A They receive 15% lower fees for services than participating providers.

B They receive 10% lower fees for services than participating providers.

C They have access to beneficiary eligibility information.

D They are required to file Medicare claims on behalf of Medicare patients.

Question #19

Medicare patients with Part B fee-for-service benefits are responsible for what percentage of the Medicare Fee Schedule (MFS) after the deductible has been met and services are rendered by a provider who accepts assignment?

A 25%

B 15%

C 30%

D 20%

Question #20

The original Medicare plan is based on which type of payment method?

A Sliding scale

B Capitation

C Fee-for-service

D Per diem

Question #21

Which of the following services is covered by Medicare Part A or Part B?

A Routine eye care

B Dental care

C Physical therapy

D Acupuncture

Question #22

Certain organ transplants are covered under Part A as long as:

A a second opinion has been obtained before the surgery.

B an in-home caregiver will be available to care for the patient after surgery.

C the patient has not exceeded his or her Part A benefit limit.

D services are performed in a hospital that is an approved Medicare provider.

Question #23

Hospice services covered under Medicare Part A may be provided as:

A short-term hospital care.

B in-home care.

C All of these.

D inpatient respite care.

Question #24

For each benefit period, a Medicare Part A beneficiary will receive coverage for:

A 60 days of hospital care.

B unlimited days of hospital care if medically necessary.

C 30 days of hospital care.

D 90 days of hospital care.

Question #25

Organizations that are hired by the CMS to carry out day-to-day Medicare program operations are known as:

A carriers.

B intermediaries.

C administrators.

D contractors.

Question #26

The Medicare program that provides expanded benefits through private managed care health plans is:

A Medicare Advantage (MA).

B Medicare Part A.

C Medicare Part B.

D Medicare Part D.

Question #27

A case that cannot be assigned an appropriate DRG because of an atypical situation is called a cost outlier.

A TRUE

B FALSE

Question #28

Per diem is a type of reimbursement that pays a fixed rate per day for all services provided by a hospital.

A TRUE

B FALSE

Question #29

The type of care that provides palliative services for terminally ill patients is known as:

A hospice care.

B home healthcare.

C critical care.

D terminal care.

Question #30

In form locator 17 on the UB-04 claim form, the codes for “Left against medical advice or discontinued care,” “Expired (or did not recover),” and “Admitted as an inpatient to this hospital” represent:

A admission source codes.

B condition codes.

C discharge status codes.

D admission type codes.

Question #31

If the time that a patient was admitted to the hospital is unknown, which code would be entered in form locator 13?

A Code 99

B It would be noted as “unknown.”

C Code 00

D It would be left blank.

Question #32

Which of the following codes would be entered to report that the patient is female in form locator 11 on the UB-04?

A 2

B 1

C F

D M

Question #33

When using a FOUR-digit Medicare “type of bill” code in form locator 4, the type of facility is represented by the:

A first digit.

B second digit.

C third digit.

D fourth digit.

Question #34

A pre-existing condition that, because of its effect on the principal diagnosis, results in more intensive therapy or a longer stay is a(n):

A exacerbation.

B complication.

C comorbidity.

D chronic condition.

Question #35

The physician who is primarily responsible for a patient’s care while in the hospital is referred to as the:

A attending physician.

B primary care physician.

C rendering physician.

D admitting physician.

Question #36

Most major diagnostic categories (MDCs) are based on:

A health status of the patient.

B number of diagnoses.

C age of the patient.

D a particular organ system.

Question #37

The Ambulatory Payment Classification (APC) system bases payments on:

A number of days.

B procedures.

C diagnoses.

D usual fees.

Question #38

To prevent a cash flow problem, hospital records should be completed and signed no later than:

A 14 days following discharge.

B 7 days following admittance.

C 30 days following admittance.

D 1—2 days following discharge.

Question #39

The source document used by a medical office specialist to enter patient encounter data into a computerized accounting system is the superbill.

A TRUE

B FALSE

Question #40

On the CMS-1500 claim form, the abbreviation EIN refers to:

A Employer Identification Number.

B Employer Identifier for National Coverage.

C Examination Indicates Nothing.

D Estimated Insurance Number for payment.

Question #41

On the CMS-1500 claim form, the abbreviation NPI indicates that:

A a condition was Not Present or Indicated upon examination.

B the National Health Plan Identifier must be entered.

C the National Provider Identifier must be entered.

D the National Preferred Identifier for clearinghouses must be entered.

Question #42

Components of the Administration Simplification subsection of HIPAA include all of the following EXCEPT:

A privacy and security rules.

B compliance and auditing guidelines.

C transaction and code sets.

D uniform identifiers.

Question #43

What information should be filled out in form locator 28?

A total charges.

B patient’s account number.

C physician’s federal tax ID number.

D amount paid.

Question #44

If an individual is covered under Plan A through her employment and is covered under Plan B through her spouse’s employment:

A Plan B will pay all of the benefits.

B Plan B is primary, and Plan A is secondary.

C only Plan A will pay for her benefits.

D Plan A is primary, and Plan B is secondary.

Question #45

If needed information is missing from a claim when it is submitted to an insurance carrier, it is referred to as a(n):

A incomplete claim

B clean claim.

C erroneous claim.

D dirty claim.

Question #46

The employer identification number (EIN) or federal tax ID number is issued by:

A the Health Insurance Portability and Accountability Act (HIPAA).

B the Internal Revenue Service (IRS).

C the Centers for Medicare and Medicaid Services (CMS).

D insurance carriers.

Question #47

A company that receives claims from providers, audits them, and forwards them on to insurance carriers is a(n):

A independent auditing firm.

B third-party administrator.

C billing service.

D clearinghouse.

Question #48

Most physicians bill insurance carriers by completing paper or electronic versions of which form?

A Verification of benefits form

B Superbill

C CMS-1500 claim form

D UB-04 claim form

Question #49

A claim can only be submitted to an insurance carrier on the patient’s behalf if the patient has signed a(n):

A explanation of benefits form.

B assignment of benefits form.

C patient information form.

D release of information form.

Question #50

Common problems while completing the CMS-1500 include all the following EXCEPT:

A patient’s insurance number is incorrect.

B the diagnosis code does not match the CPT code.

C date of last menstrual period (LMP) is missing.

D accept assignment is checked.

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