Question 1: What term describes the statement issued by the payer to the insured explaining services provided and the payments made by the payer?
A. Invoice
B. Explanation of benefits
C. Remittance advice
D. Advance beneficiary notice
Question 2: The Office of the Inspector General has the authority to impose sanctions against individuals who fail to comply with Medicare rules. Which of the following is NOT a possible sanction?
A. Provider warning and education
B. Continued payment even if provider is excluded from the Medicare program
C. Exclusion of the provider from the Medicare program
D. Revocation of assigning privileges
Question 3: Which task is NOT part of the electronic claims submission process?
A. Codes and modifiers are reviewed by a rule engine.
B. The claim is uploaded to a clearinghouse.
C. Once the claim is accepted, the clearinghouse manually transmits the claim.
D. Claims are scrubbed for errors.
Question 4: A DRG assignment is determined by all of the following EXCEPT:
A. Principal diagnosis and surgical procedures
B. Length of stay
C. Patient's age
D. Complications and comorbidities
Question 5: Which type of Medicare provider can decide to accept or deny assignment and a 5% lower fee allowances for services?
A. Participating Part B provider
B. Medicare Part A provider
C. A non-physician practitioner
D. Nonparticipating provider
Question 6: Which of the following scenarios is an example of fraud?
A. A clinic provides free services to Medicare patients, in turn billing Medicare for the services.
B. A patient registers with a nickname instead of his legal first name, resulting in a duplicate medical record number assignment.
C. An outpatient rehab facility routinely assigns the same diagnosis for all patients receiving physical therapy for muscle strain.
D. A lab performs and bills for services ordered by a provider entering a wrong diagnosis code by transposing the digits.
Question 7: What term describes a tool that the coding staff uses to assist in the assignment of correct codes?
A. Calculator
B. Data collection tool
C. MPI
D. Encoder
Question 8: Which of the following is NOT a qualifier for the Medicare reimbursement program?
A. People receiving kidney dialysis for permanent kidney failure
B. Individuals who have become unemployed and are not eligible for insurance
C. Individuals with permanent disabilities or blindness
D. Individuals age 65 or older
Question 9: What term describes the reimbursement method for ambulatory surgical procedures for Medicare patients?
A. APCs
B. RUGS
C. Resource based relative value (RBRVS)
D. Fee for Service
Question 10: What term describes the compensation or payment for healthcare services rendered by a provider?
A. Disbursement
B. Premium
C. Reimbursement
D. Coinsurance