ANS: T PTS: 1 DIF: 1 TOP: THEORY

Bucks Step by Step Medical Coding 2022 Edition 1st Edition Elsevier Test Bank

Chapter 1: Reimbursement, HIPAA, and Compliance

Elsevier: Buck's Step-by-Step Medical Coding, 2022 Edition

TRUE/FALSE

• The coder’s responsibility is to ensure that the data are as accurate as possible not only for

classification and study purposes but also to obtain appropriate reimbursement.

ANS: T PTS: 1 DIF: 1 TOP: THEORY

• The Federal Register is the official publication for all “Presidential Documents,” “Rules and

Regulations,” “Proposed Rules,” and “Notices.”

ANS: T PTS: 1 DIF: 1 TOP: THEORY

• Nationally, unit values have been assigned for each service by Medicare (CPT and HCPCS)

and determined on the basis of the resources necessary for the physician’s performance of the service.

ANS: T PTS: 1 DIF: 1 TOP: THEORY

• Fraud is an intentional deception or misrepresentation that an individual knows to be false or

does not believe to be true and makes knowing that the deception could result in some unauthorized benefit to himself/herself or some other person.

ANS: T PTS: 1 DIF: 1 TOP: THEORY

• Kickbacks from patients are allowed under certain circumstances according to Medicare

guidelines.

ANS: F PTS: 1 DIF: 1 TOP: THEORY

MULTIPLE CHOICE

6. The Medicare program was established in:

• 1955 c. 1965
• 1960 d. 1970

ANS: C PTS: 1 DIF: 1 TOP: THEORY

7. Medicare Part A pays for:

• professional services and durable medical equipment
• hospital/facility care
• physician services and durable medical equipment
• hospital/facility care and durable medical equipment

ANS: B PTS: 1 DIF: 1 TOP: THEORY 1 / 4

8. Medicare Part B pays for:

• durable medical equipment
• hospital/facility care
• physician services and durable medical equipment
• hospital/facility care and durable medical equipment

ANS: C PTS: 1 DIF: 1 TOP: THEORY

• Who handles the day-to-day operation of the Medicare program for the CMS?
• HCFA c. MACs
• peer review organization d. IPPS

ANS: C PTS: 1 DIF: 1 TOP: THEORY

• Medicare pays for what percentage of covered charges?
• 70% c. 80%
• 75% d. 85%

ANS: C PTS: 1 DIF: 1 TOP: THEORY

11. The incentive to Medicare participating providers is:

• direct payment on all claims c. faster processing
• a 5% higher fee schedule d. all are correct

ANS: D PTS: 1 DIF: 1 TOP: THEORY

12. Part B services are billed using:

• RBRVS, GPCI, and RVUs c. MS-DRGs
• ICD-10-CM, CPT, HCPCS d. APCs

ANS: B PTS: 1 DIF: 1 TOP: THEORY

• Who is the largest third-party payer in the nation?
• Blue Cross Blue Shield c. Cigna
• Aetna d. the government

ANS: D PTS: 1 DIF: 1 TOP: THEORY

• A major change took place in Medicare in with the enactment of the Omnibus Budget

Reconciliation Act.

• 1989 c. 1997
• 1992 d. 2000

ANS: A PTS: 1 DIF: 1 TOP: THEORY

15. The physician fee schedule is updated each April 15 and is composed of:

• the relative value units for each service
• a geographic adjustment factor to adjust for regional variations in the cost of

operating a health care facility

• a national conversion factor
• all are correct
• none are correct 2 / 4

ANS: D PTS: 1 DIF: 3 TOP: THEORY

• If a surgeon performs more than one procedure on the same patient on the same day, and

discounts were made on all subsequent procedures, Medicare would pay what percentages for the first, second, third, fourth, and fifth procedures?

• 100%, 100%, 100%, 100%, 100% c. 100%, 50%, 50%, 25%, 25%
• 100%, 50%, 50%, 50%, 25% d. 100%, 50%, 50%, 50%, 50%

ANS: D PTS: 1 DIF: 2 TOP: THEORY

• Medicare sets the payment level for assistant surgeons at a percentage of the fee schedule

amount for the surgical service.

• global c. partial
• united d. subsequent

ANS: A PTS: 1 DIF: 2 TOP: THEORY

• What edition of the Federal Register would hospital facilities be especially interested in?
• October c. January
• November or December d. July

ANS: A PTS: 1 DIF: 2 TOP: THEORY

• What edition of the Federal Register would outpatient facilities be especially interested in?
• October c. January
• November or December d. July

ANS: B PTS: 1 DIF: 2 TOP: THEORY

• What are the three items that the Medicare beneficiaries are responsible for paying before

Medicare will begin to pay for services?

• personal care items
• deductibles, drug costs, personal care items
• premiums
• deductibles, premiums, and coinsurance

ANS: D PTS: 1 DIF: 3 TOP: THEORY

21. Medicare funds are collected by:

• U.S. Food and Drug Administration c. National Centers for Health Statistics
• Social Security Administration d. Department of the Treasury

ANS: B PTS: 1 DIF: 3 TOP: THEORY

• CMS handles the daily operation of the Medicare program through the use of

, formerly Fiscal Intermediaries.

• Medical Adjustment Contractor
• Medicare Administrative Cooperative
• Medicare Administrative Contractors
• Medical Administrative Contractors 3 / 4

ANS: C PTS: 1 DIF: 1 TOP: THEORY

• Which of the following is NOT a stated goal of the Physician Payment Reform?
• decrease Medicare expenditures
• assure quality health care at a reasonable cost
• limit provider liabilities
• redistribute physician payment more equitably

ANS: C PTS: 1 DIF: 1 TOP: THEORY

• If a QIO provider renders a covered service that costs $100 and bills Medicare for the

service and Medicare allowed $58, the provider would bill this amount to the patient.

• $42 c. $100
• $58 d. $0

ANS: D PTS: 1 DIF: 1 TOP: THEORY

• The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established

these new benefits available under the Medicare program.

• Part A c. Part C
• Part B d. Part D

ANS: D PTS: 1 DIF: 1 TOP: THEORY

• This program is also known as Medicare Advantage.
• Part A c. Part C
• Part B d. Part D

ANS: C PTS: 1 DIF: 1 TOP: THEORY

• are activities involving the transfer of health care information and means the

movement of electronic data between two entities and the technology that supports the transfer.

• Transmissions, transaction c. Interchanges, transmission
• Transactions, transmission d. Transmissions, interchange

ANS: B PTS: 1 DIF: 1 TOP: THEORY

• The program was developed by Congress to monitor the necessity

of hospital admissions and review the treatment costs and medical records of hospitals.

• Medicare Administrative Contractors (MACs)
• Quality Improvement Organizations (QIO)
• Health Maintenance Organization (HMO)
• Special Needs Plan (SNP)

ANS: B PTS: 1 DIF: 1 TOP: THEORY

• The conversion factor (CF) is a national dollar amount that is applied to all services paid on

the basis of the .

• Special Needs Plan c. Private Fee-for-Service Plan
• Affordable Care Act d. Medicare Fee Schedule
• / 4