Question 1

Critical pathways usually focus on one discipline and provide guidelines for standards of care.

Accepted Answer

A) True 
 B)False

Question 2

The goal of the Recovery Audit Contractor program is to

Accepted Answer

A)   audit health care records for incomplete documentation.
B)   identify improper payments made on claims of health care services provided to Medicare beneficiaries.
C)   recover payments made to health care facilities, regardless of the payer.
D)   reimburse beneficiaries for payments made to them in error.E) None of the above
F) All of the above

Question 3

The Correct Coding Initiative was implemented to reduce ____________________ expenditures by detecting inappropriate coding on claims.

Accepted Answer

The answer of The Correct Coding Initiative was implemented to...

Question 4

Upcoding is the assignment of a DRG that does not match documentation and is for the purpose of increasing outpatient reimbursement.

Accepted Answer

A) True 
 B)False

Question 5

The End-Stage Renal Disease Composite Payment Rate System was established by the _____.

Accepted Answer

A)   Balanced Budget Act of 1997
B)   Deficit Reduction Act of 1984
C)   Medicare Prescription Drug, Improvement and Modernization Act of 2003
D)   Omnibus Budget Reconciliation Act of 1980E) B) and D)
F) B) and C)

Question 6

Commercial health insurance payers include private and employer-based health insurance plans.

Accepted Answer

A) True 
 B)False

Question 7

HCPCS Level II codes are in the public domain, and they are not copyrighted.

Accepted Answer

A) True 
 B)False

Question 8

The national limitation amount serves as a ceiling on the amount that third-party payers can pay for clinical laboratory tests.

Accepted Answer

A) True 
 B)False

Question 9

Which of the following is not an example of a never event?

Accepted Answer

A)   Foreign body left in a patient after surgery
B)   Mismatched blood transfusion
C)   Severe pressure ulcer present on admission to the hospital
D)   Medication errorE) A) and B)
F) A) and C)

Question 10

Describe when a veteran's dependents may receive benefits from the CHAMPVA program.

Accepted Answer

A veteran's dependents may receive benef...

Question 11

State the name of the organization that developed the Systematized Nomenclature of Pathology (SNOP) and the purpose of the nomenclature.

Accepted Answer

SNOP was developed by the Coll...

Question 12

The inpatient prospective payment system (IPPS)  72-hour rule requires that outpatient preadmission services provided by a hospital up to three days prior to a patient's inpatient admission be covered by the DRG payment for

Accepted Answer

A)   diagnostic services.
B)   diagnostic and pharmacy services.
C)   diagnostic and therapeutic services with the same principal diagnosis code.
D)   therapeutic services.E) A) and B)
F) A) and C)

Question 13

The Military Health System (MHS) provides health care services and support to __________________________________________________.

Accepted Answer

members of the unifo...

Question 14

:Interdisciplinary guidelines developed by hospitals to facilitate the management and delivery of quality clinical care are called

Accepted Answer

A)   clinical pathways.
B)   critical pathways.
C)   MQ pathways.
D)   quality pathways.E) A) and B)
F) B) and C)

Question 15

Polly's job responsibilities include collecting outcome and assessment information set (OASIS)  data and entering the data set into Home Assessment Validation Entry (HAVEN)  data-entry software. She most likely works at a

Accepted Answer

A)   hospital.
B)   home health agency.
C)   nursing facility.
D)   rehabilitation center.E) C) and D)
F) A) and B)

Question 16

Third-party payers often adopt payment systems and fee schedules after ____________________ has implemented them.

Accepted Answer

The answer of Third-party payers often adopt payment systems and...

Question 17

In 2008, Medicare implemented ambulatory payment classifications (APCs)  and relative payment weights to reimburse ________ for surgical procedures performed.

Accepted Answer

A)   ambulatory surgery centers
B)   clinics
C)   inpatient facilities
D)   emergency departmentsE) B) and C)
F) All of the above

Question 18

A durable medical equipment company would classify medical equipment using

Accepted Answer

A)   CPT codes.
B)   CDT codes.
C)   HCPCS Level II codes.
D)   NDC codes.E) B) and C)
F) None of the above

Question 19

Preestablished reimbursement rates for health care services are part of a(n) ____________________.

Accepted Answer

prospectiv...

Question 20

Which organization publishes CPT?

Accepted Answer

A)   AHIMA
B)   AAPC
C)   AMA
D)   CMSE) C) and D)
F) A) and D)

Exam 10: Introduction to Coding and Reimbursement

Polly's job responsibilities include collecting outcome and assessment information set (OASIS) data and entering the data set into Home Assessment Validation Entry (HAVEN) data-entry software. She most likely works at a

Correct AnswerverifiedShow Answer

The Correct Coding Initiative was implemented to reduce ____________________ expenditures by detecting inappropriate coding on claims.

Correct AnswerverifiedShow Answer

State the name of the organization that developed the Systematized Nomenclature of Pathology (SNOP) and the purpose of the nomenclature.

Correct AnswerverifiedSNOP was developed by the Coll...View AnswerShow Answer

The Military Health System (MHS) provides health care services and support to __________________________________________________.

Correct Answerverifiedmembers of the unifo...View AnswerShow Answer

:Interdisciplinary guidelines developed by hospitals to facilitate the management and delivery of quality clinical care are called

Correct AnswerverifiedShow Answer

The goal of the Recovery Audit Contractor program is to

Correct AnswerverifiedShow Answer

Upcoding is the assignment of a DRG that does not match documentation and is for the purpose of increasing outpatient reimbursement.

Correct AnswerverifiedShow Answer

Which organization publishes CPT?

Correct AnswerverifiedShow Answer

A durable medical equipment company would classify medical equipment using

Correct AnswerverifiedShow Answer

The national limitation amount serves as a ceiling on the amount that third-party payers can pay for clinical laboratory tests.

Correct AnswerverifiedShow Answer

The End-Stage Renal Disease Composite Payment Rate System was established by the _____.

Correct AnswerverifiedShow Answer

Third-party payers often adopt payment systems and fee schedules after ____________________ has implemented them.

Correct AnswerverifiedShow Answer

Critical pathways usually focus on one discipline and provide guidelines for standards of care.

Correct AnswerverifiedShow Answer

Preestablished reimbursement rates for health care services are part of a(n) ____________________.

Correct Answerverifiedprospectiv...View AnswerShow Answer

Commercial health insurance payers include private and employer-based health insurance plans.

Correct AnswerverifiedShow Answer

In 2008, Medicare implemented ambulatory payment classifications (APCs) and relative payment weights to reimburse ________ for surgical procedures performed.

Correct AnswerverifiedShow Answer

Describe when a veteran's dependents may receive benefits from the CHAMPVA program.

Correct AnswerverifiedA veteran's dependents may receive benef...View AnswerShow Answer

Which of the following is not an example of a never event?

Correct AnswerverifiedShow Answer

HCPCS Level II codes are in the public domain, and they are not copyrighted.

Correct AnswerverifiedShow Answer

The inpatient prospective payment system (IPPS) 72-hour rule requires that outpatient preadmission services provided by a hospital up to three days prior to a patient's inpatient admission be covered by the DRG payment for

Correct AnswerverifiedShow Answer

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SNOP was developed by the Coll...
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members of the unifo...
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prospectiv...
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A veteran's dependents may receive benef...
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