Question 1

Many state and federal laws prohibit which of the following?

Accepted Answer

A)   professional courtesy
B)   edits
C)   audits
D)   adjustmentsE) C) and D)
F) A) and B)

Question 2

The Medicare conversion factor is set

Accepted Answer

A)   each decade.
B)   annually.
C)   semi-annually.
D)   twice a year.E) None of the above
F) A) and B)

Question 3

A __________fee structure reflects the amounts that providers typically charge for services and procedures.

Accepted Answer

A)   charge-based
B)   resource-based
C)   fee-based
D)   time-basedE) A) and B)
F) A) and C)

Question 4

In an allowed charges payment method, if a provider's charge is higher than the allowed amount, the provider's reimbursement is based on

Accepted Answer

A)   the amount billed.
B)   the amount allowed.
C)   the co-insurance.
D)   the deductible.E) All of the above
F) A) and B)

Question 5

Which of the following is not fraudulent?

Accepted Answer

A)   using a non-specific diagnosis code
B)   altering documentation after services are reported
C)   reporting services provided by unlicensed personnel
D)   coding without proper documentationE) A) and D)
F) B) and C)

Question 6

If a payer judges that a code level assigned by a practice is too high for a reported service, the usual action is to

Accepted Answer

A)   upcode the reported procedure code.
B)   add a modifier to the reported procedure code.
C)   deny the claim.
D)   downcode the reported procedure code.E) B) and C)
F) A) and D)

Question 7

Under RBRVS, the nationally uniform relative value is based on

Accepted Answer

A)   the provider's work, practice cost, and malpractice insurance costs.
B)   the geographic adjustment factor.
C)   the UCR, practice cost, and malpractice insurance costs.
D)   the uniform conversion factor.E) A) and B)
F) All of the above

Question 8

One type of job reference aid is

Accepted Answer

A)   a list of pre-linked diagnosis and procedure codes.
B)   a list of the practice's frequently reported diagnosis and procedure codes.
C)   a list of the practice's frequently reported diagnoses.
D)   a list of the practice's frequently reported procedures.E) All of the above
F) B) and D)

Question 9

If a RAC's request is not answered within an appropriate amount of time, which of the following might occur?

Accepted Answer

A)   None of these are correct.
B)   An error is declared.
C)   Penalties may result.
D)   An error is declared and penalties may result.E) B) and D)
F) C) and D)

Question 10

If balance billing is permitted under a plan, the insured must

Accepted Answer

A)   pay nothing since it is part of the contractual agreement.
B)   pay for the entire provider's charge.
C)   pay for the difference between the provider's charge and the allowed charge.
D)   pay for only his/her deductible.E) A) and D)
F) A) and C)

Question 11

How is upcoding being monitored by payers?

Accepted Answer

A)   Benchmarking practice's E/M codes with local averages
B)   collecting practice's contracts each year
C)   collecting practice's profit and loss statement each year
D)   Benchmarking practice's E/M codes with national averagesE) B) and C)
F) None of the above

Question 12

The purpose of the GPCI is to account for

Accepted Answer

A)   differences in relative work values.
B)   regional differences in costs.
C)   none of these are correct.
D)   changes in the cost of living index.E) A) and D)
F) B) and C)

Question 13

MPFS is the abbreviation for the

Accepted Answer

A)   Medicare Physician Fee Schedule.
B)   Medical Physician Funding Schedule.
C)   Medical Physician Fee Schedule.
D)   Medicare Physician Funding Schedule.E) None of the above
F) C) and D)

Question 14

CCI is an abbreviation for

Accepted Answer

A)   Correct Coding Investigation.
B)   Current Coding Initiative.
C)   Current Coding Investigation.
D)   Correct Coding Initiative.E) B) and D)
F) All of the above

Question 15

Although anyone who comes into contact with a medical record is responsible for the accuracy of his or her own entry, who in the medical practice is ultimately responsible for proper documentation and correct coding?

Accepted Answer

A)   registered nurse
B)   payer representative
C)   physician
D)   medical coderE) B) and D)
F) C) and D)

Question 16

A conversion factor is multiplied by a _________ to arrive at a charge.

Accepted Answer

A)   charge
B)   relative value unit
C)   time allowance
D)   fee scheduleE) C) and D)
F) B) and D)

Question 17

Correct claims report the connection between a billed service and a diagnosis. This is called

Accepted Answer

A)   bundled payment.
B)   code linkage.
C)   balance billing.
D)   downcoding.E) None of the above
F) B) and D)

Question 18

RVU is the abbreviation for

Accepted Answer

A)   relative volume unit.
B)   relative value unit.
C)   resource value unit.
D)   resource volume unit.E) B) and C)
F) B) and D)

Question 19

______________ refers to a coding problem in which the age of the patient and the selected code do not match.

Accepted Answer

A)   Incorrect coding
B)   Assumption coding
C)   Downcoding
D)   UpcodingE) C) and D)
F) A) and C)

Question 20

Unless there are indications of a problem, an audit typically involves reviewing

Accepted Answer

A)   every claim and document.
B)   all income and expenses.
C)   10% of the claims.
D)   a sample of the whole.E) All of the above
F) A) and B)

Exam 6: Visit Charges and Compliant Billing

Which of the following is not fraudulent?

Correct AnswerverifiedShow Answer

A __________fee structure reflects the amounts that providers typically charge for services and procedures.

Correct AnswerverifiedShow Answer

In an allowed charges payment method, if a provider's charge is higher than the allowed amount, the provider's reimbursement is based on

Correct AnswerverifiedShow Answer

If a RAC's request is not answered within an appropriate amount of time, which of the following might occur?

Correct AnswerverifiedShow Answer

If a payer judges that a code level assigned by a practice is too high for a reported service, the usual action is to

Correct AnswerverifiedShow Answer

Although anyone who comes into contact with a medical record is responsible for the accuracy of his or her own entry, who in the medical practice is ultimately responsible for proper documentation and correct coding?

Correct AnswerverifiedShow Answer

MPFS is the abbreviation for the

Correct AnswerverifiedShow Answer

One type of job reference aid is

Correct AnswerverifiedShow Answer

______________ refers to a coding problem in which the age of the patient and the selected code do not match.

Correct AnswerverifiedShow Answer

The Medicare conversion factor is set

Correct AnswerverifiedShow Answer

The purpose of the GPCI is to account for

Correct AnswerverifiedShow Answer

A conversion factor is multiplied by a _________ to arrive at a charge.

Correct AnswerverifiedShow Answer

RVU is the abbreviation for

Correct AnswerverifiedShow Answer

How is upcoding being monitored by payers?

Correct AnswerverifiedShow Answer

Correct claims report the connection between a billed service and a diagnosis. This is called

Correct AnswerverifiedShow Answer

CCI is an abbreviation for

Correct AnswerverifiedShow Answer

If balance billing is permitted under a plan, the insured must

Correct AnswerverifiedShow Answer

Unless there are indications of a problem, an audit typically involves reviewing

Correct AnswerverifiedShow Answer

Many state and federal laws prohibit which of the following?

Correct AnswerverifiedShow Answer

Under RBRVS, the nationally uniform relative value is based on

Correct AnswerverifiedShow Answer

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