Revenue Cycle Final Exam Study Guide 2 with complete
solution
Which is a licensed physician in good standing who, according to state
regulations, engages in the direct management of nonphysician practitioners
whose duties are encompassed by that physician's scope of practice
supervising physician
Secondary diagnoses codes are entered in Blocks __________ of the CMS-1500
claim
21B - 24L
When entering a fee in Blocks 24F, 28, or 29, enter __________ in the cents
column
2 zeros
The MUE project was implemented by CMS as part of the NCCI to improve the
accuracy of Medicare payments by
detecting and denying unlikely Medicare claims on a prepayment basis
The CMS-1500 paper claim was designed to accommodate optical scanning of
__________ claims
Paper
When completing the CMS-1500, enter a __________ for the dollar sign or decimal
in all charges or totals and parentheses surrounding the area code in a telephone
number
Space
Surgeon's charges for inpatient and outpatient surgery are billed according to a
global fee, which means that __________ cover(s) presurgical evaluation and
management, initial and subsequent hospital visits, surgical procedure, the
discharge visit, and uncomplicated postoperative follow-up care in the surgeon's
office
one charge
Which was developed by the Centers for Medicare and Medicaid Services to
assign the unique health care provider and health plan identifiers and to serve as
a database from which to extract data
NPPES
Postoperative complications requiring a return to the operating room for surgery
related to the original procedure are billed as an additional procedure, and the
additional procedure is linked to
a new diagnosis that describes the complication
When a person uses a title such as Sr., Jr., II, or III
do not enter it on the claim unless printed on the patient's insurance ID card
Diagnoses must be entered in the patient's record to validate __________ of
procedures or services billed
medical necessity
Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS-1500 claim to
allow for entry of __________ codes, and they are reported in Block 24E
ICD-10-CM
, Which is offered to members and marketed to small business owners as a way to
provide coverage to employees
association health insurance
Which type of health insurance covers the medical expenses of individuals (e.g.,
private health insurance) and groups (e.g., employer group health insurance)
Commercial
Which type of insurance is defined as reimbursement for income lost as a result
of a temporary or permanent illness or injury
Disability
Third-party recovery standards for investigation of liability coverage and the
process for filing a lien in a potential liability case vary on a federal and state
basis. A lien is defined as
securing a debtor's property as security or payment for a debt
The base period of a disability policy usually covers 12 months and is divided
into four __________ quarters
Consecutive
Which is traditional fee-for-service health insurance that covers a portion of
services, such as inpatient hospitalizations or physician office visits, with the
patient paying the remaining costs
indemnity insurance
Which type of automobile insurance pays for damage to a covered vehicle caused
by hitting an object or being hit during an automobile accident
Collision
When the same payer issues the primary, secondary, or supplemental policies,
the correct procedure for submitting the claim would be to submit
one claim for all policies
Which includes health maintenance organizations and preferred provider
organizations
managed care
If a patient is covered by two different policies, the usual procedure for
submitting a claim would be
to submit to the primary payer first, followed by submitting to the secondary after
primary payment is received
Group health insurance is available through employers and other organizations,
and all or part of the premium costs are paid by employers. Employer-based
group health insurance
covers all employees, regardless of health status, and cannot be canceled if an
employee becomes ill
Which type of automobile insurance pays for loss of or damage to a covered
vehicle, such as that caused by fire, flood, hail, impact with an animal, theft,
vandalism, or wind
Comprehensive
Which type of insurance covers losses to a third party caused by the insured, by
an object owned by the insured, or on premises owned by the insured
Liability
solution
Which is a licensed physician in good standing who, according to state
regulations, engages in the direct management of nonphysician practitioners
whose duties are encompassed by that physician's scope of practice
supervising physician
Secondary diagnoses codes are entered in Blocks __________ of the CMS-1500
claim
21B - 24L
When entering a fee in Blocks 24F, 28, or 29, enter __________ in the cents
column
2 zeros
The MUE project was implemented by CMS as part of the NCCI to improve the
accuracy of Medicare payments by
detecting and denying unlikely Medicare claims on a prepayment basis
The CMS-1500 paper claim was designed to accommodate optical scanning of
__________ claims
Paper
When completing the CMS-1500, enter a __________ for the dollar sign or decimal
in all charges or totals and parentheses surrounding the area code in a telephone
number
Space
Surgeon's charges for inpatient and outpatient surgery are billed according to a
global fee, which means that __________ cover(s) presurgical evaluation and
management, initial and subsequent hospital visits, surgical procedure, the
discharge visit, and uncomplicated postoperative follow-up care in the surgeon's
office
one charge
Which was developed by the Centers for Medicare and Medicaid Services to
assign the unique health care provider and health plan identifiers and to serve as
a database from which to extract data
NPPES
Postoperative complications requiring a return to the operating room for surgery
related to the original procedure are billed as an additional procedure, and the
additional procedure is linked to
a new diagnosis that describes the complication
When a person uses a title such as Sr., Jr., II, or III
do not enter it on the claim unless printed on the patient's insurance ID card
Diagnoses must be entered in the patient's record to validate __________ of
procedures or services billed
medical necessity
Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS-1500 claim to
allow for entry of __________ codes, and they are reported in Block 24E
ICD-10-CM
, Which is offered to members and marketed to small business owners as a way to
provide coverage to employees
association health insurance
Which type of health insurance covers the medical expenses of individuals (e.g.,
private health insurance) and groups (e.g., employer group health insurance)
Commercial
Which type of insurance is defined as reimbursement for income lost as a result
of a temporary or permanent illness or injury
Disability
Third-party recovery standards for investigation of liability coverage and the
process for filing a lien in a potential liability case vary on a federal and state
basis. A lien is defined as
securing a debtor's property as security or payment for a debt
The base period of a disability policy usually covers 12 months and is divided
into four __________ quarters
Consecutive
Which is traditional fee-for-service health insurance that covers a portion of
services, such as inpatient hospitalizations or physician office visits, with the
patient paying the remaining costs
indemnity insurance
Which type of automobile insurance pays for damage to a covered vehicle caused
by hitting an object or being hit during an automobile accident
Collision
When the same payer issues the primary, secondary, or supplemental policies,
the correct procedure for submitting the claim would be to submit
one claim for all policies
Which includes health maintenance organizations and preferred provider
organizations
managed care
If a patient is covered by two different policies, the usual procedure for
submitting a claim would be
to submit to the primary payer first, followed by submitting to the secondary after
primary payment is received
Group health insurance is available through employers and other organizations,
and all or part of the premium costs are paid by employers. Employer-based
group health insurance
covers all employees, regardless of health status, and cannot be canceled if an
employee becomes ill
Which type of automobile insurance pays for loss of or damage to a covered
vehicle, such as that caused by fire, flood, hail, impact with an animal, theft,
vandalism, or wind
Comprehensive
Which type of insurance covers losses to a third party caused by the insured, by
an object owned by the insured, or on premises owned by the insured
Liability
