COMPREHENSIVE MODULE 2 FINAL EXAM
PART 1 FINAL PAPER 2026 COMPLETE
QUESTIONS CORRECT ANSWERS
⩥ When the third-party payer refuses to grant payment to the provider,
this is called a
clean claim.
denied claim.
unprocessed claim.
rejected claim. Answer: denied claim.
⩥ This information is used to assign each item to a particular section of
the general ledger in a particular facility's accounting section. Reports
can be generated from this information to include statistics related to
volume in terms of numbers, dollars, and payer types. Answer: general
ledger key
⩥ A patient with Medicare is seen in the physician's office.
The total charge for this office visit is $250.00.
The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00.
The nonPAR Medicare fee schedule amount for this service is $190.00.
,The patient is financially liable for the coinsurance amount, which is
Answer: 20 %
⩥ The first prospective payment system (PPS) for inpatient care was
developed in 1983. The newest PPS is used to manage the costs for
medical homes.
assisted living facilities.
home health care.
inpatient psychiatric facilities. Answer: inpatient psychiatric facilities
⩥ Changes in case-mix index (CMI) may be attributed to all of the
following factors EXCEPT
changes in services offered.
changes in coding rules.
changes in medical staff composition.
changes in coding productivity. Answer: changes in coding productivity.
⩥ This is a 10-digit, intelligence-free, numeric identifier designed to
replace all previous provider legacy numbers. This number identifies the
,physician universally to all payers. This number is issued to all HIPAA-
covered entities. It is mandatory on the CMS-1500 and UB-04 claim
forms.
National Practitioner Databank (NPD)
Master Patient Index (MPI)
National Provider Identifier (NPI)
Universal Physician Number (UPN) Answer: National Provider
Identifier (NPI)
⩥ f the Medicare non-PAR approved payment amount is $128.00 for a
proctoscopy, what is the total Medicare approved payment amount for a
doctor who does not accept assignment, applying the limiting charge for
this procedure? Answer: The limiting charge is 15% above Medicare's
approved payment amount for doctors who do NOT accept assignment
($128.00 X 1.15 = $147.20).
⩥ his is the difference between what is charged and what is paid.
costs
customary
contractual allowance
reimbursement Answer: contractual allowance
, ⩥ The term "hard coding" refers to
HCPCS/CPT codes that appear in the hospital's chargemaster and will
be included automatically on the patient's bill.
ICD-10-CM/ICD-10-PCS codes that appear in the hospital's
chargemaster and that are automatically included on the patient's bill.
HCPCS/CPT codes that are coded by the coders.
ICD-10-CM/ICD-10-PCS codes that are coded by the coders. Answer:
HCPCS/CPT codes that appear in the hospital's chargemaster and will be
included automatically on the patient's bill.
⩥ A patient undergoes outpatient surgery. During the recovery period,
the patient develops atrial fibrillation and is subsequently admitted to the
hospital as an inpatient. The present on admission (POA) indicator is
Y = Present at the time of inpatient admission.
U = Documentation is insufficient to determine if condition was present
at the time of admission.
W = Provider is unable to clinically determine if condition was present
at the time of admission.
N = Not present at the time of inpatient admission. Answer: The atrial
fibrillation developed prior to a written order for inpatient admission;
therefore, it was present at the time of inpatient admission
⩥ Under APCs, payment status indicator "S" means
PART 1 FINAL PAPER 2026 COMPLETE
QUESTIONS CORRECT ANSWERS
⩥ When the third-party payer refuses to grant payment to the provider,
this is called a
clean claim.
denied claim.
unprocessed claim.
rejected claim. Answer: denied claim.
⩥ This information is used to assign each item to a particular section of
the general ledger in a particular facility's accounting section. Reports
can be generated from this information to include statistics related to
volume in terms of numbers, dollars, and payer types. Answer: general
ledger key
⩥ A patient with Medicare is seen in the physician's office.
The total charge for this office visit is $250.00.
The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00.
The nonPAR Medicare fee schedule amount for this service is $190.00.
,The patient is financially liable for the coinsurance amount, which is
Answer: 20 %
⩥ The first prospective payment system (PPS) for inpatient care was
developed in 1983. The newest PPS is used to manage the costs for
medical homes.
assisted living facilities.
home health care.
inpatient psychiatric facilities. Answer: inpatient psychiatric facilities
⩥ Changes in case-mix index (CMI) may be attributed to all of the
following factors EXCEPT
changes in services offered.
changes in coding rules.
changes in medical staff composition.
changes in coding productivity. Answer: changes in coding productivity.
⩥ This is a 10-digit, intelligence-free, numeric identifier designed to
replace all previous provider legacy numbers. This number identifies the
,physician universally to all payers. This number is issued to all HIPAA-
covered entities. It is mandatory on the CMS-1500 and UB-04 claim
forms.
National Practitioner Databank (NPD)
Master Patient Index (MPI)
National Provider Identifier (NPI)
Universal Physician Number (UPN) Answer: National Provider
Identifier (NPI)
⩥ f the Medicare non-PAR approved payment amount is $128.00 for a
proctoscopy, what is the total Medicare approved payment amount for a
doctor who does not accept assignment, applying the limiting charge for
this procedure? Answer: The limiting charge is 15% above Medicare's
approved payment amount for doctors who do NOT accept assignment
($128.00 X 1.15 = $147.20).
⩥ his is the difference between what is charged and what is paid.
costs
customary
contractual allowance
reimbursement Answer: contractual allowance
, ⩥ The term "hard coding" refers to
HCPCS/CPT codes that appear in the hospital's chargemaster and will
be included automatically on the patient's bill.
ICD-10-CM/ICD-10-PCS codes that appear in the hospital's
chargemaster and that are automatically included on the patient's bill.
HCPCS/CPT codes that are coded by the coders.
ICD-10-CM/ICD-10-PCS codes that are coded by the coders. Answer:
HCPCS/CPT codes that appear in the hospital's chargemaster and will be
included automatically on the patient's bill.
⩥ A patient undergoes outpatient surgery. During the recovery period,
the patient develops atrial fibrillation and is subsequently admitted to the
hospital as an inpatient. The present on admission (POA) indicator is
Y = Present at the time of inpatient admission.
U = Documentation is insufficient to determine if condition was present
at the time of admission.
W = Provider is unable to clinically determine if condition was present
at the time of admission.
N = Not present at the time of inpatient admission. Answer: The atrial
fibrillation developed prior to a written order for inpatient admission;
therefore, it was present at the time of inpatient admission
⩥ Under APCs, payment status indicator "S" means
