Reimbursement Test with Accurate
Solutions
__assignment is when a provider does not bill the patient for the difference between the
service cost and Medicare allowed? - ANSWER-accepting
A _____ usually an insurance company handles the daily operations for Medicare,
including paperwork claims payments? - ANSWER-Medicare Administrative Contractor
(MAC's)
A medical coder's responsibility is to code ___and ___? - ANSWER-Accurately and
completely
Abuse is? - ANSWER-Unintended and repetitive behavior
CMS's Mission:
CMS's Vision: - ANSWER-to ensure effective, up-to-date health care coverage and to
promote quality care for beneficiaries.
To achieve a transformed and modernized health care system.
CMS will accomplish our mission by continuing to transform and modernize America's
health care system.
HIPAA now uses? - ANSWER-5010
How much does the patient pay-beneficiary ?
How much does the insurance pay? - ANSWER-20%
80%
How to protect yourself form Fraud? - ANSWER-As the person submitting the Medicare
claims you are one of those whom CMS hold responsible for submitting truthful and
accurate claims. If you are unsure about a charge or a request, check with the physician
or other supervisory personnel to ensure that you are submitting the correct charges for
each patient.
In which issue of the "Federal Register" are updates to Medicare outpatient
reimbursement NOT published? - ANSWER-October
Inpatient can register in?
Outpatient can register in? - ANSWER-October
November or December
, Is Part B Automatic or not automatic? - ANSWER-not automatic and beneficiaries must
purchase benefits with a monthly premium.
Medicare___ is a prescription drug benefit? - ANSWER-Part D
PAR?
NON-PAR? - ANSWER-accept
not accept
Part A covers for inpatient? - ANSWER-is automatic
semiprivate room, meals and special diet, plus all other medically necessary services,
general nursing, drugs as part inpatient treatment, and other hospital serives and
supplies.
People covered by Medicare is? - ANSWER-Beneficiaries
The ___ is the fastest growing segment of the population? - ANSWER-elderly
What are the 3 codes that part B uses? - ANSWER-Diagnosis codes-ICD-9, CPT
codes, and HCPCS.
What does Centers for Medicare and Medicaid Services (CMS) do? - ANSWER-handles
the daily operation of the Medicare Program though the use of MAC
What Does Office of Inspector General (OIG) do? - ANSWER-department of Health and
Human Services, is responsible for developing an annual work plan that outlines the
ways in which the Medicare program is monitored to identify fraud and abuse.
What does Part A NOT cover? - ANSWER-personal-convenience items and private-
duty nurses.
What does Part B outpatient Cover? - ANSWER-medically necessary professional
services, outpatient hospital services, home health care, and a number of other medical
services and supplies.
What forms does Fraud take? - ANSWER-Billing for services not furnished
Misrepresenting a diagnosis to justify a payment
soliciting, offering, or receiving a kickback
unbundling
Falsifying certificates of medical necessity, plans or treatment, and medical records to
justify payment.
billing for additional services not furnished as billed-up coding
routine waiver of co payment
What is beneficiaries? - ANSWER-Individuals covered under Medicare
Solutions
__assignment is when a provider does not bill the patient for the difference between the
service cost and Medicare allowed? - ANSWER-accepting
A _____ usually an insurance company handles the daily operations for Medicare,
including paperwork claims payments? - ANSWER-Medicare Administrative Contractor
(MAC's)
A medical coder's responsibility is to code ___and ___? - ANSWER-Accurately and
completely
Abuse is? - ANSWER-Unintended and repetitive behavior
CMS's Mission:
CMS's Vision: - ANSWER-to ensure effective, up-to-date health care coverage and to
promote quality care for beneficiaries.
To achieve a transformed and modernized health care system.
CMS will accomplish our mission by continuing to transform and modernize America's
health care system.
HIPAA now uses? - ANSWER-5010
How much does the patient pay-beneficiary ?
How much does the insurance pay? - ANSWER-20%
80%
How to protect yourself form Fraud? - ANSWER-As the person submitting the Medicare
claims you are one of those whom CMS hold responsible for submitting truthful and
accurate claims. If you are unsure about a charge or a request, check with the physician
or other supervisory personnel to ensure that you are submitting the correct charges for
each patient.
In which issue of the "Federal Register" are updates to Medicare outpatient
reimbursement NOT published? - ANSWER-October
Inpatient can register in?
Outpatient can register in? - ANSWER-October
November or December
, Is Part B Automatic or not automatic? - ANSWER-not automatic and beneficiaries must
purchase benefits with a monthly premium.
Medicare___ is a prescription drug benefit? - ANSWER-Part D
PAR?
NON-PAR? - ANSWER-accept
not accept
Part A covers for inpatient? - ANSWER-is automatic
semiprivate room, meals and special diet, plus all other medically necessary services,
general nursing, drugs as part inpatient treatment, and other hospital serives and
supplies.
People covered by Medicare is? - ANSWER-Beneficiaries
The ___ is the fastest growing segment of the population? - ANSWER-elderly
What are the 3 codes that part B uses? - ANSWER-Diagnosis codes-ICD-9, CPT
codes, and HCPCS.
What does Centers for Medicare and Medicaid Services (CMS) do? - ANSWER-handles
the daily operation of the Medicare Program though the use of MAC
What Does Office of Inspector General (OIG) do? - ANSWER-department of Health and
Human Services, is responsible for developing an annual work plan that outlines the
ways in which the Medicare program is monitored to identify fraud and abuse.
What does Part A NOT cover? - ANSWER-personal-convenience items and private-
duty nurses.
What does Part B outpatient Cover? - ANSWER-medically necessary professional
services, outpatient hospital services, home health care, and a number of other medical
services and supplies.
What forms does Fraud take? - ANSWER-Billing for services not furnished
Misrepresenting a diagnosis to justify a payment
soliciting, offering, or receiving a kickback
unbundling
Falsifying certificates of medical necessity, plans or treatment, and medical records to
justify payment.
billing for additional services not furnished as billed-up coding
routine waiver of co payment
What is beneficiaries? - ANSWER-Individuals covered under Medicare
