CPSS LATEST FINAL EXAM ACTUAL QUESTIONS AND
ANSWERS SURE A+
✔✔The Medicare Physician Fee Schedule Database (MPFSD) includes fee calculations
based on work expense, practice expense, and malpractice expense which are used in
determining payments to physicians. Those figures are referred to as what? -
✔✔Relative Value Units
✔✔When billing Medicare, what is the definition of "deductible?" - ✔✔The amount the
patient is financially responsible for before Medicare provides payment.
✔✔Medicare requires that patients be informed in advance when a provider believes
that a normally covered service may not be covered under certain circumstances. The
form which must be signed by the patient is called what? - ✔✔ABN
✔✔What is the standard claim form used to submit provider services to Medicare Part
B? - ✔✔CMS-1500
✔✔In order to be paid by Medicare, timely claims filing must occur within - ✔✔12
months.
, ✔✔The Centers for Medicare and Medicaid Services (CMS), in conjunction with the
National Correct Coding Institute, developed the Correct Coding Initiative (CCI) bundling
edits which are used by Medicare providers to - ✔✔Control improper coding of claims
billed
✔✔In a Medicare audit, which of the following patient statements would deem an office
visit routine and not billable to Medicare? - ✔✔I am here for my annual eye exam and
glasses check
✔✔When auditing medical records, Medicare auditors generally have no preference as
to the method a physician uses for documenting a patient chart. - ✔✔False
✔✔Under Medicare's global surgical fee concept, most services performed following
surgery are included in the global fee payment and not billable separately. A physician
may, however, bill Medicare separately for - ✔✔Diagnostic tests required to treat the
patient.
✔✔In order to treat patients effectively, a physician may have allied staff perform certain
diagnostic tests. Before the test can be performed by the technician, what must be
documented in the patient chart? - ✔✔Order for the test
✔✔Medicare payers publish medical policies on their individual websites that provide
documentation and billing guidelines for services rendered by providers. These
guidelines should be reviewed on a regular basis for updated information and are called
what? - ✔✔local Coverage Determinations
✔✔Which of the following would CMS constitute as fraud? - ✔✔Billing a more extensive
service than actually performed
✔✔What does the Office of Inspector General (OIG) release annually that identifies
areas of focus for review and investigation they believe are the most vulnerable for
possible fraud/abuse? - ✔✔work plan
✔✔HIPAA stands for - ✔✔Health Insurance Portability and Accountability Act.
✔✔The following disclosure requires signed permission from the individual whose PHI
is being requested - ✔✔Information requested by an attorney without a subpoena.
✔✔Patient names on a sign-in form are considered an intentional breach of PHI -
✔✔false
✔✔Notice of Privacy Practices (NPP) must include which of the following information? -
✔✔Description of how the entity discloses PHI.
ANSWERS SURE A+
✔✔The Medicare Physician Fee Schedule Database (MPFSD) includes fee calculations
based on work expense, practice expense, and malpractice expense which are used in
determining payments to physicians. Those figures are referred to as what? -
✔✔Relative Value Units
✔✔When billing Medicare, what is the definition of "deductible?" - ✔✔The amount the
patient is financially responsible for before Medicare provides payment.
✔✔Medicare requires that patients be informed in advance when a provider believes
that a normally covered service may not be covered under certain circumstances. The
form which must be signed by the patient is called what? - ✔✔ABN
✔✔What is the standard claim form used to submit provider services to Medicare Part
B? - ✔✔CMS-1500
✔✔In order to be paid by Medicare, timely claims filing must occur within - ✔✔12
months.
, ✔✔The Centers for Medicare and Medicaid Services (CMS), in conjunction with the
National Correct Coding Institute, developed the Correct Coding Initiative (CCI) bundling
edits which are used by Medicare providers to - ✔✔Control improper coding of claims
billed
✔✔In a Medicare audit, which of the following patient statements would deem an office
visit routine and not billable to Medicare? - ✔✔I am here for my annual eye exam and
glasses check
✔✔When auditing medical records, Medicare auditors generally have no preference as
to the method a physician uses for documenting a patient chart. - ✔✔False
✔✔Under Medicare's global surgical fee concept, most services performed following
surgery are included in the global fee payment and not billable separately. A physician
may, however, bill Medicare separately for - ✔✔Diagnostic tests required to treat the
patient.
✔✔In order to treat patients effectively, a physician may have allied staff perform certain
diagnostic tests. Before the test can be performed by the technician, what must be
documented in the patient chart? - ✔✔Order for the test
✔✔Medicare payers publish medical policies on their individual websites that provide
documentation and billing guidelines for services rendered by providers. These
guidelines should be reviewed on a regular basis for updated information and are called
what? - ✔✔local Coverage Determinations
✔✔Which of the following would CMS constitute as fraud? - ✔✔Billing a more extensive
service than actually performed
✔✔What does the Office of Inspector General (OIG) release annually that identifies
areas of focus for review and investigation they believe are the most vulnerable for
possible fraud/abuse? - ✔✔work plan
✔✔HIPAA stands for - ✔✔Health Insurance Portability and Accountability Act.
✔✔The following disclosure requires signed permission from the individual whose PHI
is being requested - ✔✔Information requested by an attorney without a subpoena.
✔✔Patient names on a sign-in form are considered an intentional breach of PHI -
✔✔false
✔✔Notice of Privacy Practices (NPP) must include which of the following information? -
✔✔Description of how the entity discloses PHI.
