CODING STUDY SET UPDATED QUESTIONS AND ANSWERS
National Correct Coding Initiative (NCCI) edits - CORRECT ANSWER✅✅✅For coding of Medicare Part
B claims.
-to prevent improper payment when incorrect code combinations are reported. The NCCI contains one
table of edits for physicians and one table of edits for outpatient hospital services
Medicare Part A - CORRECT ANSWER✅✅✅cover inpatient hospital care, as well as care provided in
skilled nursing facilities, hospice, and home health.
Which statement is TRUE regarding the Merit-Based Incentive Program (MIPS)?
a. Providers with less than 300 Part-B enrolled patients are exempt from MIPS.
b.All Medicare providers must participate in MIPS.
c.Providers with less than $90,000 in Part C allowed charges for covered professional services are
exempted.
d.Providers are excluded from MIPS if they are enrolled in a Qualifying APM program. - CORRECT
ANSWER✅✅✅-Providers are excluded from MIPS if they are enrolled in a Qualifying APM program.
Which of the following is NOT a component of the MIPS program?
a. Improvement Activities
b. Promoting Interoperability
c. Quality
d. Readmission Rates - CORRECT ANSWER✅✅✅D Readmission Rates
Medicare Part B - CORRECT ANSWER✅✅✅The part of the Medicare program that pays for physician
services, outpatient hospital services, durable medical equipment, and other services and supplies.
-optional requires premium payments
, Medicare Advantage Plans - CORRECT ANSWER✅✅✅Commonly called Plan C, these plans provide
Medicare benefits to eligible people, but they differ in that they are administered by private providers
rather than by the government.
-Includes Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. as well as supplemental
benefits include vision, hearing, dental, general checkups, and health and wellness programs.
Evaluation and management (E/M) services - CORRECT ANSWER✅✅✅provider sees a patient to
evaluate the patient's condition(s) and determine the management of care required to treat the patient
- documented in a SOAP format
What is SOAP format - CORRECT ANSWER✅✅✅S: subjective -the patient's statement about his or
her health, including symptoms
O: objective -The provider's examination and documentation of the patient's illness using observation,
palpation, auscultation, and percussion. Tests and other services performed
A: assessment - Evaluation and conclusion made by the provider. This is usually where you find the
diagnosis(es) that supports the services rendered.
P: plan- Course of action. Here the provider will list the next steps for the patient, whether it's ordering
additional tests, taking over-the-counter medications, etc.
APC
ambulatory payment classification system - CORRECT ANSWER✅✅✅is used to bill for outpatient
services and is based on the grouping procedures by CPT/HCPCS
MIPS (Merit-Based Incentive Payment System) - CORRECT ANSWER✅✅✅quality payment program
that determines Medicare payment adjustments to providers
-Using a composite performance score, eligible clinicians (ECs) may receive a payment bonus, a payment
penalty or no payment adjustment
ICD-10-PCS codes - CORRECT ANSWER✅✅✅Used for inpatient billing
UB-04 claim form - CORRECT ANSWER✅✅✅Standard insurance claim form used by institutional
providers, such as hospitals and skilled nursing facilities.
National Correct Coding Initiative (NCCI) edits - CORRECT ANSWER✅✅✅For coding of Medicare Part
B claims.
-to prevent improper payment when incorrect code combinations are reported. The NCCI contains one
table of edits for physicians and one table of edits for outpatient hospital services
Medicare Part A - CORRECT ANSWER✅✅✅cover inpatient hospital care, as well as care provided in
skilled nursing facilities, hospice, and home health.
Which statement is TRUE regarding the Merit-Based Incentive Program (MIPS)?
a. Providers with less than 300 Part-B enrolled patients are exempt from MIPS.
b.All Medicare providers must participate in MIPS.
c.Providers with less than $90,000 in Part C allowed charges for covered professional services are
exempted.
d.Providers are excluded from MIPS if they are enrolled in a Qualifying APM program. - CORRECT
ANSWER✅✅✅-Providers are excluded from MIPS if they are enrolled in a Qualifying APM program.
Which of the following is NOT a component of the MIPS program?
a. Improvement Activities
b. Promoting Interoperability
c. Quality
d. Readmission Rates - CORRECT ANSWER✅✅✅D Readmission Rates
Medicare Part B - CORRECT ANSWER✅✅✅The part of the Medicare program that pays for physician
services, outpatient hospital services, durable medical equipment, and other services and supplies.
-optional requires premium payments
, Medicare Advantage Plans - CORRECT ANSWER✅✅✅Commonly called Plan C, these plans provide
Medicare benefits to eligible people, but they differ in that they are administered by private providers
rather than by the government.
-Includes Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. as well as supplemental
benefits include vision, hearing, dental, general checkups, and health and wellness programs.
Evaluation and management (E/M) services - CORRECT ANSWER✅✅✅provider sees a patient to
evaluate the patient's condition(s) and determine the management of care required to treat the patient
- documented in a SOAP format
What is SOAP format - CORRECT ANSWER✅✅✅S: subjective -the patient's statement about his or
her health, including symptoms
O: objective -The provider's examination and documentation of the patient's illness using observation,
palpation, auscultation, and percussion. Tests and other services performed
A: assessment - Evaluation and conclusion made by the provider. This is usually where you find the
diagnosis(es) that supports the services rendered.
P: plan- Course of action. Here the provider will list the next steps for the patient, whether it's ordering
additional tests, taking over-the-counter medications, etc.
APC
ambulatory payment classification system - CORRECT ANSWER✅✅✅is used to bill for outpatient
services and is based on the grouping procedures by CPT/HCPCS
MIPS (Merit-Based Incentive Payment System) - CORRECT ANSWER✅✅✅quality payment program
that determines Medicare payment adjustments to providers
-Using a composite performance score, eligible clinicians (ECs) may receive a payment bonus, a payment
penalty or no payment adjustment
ICD-10-PCS codes - CORRECT ANSWER✅✅✅Used for inpatient billing
UB-04 claim form - CORRECT ANSWER✅✅✅Standard insurance claim form used by institutional
providers, such as hospitals and skilled nursing facilities.
