REVENUE CYCLE FINAL EXAM STUDY
GUIDE # 2 WITH COMPLETE
SOLUTIONS
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 - ANSWER-supervising physician
Secondary diagnoses codes are entered in Blocks __________ of the CMS-1500 claim
- ANSWER-21B - 24L
When entering a fee in Blocks 24F, 28, or 29, enter __________ in the cents column -
ANSWER-2 zeros
The MUE project was implemented by CMS as part of the NCCI to improve the
accuracy of Medicare payments by - ANSWER-detecting and denying unlikely Medicare
claims on a prepayment basis
The CMS-1500 paper claim was designed to accommodate optical scanning of
__________ claims - ANSWER-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
- ANSWER-Space
Which is associated with "last resort" health insurance for individuals who cannot obtain
coverage due to a serious medical condition - ANSWER-high-risk pool
Which type of automobile insurance reimburses medical expenses for covered
individuals, regardless of fault, for treatment due to an automobile accident - ANSWER-
personal injury protection
Which refers to the contractual right of a third-party payer to recover health care
expenses from a liable party - ANSWER-Subrogation
Which is the term for short-term care provided by another caregiver, so the usual
caregiver can rest - ANSWER-respite care
Private fee-for-service (PFFS) plans are offered by private insurance companies in
some regions of the country, and Medicare pays a pre-established amount of money
each month to the insurance company, which decides how much it will pay for services.
,Such plans reimburse providers on a fee-for-service basis and are authorized to charge
enrollees up to __________ percent of the plan's payment schedule - ANSWER-115
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 - ANSWER-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 - ANSWER-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 - ANSWER-a new diagnosis that describes the complication
When a person uses a title such as Sr., Jr., II, or III - ANSWER-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 - ANSWER-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 - ANSWER-ICD-10-
CM
Which is offered to members and marketed to small business owners as a way to
provide coverage to employees - ANSWER-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) - ANSWER-
Commercial
Which type of insurance is defined as reimbursement for income lost as a result of a
temporary or permanent illness or injury - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-Collision
When the same payer issues the primary, secondary, or supplemental policies, the
correct procedure for submitting the claim would be to submit - ANSWER-one claim for
all policies
Which includes health maintenance organizations and preferred provider organizations -
ANSWER-managed care
If a patient is covered by two different policies, the usual procedure for submitting a
claim would be - ANSWER-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 - ANSWER-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 -
ANSWER-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 - ANSWER-Liability
Which type of automobile insurance pays for accidental bodily injury and property
damage to others, including medical expenses, pain and suffering, lost wages, and
other special damages - ANSWER-Liability
Which type of insurance is a contract between an individual and an insurance company
whereby the individual pays a premium and, in exchange, the insurance company
agrees to pay for specific vehicle-related financial losses during the term of the policy -
ANSWER-Automobile
A Medicare-Medicaid (Medi-Medi) crossover plan provides both Medicare and Medicaid
coverage to __________ beneficiaries with low incomes - ANSWER-Medicare
Medicare lifetime reserve days, which total __________ days, are used once during a
patient's lifetime and are usually reserved for use during the patient's final, terminal
hospital stay - ANSWER-60
GUIDE # 2 WITH COMPLETE
SOLUTIONS
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 - ANSWER-supervising physician
Secondary diagnoses codes are entered in Blocks __________ of the CMS-1500 claim
- ANSWER-21B - 24L
When entering a fee in Blocks 24F, 28, or 29, enter __________ in the cents column -
ANSWER-2 zeros
The MUE project was implemented by CMS as part of the NCCI to improve the
accuracy of Medicare payments by - ANSWER-detecting and denying unlikely Medicare
claims on a prepayment basis
The CMS-1500 paper claim was designed to accommodate optical scanning of
__________ claims - ANSWER-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
- ANSWER-Space
Which is associated with "last resort" health insurance for individuals who cannot obtain
coverage due to a serious medical condition - ANSWER-high-risk pool
Which type of automobile insurance reimburses medical expenses for covered
individuals, regardless of fault, for treatment due to an automobile accident - ANSWER-
personal injury protection
Which refers to the contractual right of a third-party payer to recover health care
expenses from a liable party - ANSWER-Subrogation
Which is the term for short-term care provided by another caregiver, so the usual
caregiver can rest - ANSWER-respite care
Private fee-for-service (PFFS) plans are offered by private insurance companies in
some regions of the country, and Medicare pays a pre-established amount of money
each month to the insurance company, which decides how much it will pay for services.
,Such plans reimburse providers on a fee-for-service basis and are authorized to charge
enrollees up to __________ percent of the plan's payment schedule - ANSWER-115
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 - ANSWER-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 - ANSWER-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 - ANSWER-a new diagnosis that describes the complication
When a person uses a title such as Sr., Jr., II, or III - ANSWER-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 - ANSWER-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 - ANSWER-ICD-10-
CM
Which is offered to members and marketed to small business owners as a way to
provide coverage to employees - ANSWER-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) - ANSWER-
Commercial
Which type of insurance is defined as reimbursement for income lost as a result of a
temporary or permanent illness or injury - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-Collision
When the same payer issues the primary, secondary, or supplemental policies, the
correct procedure for submitting the claim would be to submit - ANSWER-one claim for
all policies
Which includes health maintenance organizations and preferred provider organizations -
ANSWER-managed care
If a patient is covered by two different policies, the usual procedure for submitting a
claim would be - ANSWER-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 - ANSWER-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 -
ANSWER-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 - ANSWER-Liability
Which type of automobile insurance pays for accidental bodily injury and property
damage to others, including medical expenses, pain and suffering, lost wages, and
other special damages - ANSWER-Liability
Which type of insurance is a contract between an individual and an insurance company
whereby the individual pays a premium and, in exchange, the insurance company
agrees to pay for specific vehicle-related financial losses during the term of the policy -
ANSWER-Automobile
A Medicare-Medicaid (Medi-Medi) crossover plan provides both Medicare and Medicaid
coverage to __________ beneficiaries with low incomes - ANSWER-Medicare
Medicare lifetime reserve days, which total __________ days, are used once during a
patient's lifetime and are usually reserved for use during the patient's final, terminal
hospital stay - ANSWER-60
