Medical Billing and Coding Verified Multiple Choice
and Conceptual Actual Exam Questions With
Reviewed 100% Correct Detailed Answers
Guaranteed Pass!!Current Update
1. The __________________is a statement sent to the provider to explain
payments made by third-party payers: - ANSWER Remittance Advice
2. The _______refers to a statement sent to the patient to show how much
the provider billed, how much Medicare reimbursed the provider, and what
the patient must pay the provider: - ANSWER Medicare Summary
Notice
3. The case-mix management system that utilizes information from the
Minimum Data Set (MDS) in long-term care settings is called: - ANSWER
Resource Utilization Groups (RUGs)
4. The computer-to-computer transfer of data between providers and third-
party payers in a data format agreed upon by both parties is called: -
ANSWER Electronic Data Interchange (EDI)
5. The difference between a rejected claim and a denied claim is that: -
ANSWER A rejected claim is sent back to the provider, errors may be
corrected and the claim resubmitted
,6. The following services are excluded under the Hospital Outpatient
Prospective Payment System (OPPS) Ambulatory Payment Classification
(APC) methodology: - ANSWER Clinical Lab Services
7. The following type of hospital is considered excluded when it applies for
and receives a waiver from CMS. This means that the hospital does not
participate in the inpatient prospective payment system (IPPS): - ANSWER
Cancer Hospital
8. The limiting charge is a percentage limit on fees specified by legislation that
the nonparticipating physician may bill Medicare beneficiaries above the
nonPAR fee schedule amount. The limiting charge is: - ANSWER 15%
9. The nursing initial assessment upon admission documents the presence of a
decubitus ulcer. There is no mention of the decubitus ulcer in the physician
documentation until several days after admission. The present on admission
(POA) indicator is: - ANSWER U = documentation is insufficient to
determine if condition was present at the time of admission
10.The present on admission (POA) indicator is required to be assigned to the
________diagnosis(es) for _________claims on _______admissions: -
ANSWER Principal and Secondary, Medicare, Inpatient
11.The prospective payment system based on resource utilization groups
(RUGs) is used for reimbursement to ____________for patients with
Medicare: - ANSWER Skilled Nursing Facilities
, 12.The prospective payment system replaced the Medicare physician payment
system of customary, prevailing and reasonable (CPR)" charges whereby
physicians were reimbursed according to their historical record of the
charge for the provision of each service: - ANSWER Medicare Physician
Fee Schedule (MFPS)
13.The prospective payment system used to reimburse home health agencies
for patients with Medicare utilizes data from: - ANSWER OASIS
(Outcome and Assessment Information Set)
14.The prospective payment system used to reimburse hospitals for Medicare
hospital outpatients is called: - ANSWER APCs
15.The standard claim form used by hospitals to request reimbursement for
inpatient and outpatient procedures performed or services provided is
called the: - ANSWER UB-04
16.The term used to describe a diagram depicting grouper logic in assigned
MS-DRGs is: - ANSWER Decision Tree
17.The term used to describe the information-gathering fields on the UB-04
billing form is: - ANSWER Form Locator
18.The term used to indicat:e that the service or procedure is reasonable and
necessary for the diagnosis or treatment of illness or injury consistent with
generally accepted standards of care is - ANSWER Medical Necessity
and Conceptual Actual Exam Questions With
Reviewed 100% Correct Detailed Answers
Guaranteed Pass!!Current Update
1. The __________________is a statement sent to the provider to explain
payments made by third-party payers: - ANSWER Remittance Advice
2. The _______refers to a statement sent to the patient to show how much
the provider billed, how much Medicare reimbursed the provider, and what
the patient must pay the provider: - ANSWER Medicare Summary
Notice
3. The case-mix management system that utilizes information from the
Minimum Data Set (MDS) in long-term care settings is called: - ANSWER
Resource Utilization Groups (RUGs)
4. The computer-to-computer transfer of data between providers and third-
party payers in a data format agreed upon by both parties is called: -
ANSWER Electronic Data Interchange (EDI)
5. The difference between a rejected claim and a denied claim is that: -
ANSWER A rejected claim is sent back to the provider, errors may be
corrected and the claim resubmitted
,6. The following services are excluded under the Hospital Outpatient
Prospective Payment System (OPPS) Ambulatory Payment Classification
(APC) methodology: - ANSWER Clinical Lab Services
7. The following type of hospital is considered excluded when it applies for
and receives a waiver from CMS. This means that the hospital does not
participate in the inpatient prospective payment system (IPPS): - ANSWER
Cancer Hospital
8. The limiting charge is a percentage limit on fees specified by legislation that
the nonparticipating physician may bill Medicare beneficiaries above the
nonPAR fee schedule amount. The limiting charge is: - ANSWER 15%
9. The nursing initial assessment upon admission documents the presence of a
decubitus ulcer. There is no mention of the decubitus ulcer in the physician
documentation until several days after admission. The present on admission
(POA) indicator is: - ANSWER U = documentation is insufficient to
determine if condition was present at the time of admission
10.The present on admission (POA) indicator is required to be assigned to the
________diagnosis(es) for _________claims on _______admissions: -
ANSWER Principal and Secondary, Medicare, Inpatient
11.The prospective payment system based on resource utilization groups
(RUGs) is used for reimbursement to ____________for patients with
Medicare: - ANSWER Skilled Nursing Facilities
, 12.The prospective payment system replaced the Medicare physician payment
system of customary, prevailing and reasonable (CPR)" charges whereby
physicians were reimbursed according to their historical record of the
charge for the provision of each service: - ANSWER Medicare Physician
Fee Schedule (MFPS)
13.The prospective payment system used to reimburse home health agencies
for patients with Medicare utilizes data from: - ANSWER OASIS
(Outcome and Assessment Information Set)
14.The prospective payment system used to reimburse hospitals for Medicare
hospital outpatients is called: - ANSWER APCs
15.The standard claim form used by hospitals to request reimbursement for
inpatient and outpatient procedures performed or services provided is
called the: - ANSWER UB-04
16.The term used to describe a diagram depicting grouper logic in assigned
MS-DRGs is: - ANSWER Decision Tree
17.The term used to describe the information-gathering fields on the UB-04
billing form is: - ANSWER Form Locator
18.The term used to indicat:e that the service or procedure is reasonable and
necessary for the diagnosis or treatment of illness or injury consistent with
generally accepted standards of care is - ANSWER Medical Necessity
