CQM D; GRADED EXAM
QUESTIONS AND WELL
DETAILED AND WELL
ELLABORATE QUESTIONS AND
ANSWERS. PASS
GUARANTEE.NEW! NEW! NEW!
2025/2026
Through what document does a hospital establish compliance standards? - :
ANSWER :code of conduct : QUESTION :What is the purpose OIG work plant? -
,: ANSWER :Identify Acceptable compliance programs in various provider setting :
QUESTION :If a Medicare patient is admitted on Friday, what services fall within
the three-day DRG window rule? - : ANSWER :Non-diagnostic service provided
on Tuesday through Friday : QUESTION :What does a modifier allow a provider
to do? - : ANSWER :Report a specific circumstance that affected a procedure or
service without changing the code or its definition : QUESTION :IF outpatient
diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must
happen to these charges - : ANSWER :They must be billed separately to the part B
Carrier : QUESTION :what is a recurring or series registration? - : ANSWER :One
registration record is created for multiple days of service : QUESTION :What are
nonemergency patients who come for service without prior notification to the
provider called? - : ANSWER :Unscheduled patients : QUESTION :Which of the
following statement apply to the observation patient type? - : ANSWER :It is used
to evaluate the need for an inpatient admission : QUESTION :which services are
hospice programs required to provide around the clock patient - : ANSWER
:Physician, Nursing, Pharmacy : QUESTION :Scheduler instructions are used to
prompt the scheduler to do what? - : ANSWER :Complete the scheduling process
correctly based on service requeste : QUESTION :The Time needed to prepare the
patient before service is the difference between the patients arrival time and which
, of the following? - : ANSWER :Procedure time : QUESTION :Medicare
guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - : ANSWER :Documentation of
the medical necessity for the test : QUESTION :What is the advantage of a pre-
registration program - : ANSWER :It reduces processing times at the time of
service : QUESTION :What date are required to establish a new MPI(Master
patient Index) entry - : ANSWER :The responsible party's full legal name, date of
birth, and social security number : QUESTION :Which of the following statements
is true about third-party payments? - : ANSWER :The payments are received by
the provider from the payer responsible for reimbursing the provider for the
patient's covered services. : QUESTION :Which provision protects the patient
from medical expenses that exceed the pre-set level - : ANSWER :stop loss :
QUESTION :what documentation must a primary care physician send to HMO
patient to authorize a visit to a specialist for additional testing or care? - :
ANSWER :Referral : QUESTION :Under EMTALA (Emergency Medical
Treatment and Labor Act) regulations, the provider may not ask about a patient's
insurance information if it would delay what? - : ANSWER :Medical screening and
stabilizing treatment : QUESTION :Which of the following is a step in the
discharge process? - : ANSWER :Have a case management service complete the
discharge plan : QUESTION :The hospital has a APC based contract for the
QUESTIONS AND WELL
DETAILED AND WELL
ELLABORATE QUESTIONS AND
ANSWERS. PASS
GUARANTEE.NEW! NEW! NEW!
2025/2026
Through what document does a hospital establish compliance standards? - :
ANSWER :code of conduct : QUESTION :What is the purpose OIG work plant? -
,: ANSWER :Identify Acceptable compliance programs in various provider setting :
QUESTION :If a Medicare patient is admitted on Friday, what services fall within
the three-day DRG window rule? - : ANSWER :Non-diagnostic service provided
on Tuesday through Friday : QUESTION :What does a modifier allow a provider
to do? - : ANSWER :Report a specific circumstance that affected a procedure or
service without changing the code or its definition : QUESTION :IF outpatient
diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must
happen to these charges - : ANSWER :They must be billed separately to the part B
Carrier : QUESTION :what is a recurring or series registration? - : ANSWER :One
registration record is created for multiple days of service : QUESTION :What are
nonemergency patients who come for service without prior notification to the
provider called? - : ANSWER :Unscheduled patients : QUESTION :Which of the
following statement apply to the observation patient type? - : ANSWER :It is used
to evaluate the need for an inpatient admission : QUESTION :which services are
hospice programs required to provide around the clock patient - : ANSWER
:Physician, Nursing, Pharmacy : QUESTION :Scheduler instructions are used to
prompt the scheduler to do what? - : ANSWER :Complete the scheduling process
correctly based on service requeste : QUESTION :The Time needed to prepare the
patient before service is the difference between the patients arrival time and which
, of the following? - : ANSWER :Procedure time : QUESTION :Medicare
guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - : ANSWER :Documentation of
the medical necessity for the test : QUESTION :What is the advantage of a pre-
registration program - : ANSWER :It reduces processing times at the time of
service : QUESTION :What date are required to establish a new MPI(Master
patient Index) entry - : ANSWER :The responsible party's full legal name, date of
birth, and social security number : QUESTION :Which of the following statements
is true about third-party payments? - : ANSWER :The payments are received by
the provider from the payer responsible for reimbursing the provider for the
patient's covered services. : QUESTION :Which provision protects the patient
from medical expenses that exceed the pre-set level - : ANSWER :stop loss :
QUESTION :what documentation must a primary care physician send to HMO
patient to authorize a visit to a specialist for additional testing or care? - :
ANSWER :Referral : QUESTION :Under EMTALA (Emergency Medical
Treatment and Labor Act) regulations, the provider may not ask about a patient's
insurance information if it would delay what? - : ANSWER :Medical screening and
stabilizing treatment : QUESTION :Which of the following is a step in the
discharge process? - : ANSWER :Have a case management service complete the
discharge plan : QUESTION :The hospital has a APC based contract for the
