CRC (Certified Risk Adjustment Coder) with all Correct
& 100% Verified Answers |Already Graded A+
Highly audited ares for risk adjustment are: ✔Correct Answer-Cancer, strokes, fractures, and acute
MIs
How many diagnosis codes can a provider submit in the outpatient space? ✔Correct Answer-12
Medicare Part A helps cover: ✔Correct Answer-inpatient hospital care
care provided in skilled nursing facilities
hospice care
home health care
Medicare Part B helps cover: ✔Correct Answer-medically necessary physicians' services
outpatient care
other medical services (including some preventative services) not covered under Part A
Medicare Part B is: ✔Correct Answer-Optional benefit for which the PT must pay a premium as
well as co-insurance
Medicare Part C is also called: ✔Correct Answer-Medicare Advantage
Private payers who administer Medicare Advantage are referred to as: ✔Correct Answer-Medicare
Advantage Organizations (MAOs)
Medicare Part D is: ✔Correct Answer-Prescription drug coverage
______ explain when Medicare will pay for items or services. ✔Correct Answer-National Coverage
Determinations (NCDs)
Each Medicare Administrative Contractor (MAC) is responsible for _____. ✔Correct Answer-
Translating national policies into regional policies, called Local Coverage Determinations (LCDs).
Define fraud: ✔Correct Answer-Purposefully bill for services that were never given or to bill for a
service that has a higher reimbursement than the service provided.
Define abuse: ✔Correct Answer-Payment for items or services that are billed by providers in error
that should not be paid for by Medicare.
Does a person have to have knowledge of the violation for it to be considered an offense (fraud)?
✔Correct Answer-No - there is no intent requirement.
& 100% Verified Answers |Already Graded A+
Highly audited ares for risk adjustment are: ✔Correct Answer-Cancer, strokes, fractures, and acute
MIs
How many diagnosis codes can a provider submit in the outpatient space? ✔Correct Answer-12
Medicare Part A helps cover: ✔Correct Answer-inpatient hospital care
care provided in skilled nursing facilities
hospice care
home health care
Medicare Part B helps cover: ✔Correct Answer-medically necessary physicians' services
outpatient care
other medical services (including some preventative services) not covered under Part A
Medicare Part B is: ✔Correct Answer-Optional benefit for which the PT must pay a premium as
well as co-insurance
Medicare Part C is also called: ✔Correct Answer-Medicare Advantage
Private payers who administer Medicare Advantage are referred to as: ✔Correct Answer-Medicare
Advantage Organizations (MAOs)
Medicare Part D is: ✔Correct Answer-Prescription drug coverage
______ explain when Medicare will pay for items or services. ✔Correct Answer-National Coverage
Determinations (NCDs)
Each Medicare Administrative Contractor (MAC) is responsible for _____. ✔Correct Answer-
Translating national policies into regional policies, called Local Coverage Determinations (LCDs).
Define fraud: ✔Correct Answer-Purposefully bill for services that were never given or to bill for a
service that has a higher reimbursement than the service provided.
Define abuse: ✔Correct Answer-Payment for items or services that are billed by providers in error
that should not be paid for by Medicare.
Does a person have to have knowledge of the violation for it to be considered an offense (fraud)?
✔Correct Answer-No - there is no intent requirement.
