Question 1
Which Medicare Part is reimbursed based on the risk adjustment models?
A. Part A
B. Part B
C. Part C
D. Part D
CORRECT ANSWER
C. Part C
Medicare Advantage (Medicare Part C) plans are reimbursed by CMS using risk
adjustment modes based on the health status of their members.
Question 2
Who typically employs risk adjustment coders?
A. Physician offices
B. Hospitals
C. Amulatory surgical centers
D. Health Plans
CORRECT ANSWER
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, D. Health Plans
Risk adjustment coders typically work for health plans.
Question 3
Is a health plan required to follow the minimum necessary rule?
A. Yes, health plans are covered entities and are therefore required to follow the minimum
necessary rule.
B. Yes, health plans are not covered entities but as business associates are required to follow
the minimum necessary rule.
C. No, health plans are not covered entities and are not required to follow the minimum
necessary rule.
D. No, health plans are covered entities but are not required to follow the minimum
necessary rule.
CORRECT ANSWER
A. Yes, health plans are covered entities and are therefore required to follow the
minimum necessary rule.
Health plans are considered a covered entity under HIPPA. A key provision under HIPPA is
the Minimum Necessary requirement. This requirement applies to all covered entities.
Question 4
Which examples below would be considered fraud?
A. Reporting a diagnosis or co-morbidity that does not exist to obtain higher reimbursement.
B. Reporting an additional diagnosis for a patient that is documented in the medical record.
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,C. Reporting a diagnosis that only relates to documentation.
D. Reporting additional diagnosis that affects the care of the patients.
CORRECT ANSWER
A. Reporting a diagnosis or co-morbidity that does not exist to obtain higher
reimbursement.
The definition of fraud is to purposely bill for services that were never given or to bill for
a service that has a higher reimbursement than the service provided.
Question 5
Which part of Medicare is also called Medicare Advantage?
A. Part A
B. Part B
C. Part C
D. Part D
CORRECT ANSWER
C. Part C
Medicare Part C, also called Medicare Advantage, combines the benefits of Medicare
Part A, Part, B, and-sometimes-Part D.
Question 6
What health insurance assistance program is sponsored by federal and state governments?
A. Medicare
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, B. Medicaid
C. Commercial carriers
D. Private Payer
CORRECT ANSWER
B. Medicaid
Medicaid is a health insurance assistance program for some low-income people
(especially children and pregnancy women) sponsored by federal and state governments.
It is administered on a state-by-state basis, but state programs must adhere to certain
federal guidelines.
Question 7
What OIG document should a Medicare Advantage participant review for potential
problem areas that will receive special scrutiny in the upcoming year?
A. Compliance Program Guidance
B. Safe Harbor Regulations
C. Red Flag Rules
D. OIG Work Plan
CORRECT ANSWER
D. OIG Work Plan
Twice a year, the OIG releases a work plan outlining its proprieties for the fiscal year
ahead. Of special interest to healthcare, the work plan announces potential problem
areas with claims submissions that it will target for special scrutiny.
Question 8
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Which Medicare Part is reimbursed based on the risk adjustment models?
A. Part A
B. Part B
C. Part C
D. Part D
CORRECT ANSWER
C. Part C
Medicare Advantage (Medicare Part C) plans are reimbursed by CMS using risk
adjustment modes based on the health status of their members.
Question 2
Who typically employs risk adjustment coders?
A. Physician offices
B. Hospitals
C. Amulatory surgical centers
D. Health Plans
CORRECT ANSWER
1
@https://www.stuvia.com/user/thestudyvault
, D. Health Plans
Risk adjustment coders typically work for health plans.
Question 3
Is a health plan required to follow the minimum necessary rule?
A. Yes, health plans are covered entities and are therefore required to follow the minimum
necessary rule.
B. Yes, health plans are not covered entities but as business associates are required to follow
the minimum necessary rule.
C. No, health plans are not covered entities and are not required to follow the minimum
necessary rule.
D. No, health plans are covered entities but are not required to follow the minimum
necessary rule.
CORRECT ANSWER
A. Yes, health plans are covered entities and are therefore required to follow the
minimum necessary rule.
Health plans are considered a covered entity under HIPPA. A key provision under HIPPA is
the Minimum Necessary requirement. This requirement applies to all covered entities.
Question 4
Which examples below would be considered fraud?
A. Reporting a diagnosis or co-morbidity that does not exist to obtain higher reimbursement.
B. Reporting an additional diagnosis for a patient that is documented in the medical record.
2
@https://www.stuvia.com/user/thestudyvault
,C. Reporting a diagnosis that only relates to documentation.
D. Reporting additional diagnosis that affects the care of the patients.
CORRECT ANSWER
A. Reporting a diagnosis or co-morbidity that does not exist to obtain higher
reimbursement.
The definition of fraud is to purposely bill for services that were never given or to bill for
a service that has a higher reimbursement than the service provided.
Question 5
Which part of Medicare is also called Medicare Advantage?
A. Part A
B. Part B
C. Part C
D. Part D
CORRECT ANSWER
C. Part C
Medicare Part C, also called Medicare Advantage, combines the benefits of Medicare
Part A, Part, B, and-sometimes-Part D.
Question 6
What health insurance assistance program is sponsored by federal and state governments?
A. Medicare
3
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, B. Medicaid
C. Commercial carriers
D. Private Payer
CORRECT ANSWER
B. Medicaid
Medicaid is a health insurance assistance program for some low-income people
(especially children and pregnancy women) sponsored by federal and state governments.
It is administered on a state-by-state basis, but state programs must adhere to certain
federal guidelines.
Question 7
What OIG document should a Medicare Advantage participant review for potential
problem areas that will receive special scrutiny in the upcoming year?
A. Compliance Program Guidance
B. Safe Harbor Regulations
C. Red Flag Rules
D. OIG Work Plan
CORRECT ANSWER
D. OIG Work Plan
Twice a year, the OIG releases a work plan outlining its proprieties for the fiscal year
ahead. Of special interest to healthcare, the work plan announces potential problem
areas with claims submissions that it will target for special scrutiny.
Question 8
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