A HIPPS (Health Insurance Prospective Payment System) code is a five-character
alphanumeric code. A HIPPS code is used by: - Answer-Home Health Agencies (HHA)
and
Inpatient Rehabilitation Facilities (IRF)
A discharge in which the patient was discharged from the inpatient rehabilitation facility
and returned within three calendar days (prior to midnight on the third day) is called a
(n): - Answer-Interrupted Stay
A fiscal year is a yearly accounting period. It is the 12-month period on which a budget
is planned. The federal fiscal year is: - Answer-October 1st through September 20th of
the next year
A new initiative by the government to eliminate fraud and abuse and recover over-
payments involves the use of __________. Charts are audited to identify Medicare
over-payments and underpayments. These entities are paid based on a percentage of
money they identify and collect on behalf of the government: - Answer-Recovery Audit
Contractors (RAC)
A patient is admitted for a diagnostic workup for cachexia. The final:diagnosis is
malignant neoplasm of lung with metastasis. The present on admission (POA) indicator
is - Answer-Y = present at the time of inpatient admission
A patient undergoes outpatient surgery. During the recovery period, the patient
develops atrial fibrillation and is subsequently admitted to the hospital as an inpatient.
The present on admission (POA) indicator is" - Answer-Y = present at the time of
inpatient admission
A patient was seen by Dr. Zachary. The charge for the office visit was $125. The
Medicare beneficiary had already met his deductible. The Medicare fee schedule
amount is $100. Dr. Zachary does not accept assignment. The office manager will apply
a practice termed as "balance billing" which means that the patient is: - Answer-
Financially liable for charges in excess of the Medicare fee schedule, up to a limit
A patient with Medicare is seen in the physician's office. The total charge for this office
visit is $250.00. The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00. The non PAR
Medicare fee schedule amount for this service is $190.00.
The patient is financially liable for the coinsurance amount, which is: - Answer-20%
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, A patient with Medicare is seen in the physician's office. The total charge for this office
visit is $250.00. The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00. The non PAR
Medicare fee schedule amount for this service is $190.00: - Answer-$200.00
A patient with Medicare is seen in the physician's office. The total charge for this office
visit is $250.00. The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00. The non PAR
Medicare fee schedule amount for this service is $190.00.
If this physician is a nonparticipating physician who does NOT accept assignment for
this claim, the total amount the physician will receive is: - Answer-$218.50
A patient with Medicare is seen in the physician's office. The total charge for this office
visit is $250.00. The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00. The non PAR
Medicare fee schedule amount for this service is $190.00.
If this physician is a participating physician who accepts assignment for this claim, the
total amount of this patient's financial liability (out-of-pocket expense) is: - Answer-
$40.00
A patient with Medicare is seen in the physician's office. The total charge for this office
visit is $250.00. The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00. The non PAR
Medicare fee schedule amount for this service is $190.00.
If this physician is a nonparticipating physician who does NOT accept assignment for
this claim, the total amount of the patient's financial liability (out-of-pocket expense) is: -
Answer-$66.50
Accounts Receivable (A/R) refers to: - Answer-Cases that have not yet been paid
All of the following items are "packaged" under the Medicare outpatient prospective
payment system, EXCEPT for: - Answer-Medical Visits
All of the following statements are true of MS-DRGs, EXCEPT: - Answer-A patient claim
may have multiple MS-DRGs
An Advance Beneficiary Notice (ABN) is a document signed by the: - Answer-Patient
indicating whether he/she wants to receive services that Medicare probably will not pay
for
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alphanumeric code. A HIPPS code is used by: - Answer-Home Health Agencies (HHA)
and
Inpatient Rehabilitation Facilities (IRF)
A discharge in which the patient was discharged from the inpatient rehabilitation facility
and returned within three calendar days (prior to midnight on the third day) is called a
(n): - Answer-Interrupted Stay
A fiscal year is a yearly accounting period. It is the 12-month period on which a budget
is planned. The federal fiscal year is: - Answer-October 1st through September 20th of
the next year
A new initiative by the government to eliminate fraud and abuse and recover over-
payments involves the use of __________. Charts are audited to identify Medicare
over-payments and underpayments. These entities are paid based on a percentage of
money they identify and collect on behalf of the government: - Answer-Recovery Audit
Contractors (RAC)
A patient is admitted for a diagnostic workup for cachexia. The final:diagnosis is
malignant neoplasm of lung with metastasis. The present on admission (POA) indicator
is - Answer-Y = present at the time of inpatient admission
A patient undergoes outpatient surgery. During the recovery period, the patient
develops atrial fibrillation and is subsequently admitted to the hospital as an inpatient.
The present on admission (POA) indicator is" - Answer-Y = present at the time of
inpatient admission
A patient was seen by Dr. Zachary. The charge for the office visit was $125. The
Medicare beneficiary had already met his deductible. The Medicare fee schedule
amount is $100. Dr. Zachary does not accept assignment. The office manager will apply
a practice termed as "balance billing" which means that the patient is: - Answer-
Financially liable for charges in excess of the Medicare fee schedule, up to a limit
A patient with Medicare is seen in the physician's office. The total charge for this office
visit is $250.00. The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00. The non PAR
Medicare fee schedule amount for this service is $190.00.
The patient is financially liable for the coinsurance amount, which is: - Answer-20%
1|Page
, A patient with Medicare is seen in the physician's office. The total charge for this office
visit is $250.00. The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00. The non PAR
Medicare fee schedule amount for this service is $190.00: - Answer-$200.00
A patient with Medicare is seen in the physician's office. The total charge for this office
visit is $250.00. The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00. The non PAR
Medicare fee schedule amount for this service is $190.00.
If this physician is a nonparticipating physician who does NOT accept assignment for
this claim, the total amount the physician will receive is: - Answer-$218.50
A patient with Medicare is seen in the physician's office. The total charge for this office
visit is $250.00. The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00. The non PAR
Medicare fee schedule amount for this service is $190.00.
If this physician is a participating physician who accepts assignment for this claim, the
total amount of this patient's financial liability (out-of-pocket expense) is: - Answer-
$40.00
A patient with Medicare is seen in the physician's office. The total charge for this office
visit is $250.00. The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00. The non PAR
Medicare fee schedule amount for this service is $190.00.
If this physician is a nonparticipating physician who does NOT accept assignment for
this claim, the total amount of the patient's financial liability (out-of-pocket expense) is: -
Answer-$66.50
Accounts Receivable (A/R) refers to: - Answer-Cases that have not yet been paid
All of the following items are "packaged" under the Medicare outpatient prospective
payment system, EXCEPT for: - Answer-Medical Visits
All of the following statements are true of MS-DRGs, EXCEPT: - Answer-A patient claim
may have multiple MS-DRGs
An Advance Beneficiary Notice (ABN) is a document signed by the: - Answer-Patient
indicating whether he/she wants to receive services that Medicare probably will not pay
for
2|Page
