CCA EXAM PREP DOMAIN 2
QUESTIONS AND 100% CORRECT
ANSWERS GRADED A+.
In a managed fee-for-service arrangement, which of the following would be used as a
cost-control process for inpatient surgical services?
a. Prospectively pre-certify the necessity of inpatient services
b. Determine what services can be bundled
c. Pay only 80% of the inpatient bill
d. Require the patient to pay 20% of the inpatient bill - ANS a. Prospectively pre-certify
the necessity of inpatient services
The government sponsored supplemental medical insurance that covers physicians and
surgeons services, emergency department, outpatient clinic, labs and physical therapy
is:
a. Medicaid
b. Medicare Part B
c. Medicare Part A
d. Medicare Part D - ANS b. Medicare Part B
What is one way that physicians can prevent or minimize potentially abusive or
fraudulent activities?
a. Developing a compliance plan
b. Upcoding
c. Unbundling
d. Billing for noncovered services - ANS a. Developing a compliance plan
Who is the guarantor?
a. The patient who is an inpatient
b. The person responsible for the bill, such as a parent
c. The person who bills the patient, such as the Medicare biller
d. The patient who is an outpatient - ANS b. The person responsible for the bill, such as
a parent
A coding audit shows that an inpatient coder is using multiple codes that describe the
individual components of a procedure rather than using a single code that describes all
the steps of the procedure performed. Which of the following should be done in this
case?
a. Require all coders to implement this practice
b. Report the practice to the OIG
c. Counsel the coder and stop the practice immediately
d. Put the coder on unpaid leave of absence - ANS c. Counsel the coder and stop the
practice immediately
, Which of the following types of hospitals are excluded from the Medicare inpatient
prospective payment system?
a. Children's
b. Rural
c. State supported
d. Tertiary - ANS a. Children's
Which of the following would a health record technician use to perform the billing
function for a physician's office?
a. CMS-1500
b. UB-04
c. UB-92
d. CMS 1450 - ANS a. CMS-1500
Medicare's newest claims processing payment contract entities are referred to as
________.
a. Recovery audit contractors (RACs)
b. Medicare administrative contractors (MACs)
c. Fiscal intermediaries (FIs)
d. Office of Inspector General contractors (OIGCs) - ANS b. Medicare administrative
contractors (MACs)
What statement is not reflective of meeting medical necessity requirements?
a. A service or supply provided for the diagnosis, treatment, cure, or relief of a health
condition, illness, injury, or disease.
b. A service or supply provided that is not experimental, investigational, or cosmetic in
purpose.
c. A service provided that is necessary for and appropriate to the diagnosis, treatment,
cure, or relief of a health condition, illness, injury, disease, or its symptoms.
d. A service provided solely for the convenience of the insured, the insured's family, or
the provider. - ANS d. A service provided solely for the convenience of the insured, the
insured's family, or the provider.
Timely and correct reimbursement is dependent on:
a. Adjudication
b. Clean claims
c. Remittance advice
d. Actual charge - ANS b. Clean claims
Which of the following is not reimbursed according to the Medicare outpatient
prospective payment system?
a. CMHC partial hospitalization services
b. Critical access hospitals
c. Hospital outpatient departments
d. Vaccines provided by CORFs - ANS b. Critical access hospitals
QUESTIONS AND 100% CORRECT
ANSWERS GRADED A+.
In a managed fee-for-service arrangement, which of the following would be used as a
cost-control process for inpatient surgical services?
a. Prospectively pre-certify the necessity of inpatient services
b. Determine what services can be bundled
c. Pay only 80% of the inpatient bill
d. Require the patient to pay 20% of the inpatient bill - ANS a. Prospectively pre-certify
the necessity of inpatient services
The government sponsored supplemental medical insurance that covers physicians and
surgeons services, emergency department, outpatient clinic, labs and physical therapy
is:
a. Medicaid
b. Medicare Part B
c. Medicare Part A
d. Medicare Part D - ANS b. Medicare Part B
What is one way that physicians can prevent or minimize potentially abusive or
fraudulent activities?
a. Developing a compliance plan
b. Upcoding
c. Unbundling
d. Billing for noncovered services - ANS a. Developing a compliance plan
Who is the guarantor?
a. The patient who is an inpatient
b. The person responsible for the bill, such as a parent
c. The person who bills the patient, such as the Medicare biller
d. The patient who is an outpatient - ANS b. The person responsible for the bill, such as
a parent
A coding audit shows that an inpatient coder is using multiple codes that describe the
individual components of a procedure rather than using a single code that describes all
the steps of the procedure performed. Which of the following should be done in this
case?
a. Require all coders to implement this practice
b. Report the practice to the OIG
c. Counsel the coder and stop the practice immediately
d. Put the coder on unpaid leave of absence - ANS c. Counsel the coder and stop the
practice immediately
, Which of the following types of hospitals are excluded from the Medicare inpatient
prospective payment system?
a. Children's
b. Rural
c. State supported
d. Tertiary - ANS a. Children's
Which of the following would a health record technician use to perform the billing
function for a physician's office?
a. CMS-1500
b. UB-04
c. UB-92
d. CMS 1450 - ANS a. CMS-1500
Medicare's newest claims processing payment contract entities are referred to as
________.
a. Recovery audit contractors (RACs)
b. Medicare administrative contractors (MACs)
c. Fiscal intermediaries (FIs)
d. Office of Inspector General contractors (OIGCs) - ANS b. Medicare administrative
contractors (MACs)
What statement is not reflective of meeting medical necessity requirements?
a. A service or supply provided for the diagnosis, treatment, cure, or relief of a health
condition, illness, injury, or disease.
b. A service or supply provided that is not experimental, investigational, or cosmetic in
purpose.
c. A service provided that is necessary for and appropriate to the diagnosis, treatment,
cure, or relief of a health condition, illness, injury, disease, or its symptoms.
d. A service provided solely for the convenience of the insured, the insured's family, or
the provider. - ANS d. A service provided solely for the convenience of the insured, the
insured's family, or the provider.
Timely and correct reimbursement is dependent on:
a. Adjudication
b. Clean claims
c. Remittance advice
d. Actual charge - ANS b. Clean claims
Which of the following is not reimbursed according to the Medicare outpatient
prospective payment system?
a. CMHC partial hospitalization services
b. Critical access hospitals
c. Hospital outpatient departments
d. Vaccines provided by CORFs - ANS b. Critical access hospitals
