COMPREHENSIVE MODULE 2 FINAL EXAM
PART 1 ACTUAL EXAMINATION TEST 2026
QUESTIONS WITH SOLUTIONS GRADED A+
⩥ The Centers for Medicare and Medicaid Services (CMS) will make an
adjustment to the MS-DRG payment for certain conditions that the
patient was not admitted with, but were acquired during the hospital
stay. Therefore, hospitals are required to report an indicator for each
diagnosis. This indicator is referred to as
present on admission.
a hospital acquired condition.
a payment status indicator.
a sentinel event. Answer: present on admission.
⩥ Of the following, which is a hospital-acquired condition (HAC)?
air embolism
Stage I pressure ulcer
traumatic wound infection
breach birth Answer: air embolism
,⩥ These are financial protections to ensure that certain types of facilities
(e.g., children's hospitals) recoup all of their losses due to the differences
in their APC payments and the pre-APC payments.
limiting charge
pass through
indemnity insurance
hold harmless Answer: hold harmless
⩥ There are seven criteria for high-quality clinical documentation. All of
these elements are included EXCEPT
precise.
covered (by third-party payer).
consistent.
complete. Answer: covered (by third-party payer)
⩥ 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
U = Documentation is insufficient to determine if condition was present
at the time of admission.
Y = Present at the time of inpatient admission.
, W = Provider is unable to clinically determine if condition was present
at the time of admission.
N = Not present at the time of inpatient admission. Answer: Y = Present
at the time of inpatient admission.
⩥ CMS assigns one _______________ to each APC and each
______________ code.
CPT code, HCPCS
payment status indicator, HCPCS
payment status indicator, ICD-10-CM and ICD-10-PCS
MS-DRG, CPT Answer: payment status indicator, HCPCS
⩥ If a participating provider's usual fee for a service is $700.00 and
Medicare's allowed amount is $450.00, what amount is written off by the
physician?
$250.00
none of it is written off
$391.00
$340.00 Answer: $250.00
The participating physician agrees to accept Medicare's fee as payment
in full; therefore, the physician would write off the difference between
$700.00 and $450.00, which is 250.00.
, ⩥ A patient is admitted to the hospital for a coronary artery bypass
surgery. Postoperatively, he develops a pulmonary embolism. The
present on admission (POA) indicator is
N = Not present at the time of inpatient admission.
U = Documentation is insufficient to determine if condition was present
at the time of admission.
W = Provider is unable to clinically determine if condition was present
at the time of admission.
Y = Present at the time of inpatient admission. Answer: N = Not present
at the time of inpatient admission
⩥ The standard claim form used by hospitals to request reimbursement
for inpatient and outpatient procedures performed or services provided is
called the
.UB-04
CMS-1491.
CMS-1500.
CMS-1600. Answer: UB-04
The UB-04 is used by hospitals. The CMS-1500 is used by physicians
and other noninstitutional providers and suppliers. The CMS-1491 is
used by ambulance services.
PART 1 ACTUAL EXAMINATION TEST 2026
QUESTIONS WITH SOLUTIONS GRADED A+
⩥ The Centers for Medicare and Medicaid Services (CMS) will make an
adjustment to the MS-DRG payment for certain conditions that the
patient was not admitted with, but were acquired during the hospital
stay. Therefore, hospitals are required to report an indicator for each
diagnosis. This indicator is referred to as
present on admission.
a hospital acquired condition.
a payment status indicator.
a sentinel event. Answer: present on admission.
⩥ Of the following, which is a hospital-acquired condition (HAC)?
air embolism
Stage I pressure ulcer
traumatic wound infection
breach birth Answer: air embolism
,⩥ These are financial protections to ensure that certain types of facilities
(e.g., children's hospitals) recoup all of their losses due to the differences
in their APC payments and the pre-APC payments.
limiting charge
pass through
indemnity insurance
hold harmless Answer: hold harmless
⩥ There are seven criteria for high-quality clinical documentation. All of
these elements are included EXCEPT
precise.
covered (by third-party payer).
consistent.
complete. Answer: covered (by third-party payer)
⩥ 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
U = Documentation is insufficient to determine if condition was present
at the time of admission.
Y = Present at the time of inpatient admission.
, W = Provider is unable to clinically determine if condition was present
at the time of admission.
N = Not present at the time of inpatient admission. Answer: Y = Present
at the time of inpatient admission.
⩥ CMS assigns one _______________ to each APC and each
______________ code.
CPT code, HCPCS
payment status indicator, HCPCS
payment status indicator, ICD-10-CM and ICD-10-PCS
MS-DRG, CPT Answer: payment status indicator, HCPCS
⩥ If a participating provider's usual fee for a service is $700.00 and
Medicare's allowed amount is $450.00, what amount is written off by the
physician?
$250.00
none of it is written off
$391.00
$340.00 Answer: $250.00
The participating physician agrees to accept Medicare's fee as payment
in full; therefore, the physician would write off the difference between
$700.00 and $450.00, which is 250.00.
, ⩥ A patient is admitted to the hospital for a coronary artery bypass
surgery. Postoperatively, he develops a pulmonary embolism. The
present on admission (POA) indicator is
N = Not present at the time of inpatient admission.
U = Documentation is insufficient to determine if condition was present
at the time of admission.
W = Provider is unable to clinically determine if condition was present
at the time of admission.
Y = Present at the time of inpatient admission. Answer: N = Not present
at the time of inpatient admission
⩥ The standard claim form used by hospitals to request reimbursement
for inpatient and outpatient procedures performed or services provided is
called the
.UB-04
CMS-1491.
CMS-1500.
CMS-1600. Answer: UB-04
The UB-04 is used by hospitals. The CMS-1500 is used by physicians
and other noninstitutional providers and suppliers. The CMS-1491 is
used by ambulance services.
