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MIBC B16
A Buck Ch16
| Question | Answer |
|---|---|
| The coders' responsibility is to ensure that the data are as accurate as possible not only for classification and study purposes but also to obtain appropriate reimbursement | True |
| The Federal Register is the official publication for all "Presidential Documents," "Rules and Regulations," "Proposed Rules," and "Notices" | True |
| Nationally unit values have been assigned for each service (CPT), and they are determined on the basis of the resources necessary to the physician's performance of the service | True |
| Medicare defines fraud as an intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes it knowing that the deception could result in some unauthorized benefit to himself or some other person | True |
| Kickbacks are allowed under certain circumstances | False |
| There is a "safe harbor" clause in the anti-kickback statute that protects certain types of discounting of medical services. | True |
| The Medicare program was established in | 1965 |
| The Medicare Part A pays for | hospital/facility care |
| Medicare Part B pays for | physician services and durable medical equipment |
| Who handles the day-to-day operation of the Medicare program for the CMS | fisical intermediary |
| Medicare pays for what percentage of covered charges | 80 % |
| The incentive to Medicare participating providers is | Direct payment is made on all clains, faster processing and a 5% higher fee schedule |
| Part B services are billed using | ICD-9-CM, CPT, HCPCS |
| Who is the largest third-party payer in the nation | the government |
| A major change took place in Medicare in __ with the enactment of the Omnibus Budget Reconciliation Act | 1989 |
| The physician fee schedule is updated each April 15 and is composed of | The relative value units for each service, a geographic adjustment factor to adjust for regional variations in the cost operating a health care facility and a national conversion factor |
| Services that are performed primarily in office settings are subject to a payment discount if they are performed in outpatient hospital departments. This is called | Site of Service limitations |
| If a surgeon performs more than one procedure on the same patient on the same day, discounts are made on all subsequent procedures. Medicare will pay what percentages for the first, second, third and fourth procedures | 100%, 50%, 25%, 25% |
| Medicare sets the payment level for assistants at surgery at what percentage of the fee schedule amount for the global surgical service | 16% |
| When an unlisted procedure is billed because no other code exists to describe the treatment, payment is based on a mazimym of this percentage of the value of the intraoperation services originally performed | 50% |
| What edition of the Federal Register would hospital facilit6ies be especially interested in | October |
| What edition of the Federal Register would outpatient facilities be especially interested in | November or December |
| What is the largest third-party payer | American government |
| What government organization is responsible for administering the Medicare program | Centers for Medicare and Medicaid Services (CMS) |
| What are the three items that the Medicare beneficiaries are responsible to pay before Medicare will begin to pay for services | deductibles, premiums, and coinsurance |
| Where and when were the DRGs first developed | Yale, 1960s |
| What was the state that first used the DRGs on a large scale | New Jersey |
| What is the total number of MDCs | 25 |
| The creation of the PRO was made possible under a provision of what act | TEFRA |
| Which of the following is not a patient attribute for classification into a DRG | length of stay |
| What is the name of the document that is produced by CMS that defines the type and number of health records that must be reviewed for a patient record | Scope of Work |
| A complication is defined as a condition that increases the patient's length of stay in the hospital by at least 1 say in at least what percent of cases | 75% |
| This is not used to identify surgery unrelated to the principal diagnosis | 482 |
| Medicare funds are collected by | Social Security Administration |
| Centers for Medicare & Medicade Services | CMS |
| Peer Review Organization | PRO |
| Resource Based Relative Value Scale | RBRVS |
| Omnibus Budget Reconciliation Act | OBRA |
| Diagnostic Related Group | DRG |
| Ambulatory Patient Groups | APG |
| Maximum Annual Allowable Charge | MAAC |
| Relative Value Unit | RVU |
| Geographic Practice Cost Indiees | GPCI |
| Prospective payment system | PPS |
| Office of the Inspector General | OIG |
| Department of Health & Human Services | DHHS |
| In the role as a medical coder, it is your responsibility to ensure that you code _ & _ to optimixe reimbursement for services provided | accurately & completely |
| The complexity of a hospital's case load is referred to as a hospital's | case mix |
| A computer program called a __ is used to input the principal diagnosis and other critical information about a patient | grouper |
| The __ program was developed by congress to monitor the necessity of hospital admissions and review the treatment costs and medical records of hospitals | PRO |
| The __ is a national dollar amount that is applied to all services paid on the basis of the Medicare Fee Schedule | conversion factor |
| The amount determined by multiplying the RVU weight by the geographic indes and the conversion factor is called the __ amount | fee schedule |
| For endoscopic procedures Medicare allows the full value of the highest valued endoscopy, plus the difference between the nest highest endoscopy and the __ endoscopy | base |
| List the three components of the relative value unit | work, practice, mal practice |
| Name the two types of fraud alerts | National Medicare Fraud, Restricted Medicare Fraud |
| List the three types of persons eligible for Medicare | disabled, blind and those 65 years & over |
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