Question 1

When the Medicare program does not have primary responsibility for paying a beneficiary's medical expenses, the Medicare __________ concept applies.

Accepted Answer

A)   balance billing
B)   conversion factor
C)   limiting charge
D)   secondary payerE) B) and C)
F) A) and B)

Question 2

The process of extracting and analyzing data to identify patterns, whether predictable or unpredictable, is called data __________.

Accepted Answer

A)   allocation
B)   auditing
C)   mining
D)   warehousingE) All of the above
F) A) and C)

Question 3

Provisions of the inpatient psychiatric facility prospective payment system resulted in a __________ patient classification system that reflects differences in patient resource use and costs.

Accepted Answer

A)   cost-based
B)   price-based
C)   per diem
D)   prospectiveE) A) and D)
F) None of the above

Question 4

A chargemaster team jointly shares the responsibility of updating and revising the chargemaster to ensure its __________.

Accepted Answer

A)   accuracy
B)   compliance
C)   encryption
D)   revenueE) C) and D)
F) A) and B)

Question 5

Long-term acute care hospitals are defined by Medicare as having an average inpatient length of stay greater than __________ days.

Accepted Answer

A)   10
B)   15
C)   25
D)   30E) A) and D)
F) C) and D)

Question 6

Which communicates new or changed policies and/or procedures that are being incorporated into a specific CMS Internet-only program manual?

Accepted Answer

A)   explanation of benefits
B)   program transmittal
C)   remittance advice
D)   summary noticeE) A) and B)
F) All of the above

Question 7

An ambulatory surgical center (ASC)  is a state-licensed, Medicare-certified supplier (not provider)  of surgical health care services that must __________ on Medicare claims.

Accepted Answer

A)   accept assignment
B)   assign benefitsC) A) and B)
D) undefined

Question 8

In 1980 Medicare authorized implementation of ambulatory surgical center __________ rates as a fee to ambulatory surgery centers (ASCs)  for facility services furnished in connection with performing certain surgical procedures.

Accepted Answer

A)   differential
B)   payment
C)   per diem
D)   retrospectiveE) C) and D)
F) B) and D) B

Question 9

​A patient is admitted as a hospital inpatient for treatment of acute asthma. The patient also has hypertension, which was medically managed during the inpatient admission. Which present on admission (POA)  indicator applies to the acute asthma?

Accepted Answer

A)   ​Y (present at the time of inpatient admission) 
B)   ​N (not present at the time of inpatient admission) 
C)   ​U (documentation is insufficient to determine if condition is present on admission) 
D)   ​W (provider is unable to clinically determine whether condition was present on admission or not) E) A) and B)
F) B) and D)

Question 10

The federal government administers several health care programs, some of which require services to be reimbursed according to predetermined reimbursement methodologies, which are established as __________.

Accepted Answer

A)   cost-based rates
B)   price-based rates
C)   payment systems
D)   reasonable cost systemsE) A) and C)
F) A) and D)

Question 11

The Medicare durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS)  fee schedule reimburses DMEPOS either __________ percent of the actual charge for the item or the fee schedule amount, whichever is lower.

Accepted Answer

A)   20
B)   50
C)   80
D)   100E) B) and D)
F) All of the above C

Question 12

A patient is admitted as a hospital inpatient with a diagnosis of possible cerebrovascular accident. During admission, the patient falls out of bed fractures her right arm. Which present on admission (POA)  indicator applies to the right arm fracture diagnosis?​

Accepted Answer

A)   ​Y (present at the time of inpatient admission) 
B)   ​N (not present at the time of inpatient admission) 
C)   ​U (documentation is insufficient to determine if condition is present on admission) 
D)   ​W (provider is unable to clinically determine whether condition was present on admission or not) E) B) and C)
F) C) and D)

Question 13

The MMA of 2003 mandated implementation of a(n)  __________ payment amount as a substitute for the Ambulatory Surgical Center (ASC)  standard overhead amount for surgical procedures performed at an ASC.

Accepted Answer

A)   fee schedule
B)   inpatient prospective payment system
C)   outpatient prospective payment system
D)   resource-based relative value scale systemE) A) and B)
F) C) and D)

Question 14

HIPPS codes are determined after home health care patient assessments using the __________ are completed.

Accepted Answer

A)   MEDPAR limited data set (LDS) 
B)   minimum data set (MDS) 
C)   outcomes and assessment information set (OASIS) 
D)   uniform hospital discharge data set (UHDDS) E) None of the above
F) All of the above

Question 15

Which software is used for the computerized data entry of the minimum data set about skilled nursing facility patients to create a file in a standard format that can be electronically transmitted to a state database?

Accepted Answer

A)   HAVEN
B)   IRVEN
C)   OASIS
D)   RAVENE) A) and B)
F) B) and C) D

Question 16

Which is the distribution of financial resources among competing groups?

Accepted Answer

A)   data analytics
B)   financial viability
C)   resource allocation
D)   revenue cycle auditingE) C) and D)
F) A) and B)

Question 17

Which reimburses providers according to predetermined rates assigned to services and is revised by CMS each year?

Accepted Answer

A)   Medicare physician fee schedule
B)   Medicare relative value units
C)   Medicare resource-based fee schedule
D)   Medicare value fee scheduleE) A) and C)
F) A) and D)

Question 18

Which adjusts payments to account for geographic variations in hospitals' labor costs?

Accepted Answer

A)   case index
B)   disease index
C)   morbidity index
D)   wage indexE) None of the above
F) A) and B)

Question 19

Which classifies patients into inpatient rehabilitation facility prospective payment system groups that are based on clinical characteristics and expected resource needs?

Accepted Answer

A)   charge description master
B)   fee schedule
C)   HIPPS code set
D)   patient assessment instrumentE) A) and D)
F) B) and C)

Question 20

A condition that exists at the time an order for inpatient admission occurs is categorized according to __________.​

Accepted Answer

A)   ​case management
B)   ​data analysis
C)   ​present on admission
D)   ​revenue cycle auditingE) C) and D)
F) A) and B)

Exam 9: Cms Reimbursement Methodologies

When the Medicare program does not have primary responsibility for paying a beneficiary's medical expenses, the Medicare __________ concept applies.

Correct AnswerverifiedShow Answer

The process of extracting and analyzing data to identify patterns, whether predictable or unpredictable, is called data __________.

Correct AnswerverifiedShow Answer

Provisions of the inpatient psychiatric facility prospective payment system resulted in a __________ patient classification system that reflects differences in patient resource use and costs.

Correct AnswerverifiedShow Answer

A chargemaster team jointly shares the responsibility of updating and revising the chargemaster to ensure its __________.

Correct AnswerverifiedShow Answer

Long-term acute care hospitals are defined by Medicare as having an average inpatient length of stay greater than __________ days.

Correct AnswerverifiedShow Answer

Which communicates new or changed policies and/or procedures that are being incorporated into a specific CMS Internet-only program manual?

Correct AnswerverifiedShow Answer

An ambulatory surgical center (ASC) is a state-licensed, Medicare-certified supplier (not provider) of surgical health care services that must __________ on Medicare claims.

Correct AnswerverifiedShow Answer

In 1980 Medicare authorized implementation of ambulatory surgical center __________ rates as a fee to ambulatory surgery centers (ASCs) for facility services furnished in connection with performing certain surgical procedures.

Correct AnswerverifiedB

​A patient is admitted as a hospital inpatient for treatment of acute asthma. The patient also has hypertension, which was medically managed during the inpatient admission. Which present on admission (POA) indicator applies to the acute asthma?

Correct AnswerverifiedShow Answer

The federal government administers several health care programs, some of which require services to be reimbursed according to predetermined reimbursement methodologies, which are established as __________.

Correct AnswerverifiedShow Answer

The Medicare durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) fee schedule reimburses DMEPOS either __________ percent of the actual charge for the item or the fee schedule amount, whichever is lower.

Correct AnswerverifiedC

A patient is admitted as a hospital inpatient with a diagnosis of possible cerebrovascular accident. During admission, the patient falls out of bed fractures her right arm. Which present on admission (POA) indicator applies to the right arm fracture diagnosis?​

Correct AnswerverifiedShow Answer

The MMA of 2003 mandated implementation of a(n) __________ payment amount as a substitute for the Ambulatory Surgical Center (ASC) standard overhead amount for surgical procedures performed at an ASC.

Correct AnswerverifiedShow Answer

HIPPS codes are determined after home health care patient assessments using the __________ are completed.

Correct AnswerverifiedShow Answer

Which software is used for the computerized data entry of the minimum data set about skilled nursing facility patients to create a file in a standard format that can be electronically transmitted to a state database?

Correct AnswerverifiedD

Which is the distribution of financial resources among competing groups?

Correct AnswerverifiedShow Answer

Which reimburses providers according to predetermined rates assigned to services and is revised by CMS each year?

Correct AnswerverifiedShow Answer

Which adjusts payments to account for geographic variations in hospitals' labor costs?

Correct AnswerverifiedShow Answer

Which classifies patients into inpatient rehabilitation facility prospective payment system groups that are based on clinical characteristics and expected resource needs?

Correct AnswerverifiedShow Answer

A condition that exists at the time an order for inpatient admission occurs is categorized according to __________.​

Correct AnswerverifiedShow Answer

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B

A patient is admitted as a hospital inpatient for treatment of acute asthma. The patient also has hypertension, which was medically managed during the inpatient admission. Which present on admission (POA) indicator applies to the acute asthma?

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C

A patient is admitted as a hospital inpatient with a diagnosis of possible cerebrovascular accident. During admission, the patient falls out of bed fractures her right arm. Which present on admission (POA) indicator applies to the right arm fracture diagnosis?

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D

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A condition that exists at the time an order for inpatient admission occurs is categorized according to __________.

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