Medical coding I h07v lesson 6
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Ashworth College *
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Dec 6, 2023
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docx
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Medical coding I
h07v
lesson 6
n 1
5 / 5 points
An RVU includes all of the following factors except
Question options:
a)
physician credentials.
b)
malpractice insurance.
c)
geographic location.
d)
amount of work.
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n 2
5 / 5 points
Medicare _______ plans are contracted out to private insurers.
Question options:
a)
Advantage
b)
Part B
c)
Assistance
d)
Part A
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n 3
5 / 5 points
Providers can reduce the number of denied claims by using
Question options:
a)
eligibility verification systems.
b)
cost sharing.
c)
Medicaid contractors.
d)
paper claim forms.
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n 4
5 / 5 points
Patients who qualify for Medicaid on an income basis may also be able to apply for cash benefits through
Question options:
a)
SSI.
b)
TANF.
c)
CMS.
d)
CNP.
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n 5
5 / 5 points
An insurance plan that the federal government funds and each state manages is called
Question options:
a)
Medicaid.
b)
Medicare.
c)
the marketplace.
d)
BCBS.
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n 6
0 / 5 points
Medicare was established in
Question options:
a)
1972.
b)
1968.
c)
1965.
d)
1966.
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n 7
0 / 5 points
What kind of a claim is generated when the beneficiary has two types of healthcare coverage?
Question options:
a)
Medicaid simple claim
b)
Medicaid secondary claim
c)
Medicare secondary claim
d)
Disproportionate share claim
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n 8
5 / 5 points
A Medicare Part C insurance plan is evaluated by its members in which program?
Question options:
a)
HEDIS
b)
MACRA
c)
STARS
d)
MIPS
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n 9
0 / 5 points
A Medicaid patient who also has BCBS receives services that aren't covered by Medicaid but are covered
by BCBS. Who is responsible for the coinsurance and copay?
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Question options:
a)
Medicaid
b)
BCBS
c)
No one; it must be written off.
d)
The patient
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n 10
0 / 5 points
Which of the following best explains the main difference between Medicare and Medicaid?
Question options:
a)
Medicaid eligibility is age-based, while Medicare is disability- or income-based.
b)
Medicare eligibility is age- and disability-based, while Medicaid can be disability- or income-based.
c)
Medicare eligibility is disability-based, while Medicaid is income-based.
d)
Medicare eligibility is age-based, while Medicaid is income-based.
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n 11
5 / 5 points
What comprehensive federal policy was established to prevent and reduce provider fraud, waste, and
abuse in the Medicaid program?
Question options:
a)
Medicaid Integrity Program
b)
Medicaid pay and chase
c)
Third-party liability
d)
Means test program
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n 12
5 / 5 points
Which disease automatically qualifies a patient for Medicare Parts A and B?
Question options:
a)
Multiple sclerosis
b)
ALS (Lou Gehrig's disease)
c)
Scleroderma
d)
Kaposi's sarcoma
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n 13
5 / 5 points
An EDI 835 transaction will provide a coder with
Question options:
a)
remittance advice.
b)
a claim status response.
c)
a claim form.
d)
eligibility information.
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n 14
0 / 5 points
A request to review a denied or rejected Medicare claim is a
Question options:
a)
readjudication.
b)
demand bill.
c)
request for reconsideration.
d)
resubmission.
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n 15
0 / 5 points
The Secretary of the HHS opens a competitive bidding process every five years for
Question options:
a)
RACs.
b)
OIG.
c)
ZPICs.
d)
MACs.
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n 16
5 / 5 points
When a healthcare provider engages in intentional misrepresentation or deception that could result in
an unauthorized benefit to an individual, it's called
Question options:
a)
negligence.
b)
abuse.
c)
malpractice.
d)
fraud.
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n 17
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A plan that pays for Medicare coinsurance and certain services that Medicare doesn't cover is called
Question options:
a)
Medicare Part C.
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b)
Medicare Part D.
c)
Medigap.
d)
Medicaid.
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n 18
5 / 5 points
An LCD provides guidance on medical necessity regarding procedures and ICD-10-CM diagnoses codes
that are issued by
Question options:
a)
HHS.
b)
TJC.
c)
MAC.
d)
CMS.
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n 19
5 / 5 points
What's a MAC?
Question options:
a)
Part of Medicare Part C
b)
An entity responsible for recouping Medicare overpayments
c)
A division of CMS
d)
A contractor who administers benefits for Medicare
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n 20
5 / 5 points
The _______ begins the day a patient is admitted to a hospital or skilled nursing facility.
Question options:
a)
benefit period
b)
inpatient stay
c)
episode of care
d)
global period
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