Test Bank for Bucks Step by Step Medical Coding 2019 Edition.

CHAPTER 1: REIMBURSEMENT, HIPAA, AND COMPLIANCE


TRUE/FALSE

1. The coder’s responsibility is to ensure that the data are as accurate as possible not only for classificat
also to obtain appropriate reimbursement.

ANS: T PTS: 1 DIF: 1 TOP: THEORY

2. The Federal Register is the official publication for all “Presidential Documents,” “Rules and Regulat
and “Notices.”

ANS: T PTS: 1 DIF: 1 TOP: THEORY

3. Nationally, unit values have been assigned for each service by Medicare (CPT and HCPCS) and dete
resources necessary for the physician’s performance of the service.

ANS: T PTS: 1 DIF: 1 TOP: THEORY

4. Fraud is an intentional deception or misrepresentation that an individual knows to be false or does no
makes knowing that the deception could result in some unauthorized benefit to himself/herself or som

ANS: T PTS: 1 DIF: 1 TOP: THEORY

5. Kickbacks from patients are allowed under certain circumstances according to Medicare guidelines.

ANS: F PTS: 1 DIF: 1 TOP: THEORY

MULTIPLE CHOICE

6. The Medicare program was established in:
a. 1955 c. 1965
b. 1960 d. 1970
ANS: C PTS: 1 DIF: 1 TOP: THEORY

7. Medicare Part A pays for:
a. professional services and durable medical equipment
b. hospital/facility care
c. physician services and durable medical equipment
d. hospital/facility care and durable medical equipment
ANS: B PTS: 1 DIF: 1 TOP: THEORY

8. Medicare Part B pays for:
a. durable medical equipment
b. hospital/facility care
c. physician services and durable medical equipment
d. hospital/facility care and durable medical equipment
ANS: C PTS: 1 DIF: 1 TOP: THEORY

9. Who handles the day-to-day operation of the Medicare program for the CMS?
a. HCFA c. MACs
b. peer review organization d. IPPS
ANS: C PTS: 1 DIF: 1 TOP: THEORY

, 13. Who is the largest third-party payer in the nation?
a. Blue Cross Blue Shield c. Cigna
b. Aetna d. the government
ANS: D PTS: 1 DIF: 1 TOP: THEORY

14. A major change took place in Medicare in ____ with the enactment of the Omnibus Budget Reconcil
a. 1989 c. 1997
b. 1992 d. 2000
ANS: A PTS: 1 DIF: 1 TOP: THEORY

15. The physician fee schedule is updated each April 15 and is composed of:
a. the relative value units for each service
b. a geographic adjustment factor to adjust for regional variations in the cost of
operating a health care facility
c. a national conversion factor
d. all of the above
e. none of the above
ANS: D PTS: 1 DIF: 3 TOP: THEORY

16. If a surgeon performs more than one procedure on the same patient on the same day, and discounts w
procedures, Medicare would pay what percentages for the first, second, third, fourth, and fifth proced
a. 100%, 100%, 100%, 100%, 100% c. 100%, 50%, 50%, 25%, 25%
b. 100%, 50%, 50%, 50%, 25% d. 100%, 50%, 50%, 50%, 50%
ANS: D PTS: 1 DIF: 2 TOP: THEORY

17. Medicare sets the payment level for assistant surgeons at a percentage of the fee schedule amount for
a. global c. partial
b. united d. subsequent
ANS: A PTS: 1 DIF: 2 TOP: THEORY

18. What edition of the Federal Register would hospital facilities be especially interested in?
a. October c. January
b. November or December d. July
ANS: A PTS: 1 DIF: 2 TOP: THEORY

19. What edition of the Federal Register would outpatient facilities be especially interested in?
a. October c. January
b. November or December d. July
ANS: B PTS: 1 DIF: 2 TOP: THEORY

20. What are the three items that the Medicare beneficiaries are responsible for paying before Medicare w
services?
a. personal care items
b. deductibles, drug costs, personal care items
c. premiums
d. deductibles, premiums, and coinsurance
ANS: D PTS: 1 DIF: 3 TOP: THEORY

21. Medicare funds are collected by:
a. U.S. Food and Drug Administration c. National Centers for Health Statistics
b. Social Security Administration d. Department of the Treasury
ANS: B PTS: 1 DIF: 3 TOP: THEORY