UHC MEDICARE CERTIFICATION ACTUAL EXAM REAL
QUESTIONS AND CORRECT DETAILED ANSWERS
(CORRECT VERIFIED ANSWERS) A NEW UPDATED
VERSION |GUARANTEED PASS A+ (NEW!!)
T/F: When Medicare began in July 1, 1966, it was the primary payer for all
beneficiaries except for those who had benefits from Large Group Health Plans
(LGHPs). - ANSWER: False
T/F: For diagnostic tests provided to Part A beneficiaries that are split into technical
component and a professional component, both components are subject to Skilled
Nursing Facility Consolidated Billing. - ANSWER: False
T/F: A physician is an example of a provider that submits claims for Part B services. -
ANSWER: True
T/F: It is a violation of the Physician Self Referral Act for a physician to refer to a
Medicare beneficiary for certain Designated Health Services (DHS) to a business
owned by his/her spouse. - ANSWER: True
T/F: All beneficiaries are automatically enrolled in a Medicare Prescription drug plan
when they become eligible for Medicare - ANSWER: False
T/F: Three punctuation symbols listed in the official ICD-9-CM guidelines are
brackets, parentheses, and commas. - ANSWER: False
Denial or revocation of Medicare billing privileges, suspension of provider payments,
and application of Civil Monetary Penalties (CMPs) are all examples of
________________. - ANSWER: administrative sanctions
T/F: People in the Original Medicare Plan can get prescription drug coverage by
either joining a Medicare Prescription Drug Plan or selecting a Medigap policy that
includes prescription drug coverage. - ANSWER: False
T/F: Medicare requires a health care professional to give an Advance Beneficiary
Notice (ABN) of Noncoverage to a beneficiary after a service is provided but prior to
building. - ANSWER: False
Medicare beneficiaries with End-Stage Renal Disease (ESRD) and Group Health Plan
(GHP) coverage will have Medicare as the primary payer after the ____________
coordination period has elapsed. - ANSWER: 30-month
T/F: The first step of the Medicare Electronic Data Interchange (EDI) process is to
review Remittance Advice (RA). - ANSWER: False
, Condition codes, revenue codes, and occurrence codes are examples of __________
Health Insurance Portability and Accountability Act (HIPAA) standard code sets. -
ANSWER: Non-medical
T/F: Terms listed under certain four- and five-digit diagnosis codes are called
Inclusion Terms. These terms are conditions for which a diagnosis code number is to
be used. - ANSWER: True
T/F: CMS enterprise applications will NOT allow providers to determine beneficiary
payment responsibility with regard to deductible/copayment/coinsurance. -
ANSWER: False
Which Health Insurance Portability and Accountability Act (HIPAA) standard
transaction will you use to check the status of a claim? ASC X12N ___________ -
ANSWER: 270/271
Field 24E on FOrm CMS-1500 contains the most significant reason for the visit or
encounter. What field is this? - ANSWER: diagnosis code
T/F: The Original Medicare Plan includes Part A and Part B. - ANSWER: False
A beneficiary's red, white and blue Medicare card indicates whether he/she has
enrolled in a Medicare Advantage (MA) Plan. - ANSWER: False
T/F: "Percentage of the total body with first-degree burns" is one of the four basic
elements when diagnosis coding for burns. - ANSWER: False
Which Health Insurance Portability and Accountability Act (HIPAA) standard
transaction will you use to inquire about a beneficiary's eligibility or coverage? ASC
X12N ________ - ANSWER: 278
Development Questionnaires are used to determine if there are any additional
______________ for health care services. - ANSWER: papers to be filed
T/F: The Medical Review (MR) Program identifies and addresses billing errors
through the following: identifying potential billing errors concerning coverage and
coding; profiling of providers, services, and/or beneficiary utilization; evaluation of
complaints, enrollment, and/or cost report data; and data analysis. - ANSWER: True
T/F: Decimal digit .6 is usually used to indicate Other Specified, Unspecified, and Not
Otherwise Specified conditions. - ANSWER: False
T/F: Diagnosis codes are used to determine how much money a provider will get for
procedures performed at a health care facility. - ANSWER: False
T/F: Diagnosis codes are used to help evaluate the appropriateness and timelines of
medical care. - ANSWER: True
QUESTIONS AND CORRECT DETAILED ANSWERS
(CORRECT VERIFIED ANSWERS) A NEW UPDATED
VERSION |GUARANTEED PASS A+ (NEW!!)
T/F: When Medicare began in July 1, 1966, it was the primary payer for all
beneficiaries except for those who had benefits from Large Group Health Plans
(LGHPs). - ANSWER: False
T/F: For diagnostic tests provided to Part A beneficiaries that are split into technical
component and a professional component, both components are subject to Skilled
Nursing Facility Consolidated Billing. - ANSWER: False
T/F: A physician is an example of a provider that submits claims for Part B services. -
ANSWER: True
T/F: It is a violation of the Physician Self Referral Act for a physician to refer to a
Medicare beneficiary for certain Designated Health Services (DHS) to a business
owned by his/her spouse. - ANSWER: True
T/F: All beneficiaries are automatically enrolled in a Medicare Prescription drug plan
when they become eligible for Medicare - ANSWER: False
T/F: Three punctuation symbols listed in the official ICD-9-CM guidelines are
brackets, parentheses, and commas. - ANSWER: False
Denial or revocation of Medicare billing privileges, suspension of provider payments,
and application of Civil Monetary Penalties (CMPs) are all examples of
________________. - ANSWER: administrative sanctions
T/F: People in the Original Medicare Plan can get prescription drug coverage by
either joining a Medicare Prescription Drug Plan or selecting a Medigap policy that
includes prescription drug coverage. - ANSWER: False
T/F: Medicare requires a health care professional to give an Advance Beneficiary
Notice (ABN) of Noncoverage to a beneficiary after a service is provided but prior to
building. - ANSWER: False
Medicare beneficiaries with End-Stage Renal Disease (ESRD) and Group Health Plan
(GHP) coverage will have Medicare as the primary payer after the ____________
coordination period has elapsed. - ANSWER: 30-month
T/F: The first step of the Medicare Electronic Data Interchange (EDI) process is to
review Remittance Advice (RA). - ANSWER: False
, Condition codes, revenue codes, and occurrence codes are examples of __________
Health Insurance Portability and Accountability Act (HIPAA) standard code sets. -
ANSWER: Non-medical
T/F: Terms listed under certain four- and five-digit diagnosis codes are called
Inclusion Terms. These terms are conditions for which a diagnosis code number is to
be used. - ANSWER: True
T/F: CMS enterprise applications will NOT allow providers to determine beneficiary
payment responsibility with regard to deductible/copayment/coinsurance. -
ANSWER: False
Which Health Insurance Portability and Accountability Act (HIPAA) standard
transaction will you use to check the status of a claim? ASC X12N ___________ -
ANSWER: 270/271
Field 24E on FOrm CMS-1500 contains the most significant reason for the visit or
encounter. What field is this? - ANSWER: diagnosis code
T/F: The Original Medicare Plan includes Part A and Part B. - ANSWER: False
A beneficiary's red, white and blue Medicare card indicates whether he/she has
enrolled in a Medicare Advantage (MA) Plan. - ANSWER: False
T/F: "Percentage of the total body with first-degree burns" is one of the four basic
elements when diagnosis coding for burns. - ANSWER: False
Which Health Insurance Portability and Accountability Act (HIPAA) standard
transaction will you use to inquire about a beneficiary's eligibility or coverage? ASC
X12N ________ - ANSWER: 278
Development Questionnaires are used to determine if there are any additional
______________ for health care services. - ANSWER: papers to be filed
T/F: The Medical Review (MR) Program identifies and addresses billing errors
through the following: identifying potential billing errors concerning coverage and
coding; profiling of providers, services, and/or beneficiary utilization; evaluation of
complaints, enrollment, and/or cost report data; and data analysis. - ANSWER: True
T/F: Decimal digit .6 is usually used to indicate Other Specified, Unspecified, and Not
Otherwise Specified conditions. - ANSWER: False
T/F: Diagnosis codes are used to determine how much money a provider will get for
procedures performed at a health care facility. - ANSWER: False
T/F: Diagnosis codes are used to help evaluate the appropriateness and timelines of
medical care. - ANSWER: True
