CCA Exam Preparation Domain II
Reimbursement methodologies fully
solved
Which of the following software applications would be used to aid in the coding function in a physician's
office? - correct answer ✔✔Encoder
Which payment system was introduced in 1992 and replaced Medicare's customary, prevailing, and
reasonable (CPR) payment system? - correct answer ✔✔Resource-based relative value scale system
The patient had a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The coder
assigned the following codes: 58150; 58700 What error has the coder made by using these codes? -
correct answer ✔✔Unbundling
What is the best reference tool to determine how CPT codes should be assigned? - correct answer
✔✔American Medical Association's CPT Assistant newsletter.
In the laboratory section of CPT, if a group of tests overlaps two or more panels, report the panel that
incorporates the greatest number of tests to fulfill the code definition. What would a coder do with the
remaining test codes that are not part of a panel? - correct answer ✔✔Report the remaining test using
individual test codes, according to CPT.
What did the Center of Medicare and Medicaid Services develop to promote national correct coding
methodologies and to control improper coding leading to inappropriate payment in Part B claims? -
correct answer ✔✔National Correct Coding Initiative (NCCI)
What is the best reference tool for ICD-9-CM coding advice? - correct answer ✔✔AHA's Coding Clinic for
ICD-9-CM
CMS developed medically unlikely edits (MUEs) to prevent providers from billing units of services greater
than the norm would indicate. These MUEs were implemented on January, 2007, and are applied to
which code set? - correct answer ✔✔HCPCS/CPT codes
, Several key principles require appropriate physician documentation to secure payment from the insurer.
Which answer (listed here) fails to impact payment based on physician responsibility? - correct answer
✔✔Documenting the charges and services on the itemized bill.
The documentation of each patient encounter should include the following to secure payment from the
insurer except: - correct answer ✔✔The identity of the patient's nearest relative and emergency contact
number.
Two patients were hospitalized with bacterial pneumonia.One patient was hospitalized for three days,
and the other patient was hospitalized for 30 days. Both cases result in the same DRG with different
length of stay. Which answer most closely describes how the hospital will be reimbursed? - correct
answer ✔✔The hospital will receive the same reimbursement for the same DRG regardless of the length
of stay.
Which of the following statements are true? - correct answer ✔✔The higher the relative weight, the
higher the payment rates.
Which classification system is in place to reimburse home health agencies? - correct answer ✔✔HHRGs
What reimbursement system uses the Medicare fee schedule? - correct answer ✔✔RBRVS (Resource
base relative value scale)
MS diagnostic-related groups are organized into: - correct answer ✔✔Major diagnostic categories.
Which of the following hospitals are excluded from the Medicare acute-care prospective payment
system? - correct answer ✔✔Children's
CMS identified conditions that are not present on admission and could be "reasonably preventable", and
therefore hospitals are not allowed to receive additional payment for these conditions that do present.
What are these conditions called? - correct answer ✔✔Hospital-acquired conditions
Which of the following fails to meet the CMS classification of a hospital-acquired condition? - correct
answer ✔✔Gram-negative pneumonia and Stage I pressure ulcers
Reimbursement methodologies fully
solved
Which of the following software applications would be used to aid in the coding function in a physician's
office? - correct answer ✔✔Encoder
Which payment system was introduced in 1992 and replaced Medicare's customary, prevailing, and
reasonable (CPR) payment system? - correct answer ✔✔Resource-based relative value scale system
The patient had a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The coder
assigned the following codes: 58150; 58700 What error has the coder made by using these codes? -
correct answer ✔✔Unbundling
What is the best reference tool to determine how CPT codes should be assigned? - correct answer
✔✔American Medical Association's CPT Assistant newsletter.
In the laboratory section of CPT, if a group of tests overlaps two or more panels, report the panel that
incorporates the greatest number of tests to fulfill the code definition. What would a coder do with the
remaining test codes that are not part of a panel? - correct answer ✔✔Report the remaining test using
individual test codes, according to CPT.
What did the Center of Medicare and Medicaid Services develop to promote national correct coding
methodologies and to control improper coding leading to inappropriate payment in Part B claims? -
correct answer ✔✔National Correct Coding Initiative (NCCI)
What is the best reference tool for ICD-9-CM coding advice? - correct answer ✔✔AHA's Coding Clinic for
ICD-9-CM
CMS developed medically unlikely edits (MUEs) to prevent providers from billing units of services greater
than the norm would indicate. These MUEs were implemented on January, 2007, and are applied to
which code set? - correct answer ✔✔HCPCS/CPT codes
, Several key principles require appropriate physician documentation to secure payment from the insurer.
Which answer (listed here) fails to impact payment based on physician responsibility? - correct answer
✔✔Documenting the charges and services on the itemized bill.
The documentation of each patient encounter should include the following to secure payment from the
insurer except: - correct answer ✔✔The identity of the patient's nearest relative and emergency contact
number.
Two patients were hospitalized with bacterial pneumonia.One patient was hospitalized for three days,
and the other patient was hospitalized for 30 days. Both cases result in the same DRG with different
length of stay. Which answer most closely describes how the hospital will be reimbursed? - correct
answer ✔✔The hospital will receive the same reimbursement for the same DRG regardless of the length
of stay.
Which of the following statements are true? - correct answer ✔✔The higher the relative weight, the
higher the payment rates.
Which classification system is in place to reimburse home health agencies? - correct answer ✔✔HHRGs
What reimbursement system uses the Medicare fee schedule? - correct answer ✔✔RBRVS (Resource
base relative value scale)
MS diagnostic-related groups are organized into: - correct answer ✔✔Major diagnostic categories.
Which of the following hospitals are excluded from the Medicare acute-care prospective payment
system? - correct answer ✔✔Children's
CMS identified conditions that are not present on admission and could be "reasonably preventable", and
therefore hospitals are not allowed to receive additional payment for these conditions that do present.
What are these conditions called? - correct answer ✔✔Hospital-acquired conditions
Which of the following fails to meet the CMS classification of a hospital-acquired condition? - correct
answer ✔✔Gram-negative pneumonia and Stage I pressure ulcers
