A Buck Ch16


Question Answer
The coders' responsibility is to ensure that the data are as accurate as possible not only for classification and study purposes but also to obtain appropriate reimbursement True
The Federal Register is the official publication for all "Presidential Documents," "Rules and Regulations," "Proposed Rules," and "Notices" True
Nationally unit values have been assigned for each service (CPT), and they are determined on the basis of the resources necessary to the physician's performance of the service True
Medicare defines fraud as an intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes it knowing that the deception could result in some unauthorized benefit to himself or some other person True
Kickbacks are allowed under certain circumstances False
There is a "safe harbor" clause in the anti-kickback statute that protects certain types of discounting of medical services. True
The Medicare program was established in 1965
The Medicare Part A pays for hospital/facility care
Medicare Part B pays for physician services and durable medical equipment
Who handles the day-to-day operation of the Medicare program for the CMS fisical intermediary
Medicare pays for what percentage of covered charges 80 %
The incentive to Medicare participating providers is Direct payment is made on all clains, faster processing and a 5% higher fee schedule
Part B services are billed using ICD-9-CM, CPT, HCPCS
Who is the largest third-party payer in the nation the government
A major change took place in Medicare in __ with the enactment of the Omnibus Budget Reconciliation Act 1989
The physician fee schedule is updated each April 15 and is composed of The relative value units for each service, a geographic adjustment factor to adjust for regional variations in the cost operating a health care facility and a national conversion factor
Services that are performed primarily in office settings are subject to a payment discount if they are performed in outpatient hospital departments. This is called Site of Service limitations
If a surgeon performs more than one procedure on the same patient on the same day, discounts are made on all subsequent procedures. Medicare will pay what percentages for the first, second, third and fourth procedures 100%, 50%, 25%, 25%
Medicare sets the payment level for assistants at surgery at what percentage of the fee schedule amount for the global surgical service 16%
When an unlisted procedure is billed because no other code exists to describe the treatment, payment is based on a mazimym of this percentage of the value of the intraoperation services originally performed 50%
What edition of the Federal Register would hospital facilit6ies be especially interested in October
What edition of the Federal Register would outpatient facilities be especially interested in November or December
What is the largest third-party payer American government
What government organization is responsible for administering the Medicare program Centers for Medicare and Medicaid Services (CMS)
What are the three items that the Medicare beneficiaries are responsible to pay before Medicare will begin to pay for services deductibles, premiums, and coinsurance
Where and when were the DRGs first developed Yale, 1960s
What was the state that first used the DRGs on a large scale New Jersey
What is the total number of MDCs 25
The creation of the PRO was made possible under a provision of what act TEFRA
Which of the following is not a patient attribute for classification into a DRG length of stay
What is the name of the document that is produced by CMS that defines the type and number of health records that must be reviewed for a patient record Scope of Work
A complication is defined as a condition that increases the patient's length of stay in the hospital by at least 1 say in at least what percent of cases 75%
This is not used to identify surgery unrelated to the principal diagnosis 482
Medicare funds are collected by Social Security Administration
Centers for Medicare & Medicade Services CMS
Peer Review Organization PRO
Resource Based Relative Value Scale RBRVS
Omnibus Budget Reconciliation Act OBRA
Diagnostic Related Group DRG
Ambulatory Patient Groups APG
Maximum Annual Allowable Charge MAAC
Relative Value Unit RVU
Geographic Practice Cost Indiees GPCI
Prospective payment system PPS
Office of the Inspector General OIG
Department of Health & Human Services DHHS
In the role as a medical coder, it is your responsibility to ensure that you code _ & _ to optimixe reimbursement for services provided accurately & completely
The complexity of a hospital's case load is referred to as a hospital's case mix
A computer program called a __ is used to input the principal diagnosis and other critical information about a patient grouper
The __ program was developed by congress to monitor the necessity of hospital admissions and review the treatment costs and medical records of hospitals PRO
The __ is a national dollar amount that is applied to all services paid on the basis of the Medicare Fee Schedule conversion factor
The amount determined by multiplying the RVU weight by the geographic indes and the conversion factor is called the __ amount fee schedule
For endoscopic procedures Medicare allows the full value of the highest valued endoscopy, plus the difference between the nest highest endoscopy and the __ endoscopy base
List the three components of the relative value unit work, practice, mal practice
Name the two types of fraud alerts National Medicare Fraud, Restricted Medicare Fraud
List the three types of persons eligible for Medicare disabled, blind and those 65 years & over



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