When other insurers are initially liable for payment on a medical service or supply provided to a patient, Medicare classifies them as the _________ payer.

When other insurers are initially liable for payment on a medical service or supply provided to a patient, Medicare classifies them as the _________ payer.

Medicare secondary

primary

secondary

supplemental

2 points

Question 3

What term is used to describe the types and categories of patients treated by a health care facility or provider?

Medicare mix

case mix

secondary adverse

covered population

2 points

Question 4

HCPCS level II modifiers consist of two characters that are

alphabetic only

alphabetic or alphanumeric

alphanumeric only

one letter and one symbol

2 points

Question 5

Provider services for inpatient medical cases are billed on what basis?

fee-for-service

global fee

OPPS

services not billed

2 points

Question 6

New CPT codes go into effect

twice each year, on January 1 and July 1.

twice each year, on October 1 and April 1.

once each year, on October 1.

once each year, on December 1.

2 points

Question 7

The legal business name of the practice is also called the

administrative contractor

billing entity

provider identity

third-party payer

2 points

Question 8

Modifiers are reported to

alter or change the meaning of the code reported to the CMS-1500 claim.

decrease the reimbursement amount to be processed by the payer.

increase the reimbursement amount to be processed by the payer.

indicate an alteration in the description of the procedure service performed.

2 points

Question 9

Each relative value component is multiplied by the geographic cost practice index (GCPI), and then each is further multiplied by a variable figure called the

common denominator

conversion factor

related work total

relative value unit

2 points

Question 10

Qualified diagnoses are a necessary part of the patient’s hospital and office record; however, physician offices are required to report

qualified diagnoses for inpatients/outpatients

qualified diagnoses related to outpatient procedures

signs and symptoms in addition to qualified diagnoses

signs and symptoms instead of qualified diagnoses

2 points

Question 11

RBRVS contains relative value components that consist of

geographic cost, work experience, expense to the practice.

intensity of work, expense to perform services, geographic location.

liability and work expense, practice expense, malpractice expense.

work expense, practice expense, malpractice expense.

2 points

Question 12

Q codes are used

to identify services that would not ordinarily be assigned a CPT code (e.g, drugs, biologicals, and other types of medical equipment or services.

to identify professional health care procedures and services that do not have codes identified in CPT.

by state Medicaid agencies when no HCPCS level II permanent codes exist but are needed to administer the Medicaid program.

by regional MACs when exisiting permanent national codes do not include codes needed to implement a regional MAC medical review coverage policy.

2 points

Question 13

“Incident to” relates to services provided by nonPARs that are defined as services

provided incidental to other services provided by a physician.

provided solely for the comfort and best interest of the beneficiary.

provided without the nonparticipating provider’s supervision.

that would otherwise not be reimbursed by the Medicare carrier.

2 points

Question 14

Which special codes allow payers the flexibility of establishing codes if they are needed before the next January 1 annual update?

level III

miscellaneous

permanent

temporary

2 points

Question 15

The prospective payment system providing a lump-sum payment that is dependent on the patient’s principal diagnosis, cormorbidities, complications, and principal and secondary procedures is

ambulatory payment classifications (APCs)

diagnosis-related groups (DRGs)

Medicare Physician Fee Schedule (MPFS)

resource-based relative value scale (RBRVS)

2 points

Question 16

Level I HCPCS codes are created by the

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