Which resources should be referenced when determining the potential for Medicare reimbursement

Question 1

1. HCPCS “J codes” classify medications according togeneric or chemical name of drug, route of administration, and dosage.

   generic or chemical name of drug, approval for Medicare coverage, and cost.

   product name of drug, method of delivery, and cost.

   product name of drug, route of administration, and dosage.

2 points

Question 2

1. The diagnosis that is the most significant condition for which procedures/services were provided is thefirst-listed diagnosis

   primary diagnosis

   principal diagnosis

   principal procedure

2 points

Question 3

1. CPT Appendix A contains information aboutdeleted codes

   modifiers

   new code descriptions

   revised codes

2 points

Question 4

1. Medicare administrative contractors must keep Medicare fees within a $20 million spending ceiling, as stated in the Balanced Billing Act (BBA). This is calledbalanced budget rule

   budget neutrality

   Medicare spend-down

   the Medicare spending limit

2 points

Question 5

1. The document formerly known as the Explanation of Medicare Benefits is now known as theAdvance Beneficiary Notice

   Medicare Payment Notice

   Medicare Remittance Advice

   Medicare Summary Notice

2 points

Question 6

1. The hospital assigns CPT codes to reportinpatient ancillary services

   inpatient and outpatient surgery

   inpatient surgical procedures

   outpatient services and procedures

2 points

Question 7

1. The Medicare physician fee schedule amount for code 99213 is $100. The participating provider’s usual charge for this service is $125. Calculate the patient’s coinsurance amount.$20

   $25

   $76

   $80

2 points

Question 8

1. The unique identifier that CMS will assign to providers as part of the HIPAA requirements is called theGrp #

   NPI

   PIN

   UPIN

2 points

Question 9

1. Medicare is available to an individual who has worked at least5 years in Medicare-covered employment, is at least 65 years old, and is a permanent resident of the U.S.

   10 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the U.S.

   10 years in Medicare-covered employment, is at least 65 years old, and is a citizen or permanent resident of the U.S.

   25 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the U.S.

2 points

Question 10

1. Which resources should be referenced when determining the potential for Medicare reimbursement?CPT coding manual

   HCPCS coding manual

   ICD-10-CM coding manual

   Medicare Carriers Manual and Coverage Issues Manual

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