Which unique identifier is assigned to third-party payers and has 10 numeric positions, including a check digit as the tenth position?
a. HPID
b. PAYERID
c. PlanID
d. UPIN
(
Q. 2) A patient presents to an outpatient clinic with a large growth on the left side of the neck.
Examination reveals primary malignant neoplasm of lymph nodes. Confirmed diagnosis of
nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck.
A. C77.0 C. C76.0
B. C80.1 D. C77.9
(
Q. 3) Drew Baker is referred to a health care provider by an employer for treatment of a fracture that occurred during a fall at work. The physician billed Medicare and did not indicate on the claim that the injury was work related. Medicare benefits were paid to the provider for services rendered. This resulted in Medicare contacting the provider, who is liable for the __________ because of the provider's failure to disclose that the injury was work-related.
a. adjudication
b. mediation
c. overpayment
d. unbundling
(
Q. 4) A patient is admitted with abdominal pain. A C. and MRI of the abdomen reveal a malignant
neoplasm to the head of the pancreas with metastatic disease to the peritoneal cavity.
A. C25.1, C78.6 C. C25.0, C78.6
B. C78.89, C78.89 D. D01.7, C78.6
(
Q. 5) The Patient Protection and Affordable Care Act established a Medicare shared savings program to facilitate the __________ to improve the quality of care for Medicare fee-for-service beneficiaries and to reduce unnecessary costs.
a. coordination and cooperation among health care providers
b. declining investment in infrastructure and redesigned care processes
c. lack of coordinated care for services under Medicare fee-for-service
d. reduction in accountability for the care of beneficiaries
(
Q. 6) A patient has malignant melanoma of the skin of the back, nose, and scalp. The patient will be
scheduled to undergo a radical excision of the melanoma
A. C43.9 C. C4A.59, C4A.4
B. C43.59, C43.31, C43.4 D. C44.300, C44.509
(
Q. 7) The Medicare Integrity Program includes medical review, which is defined by CMS as a review of claims to determine whether services provided are __________, as well as to followup on the effectiveness of previous corrective actions.
a. affordable by patient populations
b. covered by the Medicare program
c. effective for treatment of conditions
d. medically reasonable and necessary
(
Q. 8) A patient is admitted to the hospital for treatment of dehydration following chemotherapy as
treatment for right ovarian cancer.
A. E86.0, C56.1 C. C56.1, 86.9
B. E86.9, C56.1 D. C56.1, E86.0
(
Q. 9) Which of the following is an example of abuse?
a. billing noncovered services/procedures as covered services/procedures
b. falsifying health care certificates of medical necessity plans of treatment
c. misrepresenting ICD-10-CM and CPT/HCPCS codes to justify payment
d. submitting claims for services and procedures knowingly not provided
(
Q. 10) A patient with a history of malignant neoplasm of the lung status post lobectomy was admitted
after experiencing a violent seizure lasting more than several minutes. During the course of the
hospitalization the patient has continued to have seizures. Workup revealed metastatic lesions
to the brain. The patient's seizures were treated with IV Dilantin.
A. C79.3, Z85.118, R56.9 C. C79.31, R56.9, Z85.118
B. C79.31, R56.9 D. R56.9, C79.32, Z85.118
Quick Reply
