CCA Exam Domain 2, Questions & Answers, rated A+. Graded A+ Look at book on page 14 question 6

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CCA Exam Domain 2, Questions & Answers, rated A+. Graded A+ Look at book on page 14 question 65 Given the following information, which of the following statements is correct? A. In each MS-DRG th ... e geometric mean is lower than the arithmetic mean. b. In each MS-DRG the arithmetic mean is lower than the geometric mean. c. The higher the number of patients in each MS-DRG, the greater the geometric mean for that MS-DRG. d. The geometric means are lower in MS-DRGs that are associated with a CC or MCC. - ✔✔-A The geometric mean LOS is defined as the total days of service, excluding any outliers or transfers, divided by the total number of patients Look at page 14 question 66 If another status T procedure were performed, how much would the facility receive for the second status T procedure? a. 0% b. 50% c. 75% d. 100% - ✔✔-B Multiple surgical procedures with payment status indicator T performed during the same operative session are discounted. The highest-weighted procedure is fully reimbursed. All other procedures with payment status indicator T are reimbursed at 50 percent. 67 Medical necessity for inpatient services does not always include: a. LCDs b. Related monetary benefits to payers c. Uniform written procedures for appeals d. Concurrent review - ✔✔-A There are not LCDs and NDCs for every type of procedure or service that could be provided for a patient 68 Which of the following types of hospitals are excluded from the Medicare inpatient prospective payment system? a. Children's b. Rural c. State supported d. Tertiary - ✔✔-A Psychiatric and rehabilitation hospitals, long-term care hospitals, children's hospitals, cancer hospitals, and critical access hospitals are paid on the basis of reasonable cost, subject to payment limits per discharge or under separate PPS 69 Diagnosis-related groups are organized into: a. Case-mix classifications b. Geographic practice cost indices c. Major diagnostic categories d. Resource-based relative values - ✔✔-C Diagnosis -related groupings (DRGs) are classified by one of 25 major diagnostic categories (MDCs) 70 The Medicare program pays for health care services Social Security benefits for those age 65 and older, permanently disabled people and those with: a. End stage renal disease b. Military experience c. Medicaid d. Skilled nursing services - ✔✔-A Medicare Part A is generally provided free of charge to individuals age 65 and over who are eligible for Social Security. The coverage is provided to those with end-stage renal disease 71 Which of the following is not reimbursed according to the Medicare outpatient prospective payment system? a. CMHC partial hospitalization services b. Critical access hospitals c. Hospital outpatient departments d. Vaccines provided by CORFs - ✔✔-B Critical access hospitals are paid on a cost-based payment system and are not part of the prospective payment system 72 Fee schedules are updated by third-party payers: a. Annually b. Monthly c. Semiannually d. Weekly - ✔✔-A Third-party payers who reimburse providers on a fee-for-service basis generally update fee schedules on an annual basis 73 Which of the following would a health record technician use to perform the billing function for a physician's office? a. CMS-1500 b. UB-04 c. UB-92 d. CMS 1450 - ✔✔-A Physicians submit claims via the electronic format, which takes the place of the CMS-1500 billing form 74 When a provider accepts assignment, this means that the: a. Patient authorizes payment to be made directly to the provider b. Provider agrees to accepts as payment in full the allowed charge from the fee schedule c. Balance billing is allowed on patient accounts, but at a limited rate d. Participating provider receives a fee-for-service reimbursement - ✔✔-B To accept assignment means the provider or supplier accepts, as payment in full, the allowed charge based on the fee schedule 75 A coding audit shows that an inpatient coder us using multiple codes that describe the individual components of a procedure rather than using a single code that describes all the steps of the procedure performed. Which of the following should be done in this case? a. Require all coders to implement this practice b. Report the practice to the OIG c. Counsel the coder and stop the practice immediately d. Put the coder on unpaid leave of absence - ✔✔-C Review the elements of the hospital compliance program with the employee 76 Prospective payment systems were developed by the federal government to: a. Increase healthcare access b. Manage Medicare and Medicaid costs c. Implement managed care programs d. Eliminate fee-for-service programs - ✔✔-B Since 1983, the prospective payment systems have been used to manage the courts of the Medicare and Medicaid programs 77 Given NCCI edits, if the placement of a catheter is billed along with the performance of an infusion procedure for the same date of service for an outpatient beneficiary, Medicare will pay for: a. The placement of the catheter b. The placement of the catheter and the infusion procedure c. The infusion procedure d. Neither the placement of the catheter nor the infusion procedure - ✔✔-C Access to an indwelling IV or insertion of a subcutaneous catheter or port for the purpose of a therapeutic infusion is considered part of the procedure and not separately billed 78 The goal of coding compliance programs is to reduce: a. Liability in regards to fraud and abuse b. Delays in claims processing c. Billing errors d. Inaccurate code assignments - ✔✔-A The goal of a compliance program is to reduce the liability with regards to fraud and abuse 79 Which of the following actions would be best to determine whether present on admission (POA) indicators for the conditions selected by CMS are having negative impact on the hospital's Medicare reimbursement? a. Identify all records for a period these indicators for these conditions and determine if these conditions are the only secondary diagnoses present on the claim that will lead to higher payment b. Identify all records for a period that have these indicators for these conditions. c. Identify all records for a period that have these indicators for these conditions and determine whether or not additional documentation can be submitted to Medicare to increase reimbursement. d. Take a random sample of records for a period of time for records having these indicators for these conditions and extrapolate the negative impact on Medicare reimbursement. - ✔✔-A Any secondary diagnoses assigned present on admission status will have a negative impact on reimbursement if no other code on the claim is assigned as a complication or comorbidity or a major complication or comorbidity 80 From the information provided, how many APCs would this patient have? Look at page 17 question 80. a. 1 b. 4 c. 5 d. 3 - ✔✔-C Payment for separately paid APCs depends on the status indicator assigne [Show More]

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