Question 1

Which of the following three factors are built into the resource-based fee structure?

Accepted Answer

A)   time of procedure, office overhead, risk of procedure
B)   difficulty of procedure, anesthesia costs, risk of procedure
C)   difficulty of procedure, office equipment, risk of procedure
D)   difficulty of procedure, office overhead, risk of procedureE) A) and C)
F) All of the above

Question 2

What type of fees are defined as those that physicians charge to most of their patients most of the time under typical conditions?

Accepted Answer

A)   typical fees
B)   customary fees
C)   standard fees
D)   usual feesE) None of the above
F) A) and B)

Question 3

To calculate RBRVS fees, multiply each RVU by its __________, add the three adjusted totals, and multiply the sum by the conversion factor.

Accepted Answer

A)   time allowance
B)   GPCI
C)   conversion factor
D)   UCRE) All of the above
F) B) and C)

Question 4

Maximum charge a plan pays for a service or procedure may be referred to as

Accepted Answer

A)   allowed charge.
B)   allowed amount.
C)   maximum allowable fee.
D)   all of these are correct.E) B) and D)
F) All of the above

Question 5

RACs use a software program to analyze a practice's claims, looking for

Accepted Answer

A)   excessive number of units billed.
B)   medically unnecessary treatment.
C)   obvious "black and white" coding errors.
D)   all of these are analyzed.E) All of the above
F) A) and B)

Question 6

A relative value scale assigns a higher relative value to a procedure that requires more

Accepted Answer

A)   all of these.
B)   effort.
C)   skill.
D)   time.E) C) and D)
F) None of the above

Question 7

Medical necessity is based on

Accepted Answer

A)   number of diagnoses.
B)   number of procedures.
C)   the relationship between the diagnosis and the treatment provided.
D)   extent of treatment.E) All of the above
F) None of the above

Question 8

The three parts of an RBRVS fee are

Accepted Answer

A)   None of these are correct.
B)   uniform value, GPCI, and conversion factor.
C)   usual, customary, and reasonable charges.
D)   usual charges, GPCI, and conversion factor.E) B) and C)
F) All of the above

Question 9

The normal range of fees is different in every

Accepted Answer

A)   city.
B)   town.
C)   state.
D)   geographic area.E) A) and B)
F) A) and C)

Question 10

If a practice accepts credit and debit cards, it must follow which standard?

Accepted Answer

A)   FERPA
B)   HIPAA
C)   PCI DSS
D)   HITECHE) A) and B)
F) B) and C)

Question 11

A charge that is written off is

Accepted Answer

A)   balance billed to co-insurance.
B)   just written off.
C)   deducted from patient's account.
D)   balance billed to the patient.E) A) and B)
F) B) and C)

Question 12

Which of the following refers to the payer's review and reduction of a procedure code?

Accepted Answer

A)   assumption coding
B)   truncated coding
C)   upcoding
D)   downcodingE) A) and B)
F) B) and D)

Question 13

What type of coding uses diagnoses that are not as specific as possible?

Accepted Answer

A)   assumption coding
B)   upcoding
C)   downcoding
D)   truncated codingE) All of the above
F) A) and B)

Question 14

Which of the following is not typically a feature of a practice EHR system that, if used correctly, enhances compliant billing?

Accepted Answer

A)   computer assisted coding
B)   voice recognition software
C)   Evaluation and Management Visit Tool
D)   documentation templatesE) B) and C)
F) A) and D)

Question 15

The Medicare allowed charge for a procedure is $80. What amount does the participating provider receive from Medicare, and what amount from the patient, assuming the patient deductible has been met?

Accepted Answer

A)   $40/$20
B)   $64/$16
C)   $80
D)   $60/$20E) A) and C)
F) None of the above

Question 16

If a nonparticipating provider's usual fee is $600, the allowed amount is $300, and balance billing is permitted, what amount is written off?

Accepted Answer

A)   $0
B)   $150
C)   $480
D)   $300E) A) and D)
F) C) and D)

Question 17

In the CCI, which type of codes cannot both be billed for a patient on the same day of service?

Accepted Answer

A)   unbundled
B)   mutually exclusive
C)   black box
D)   diagnosticE) None of the above
F) A) and B)

Question 18

Which of the following means that a physician has chosen to waive the charges for services to other physicians?

Accepted Answer

A)   adjustment
B)   edits
C)   audit
D)   professional courtesyE) B) and D)
F) All of the above

Question 19

Which of the following audits Medicare claims to determine if there is an opportunity to recover incorrect payments from previously paid services?

Accepted Answer

A)   Recovery Audit Contractor
B)   staff members
C)   external consulting company
D)   Compliance OfficerE) A) and C)
F) A) and B)

Question 20

Professional courtesy refers to providing free services to

Accepted Answer

A)   poor patients.
B)   other physicians and their families.
C)   none of these are correct.
D)   patients who pay on time.E) A) and B)
F) A) and C)

Exam 6: Visit Charges and Compliant Billing

The normal range of fees is different in every

Correct AnswerverifiedShow Answer

The Medicare allowed charge for a procedure is $80. What amount does the participating provider receive from Medicare, and what amount from the patient, assuming the patient deductible has been met?

Correct AnswerverifiedShow Answer

Maximum charge a plan pays for a service or procedure may be referred to as

Correct AnswerverifiedShow Answer

Which of the following is not typically a feature of a practice EHR system that, if used correctly, enhances compliant billing?

Correct AnswerverifiedShow Answer

Which of the following audits Medicare claims to determine if there is an opportunity to recover incorrect payments from previously paid services?

Correct AnswerverifiedShow Answer

What type of coding uses diagnoses that are not as specific as possible?

Correct AnswerverifiedShow Answer

Which of the following means that a physician has chosen to waive the charges for services to other physicians?

Correct AnswerverifiedShow Answer

Which of the following refers to the payer's review and reduction of a procedure code?

Correct AnswerverifiedShow Answer

Medical necessity is based on

Correct AnswerverifiedShow Answer

If a nonparticipating provider's usual fee is $600, the allowed amount is $300, and balance billing is permitted, what amount is written off?

Correct AnswerverifiedShow Answer

RACs use a software program to analyze a practice's claims, looking for

Correct AnswerverifiedShow Answer

What type of fees are defined as those that physicians charge to most of their patients most of the time under typical conditions?

Correct AnswerverifiedShow Answer

The three parts of an RBRVS fee are

Correct AnswerverifiedShow Answer

Which of the following three factors are built into the resource-based fee structure?

Correct AnswerverifiedShow Answer

A relative value scale assigns a higher relative value to a procedure that requires more

Correct AnswerverifiedShow Answer

In the CCI, which type of codes cannot both be billed for a patient on the same day of service?

Correct AnswerverifiedShow Answer

To calculate RBRVS fees, multiply each RVU by its __________, add the three adjusted totals, and multiply the sum by the conversion factor.

Correct AnswerverifiedShow Answer

A charge that is written off is

Correct AnswerverifiedShow Answer

Professional courtesy refers to providing free services to

Correct AnswerverifiedShow Answer

If a practice accepts credit and debit cards, it must follow which standard?

Correct AnswerverifiedShow Answer

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified