Deck 9: Hcpcs and Coding Compliance

Question 1

HCPCS Level II codes would include all of the following EXCEPT codes for:

A)vision and hearing services.
B)surgical services.
C)ambulance services.
D)medical and surgical supplies.

Answer 1

surgical services.

Question 2

State Medicaid agency codes are reported with what HCPCS code range?

A)C1300-C9899.
B)G0008-G9156.
C)T1000-T5999.
D)V2020-V2799.

Answer 2

T1000-T5999.

Question 3

A coder who needs to find the codes for prosthetic devices and related procedures would find it in the:

A)Level I HCPCS code book.
B)Level II HCPCS code book.
C)Level III HCPCS code book.
D)This is not considered an HCPCS code.

Answer 3

Level II HCPCS code book.

Question 4

The five-digit CPT codes used to report services and procedures performed by healthcare providers are also known as:

A)Level I HCPCS.
B)Level II HCPCS.
C)Level III HCPCS.
D)They are not considered HCPCS codes.

Question 5

HCPCS Level II codes are updated annually by the:

A)Centers for Medicare and Medicaid Services (CMS).
B)American Dental Association (ADA).
C)American Medical Association (AMA).
D)World Health Organization (WHO).

Question 6

The National Panel that maintains Level II HCPCS codes includes representatives from:

A)the Centers for Medicare and Medicaid Services (CMS).
B)the Blue Cross/Blue Shield Association.
C)the Health Insurance Association of America (HIAA).
D)all of the above.

Question 7

HCPCS Level II codes in the range J0120-J9999 would be used for:

A)durable medical equipment (DME).
B)dental procedures.
C)diagnostic radiology services.
D)drugs administered other than oral method.

Question 8

Level I HCPCS codes are also known as the:

A)American Medical Association's CPT codes.
B)Centers for Medicare and Medicaid Services (CMS) diagnostic codes.
C)Medicare local codes.
D)National dental codes.

Question 9

An example of an HCPCS Level II code is:

A)99213.
B)250.00.
C)E849.0.
D)J0290.

Question 10

Once a Medicare beneficiary signs the ________, he or she is legally responsible for the charges if Medicare denies payment for the service as "not medically necessary."

A)ABN
B)GA
C)HIPAA release
D)CMS-1500

Question 11

To identify that a procedure was performed on the thumb of the left hand, the coder would select the modifier:

A)L1.
B)LA.
C)F1.
D)FA.

Question 12

HCPCS was developed to achieve all of the following goals EXCEPT:

A)coordinating government programs by uniform application of Centers for Medicare and Medicaid Services (CMS) policies.
B)ensuring the validity of profiles and fee schedules through standardized coding.
C)allowing providers and suppliers to communicate their services in a consistent manner.
D)implementing standard fee structures for all providers across all plans.

Question 13

HCPCS modifiers consist of:

A)two digits.
B)two letters.
C)two letters or two numbers.
D)two letters or one letter and one number.

Question 14

HCPCS Level II national codes consist of:

A)five digits.
B)one alphabetic character and four digits.
C)two alphabetic characters and two digits.
D)one alphabetic character and five digits.

Question 15

HCPCS Level II national codes are used in claims submitted to:

A)public insurers only.
B)private insurers only.
C)public and private insurers.
D)self-funded plans only.

Question 16

Which type of coding error involves reporting items or services that are NOT documented in the medical record?

A)Unbundling
B)Reporting services provided by unlicensed or unqualified personnel
C)Assumption coding
D)Upcoding

Question 17

The code for durable medical equipment (DME) would be found in the:

A)Level I HCPCS code book.
B)Level II HCPCS code book.
C)Level III HCPCS code book.
D)This is not considered a HCPCS code.

Question 18

The HCPCS modifier GA indicates:

A)a waiver of liability statement is on file.
B)an advance beneficiary notice has been signed by the patient.
C)the procedure billed may be denied by Medicare as "not medically necessary."
D)all of the above.

Question 19

HCPCS Level I codes were developed by the:

A)Centers for Medicare and Medicaid Services (CMS).
B)American Dental Association (ADA).
C)American Medical Association (AMA).
D)World Health Organization (WHO).

Question 20

HCPCS is the acronym for the:

A)Healthcare Current Procedures Coding System.
B)Health Coding for Procedures and Claim Sets.
C)Healthcare Common Procedure Coding System.
D)Healthcare Coding for Procedures and Claims Systems.

Question 21

Procedure and diagnostic codes should be appropriate to the patient's:

A)age.
B)gender.
C)health condition.
D)All of the above

Question 22

The legislation that prohibits submitting a fraudulent claim or making a false statement in connection with a claim is called the:

A)Health Insurance Portability and Accountability Act.
B)Social Security Act.
C)Federal Civil False Claims Act.
D)American Civil Liberties Act.

Question 23

Services can be denied for all of the following reasons EXCEPT when:

A)the patient has a physical examination within 6 months of becoming a Medicare Part B subscriber.
B)the procedure is considered experimental.
C)there is a cap on the number of services allowed.
D)the service was not performed at an appropriate location.

Question 24

Code linkage refers to the connection between the:

A)procedure and modifier.
B)diagnosis and procedure.
C)diagnosis and symptom.
D)HCPCS Level I and Level II codes.

Question 25

To bill for a procedure that was NOT medically necessary is considered:

A)fraud.
B)abuse.
C)inaccurate.
D)incomplete.

Question 26

The written notification that must be signed by a patient with Medicare coverage to acknowledge that he or she understands that a service may NOT be considered medically necessary and therefore may not be paid by Medicare is a(n):

A)advance beneficiary notice.
B)medical necessary authorization.
C)denial of payment notice.
D)liability for potential payment notice.

Question 27

Two codes that could NOT have both been reasonably performed during a single patient encounter are referred to as:

A)mutually exclusive codes.
B)not medically necessary codes.
C)comprehensive codes.
D)component codes.

Question 28

Under civil law, the maximum penalty for medical fraud is:

A)10 years in jail.
B)exclusion from the American Medical Association.
C)$10,000.
D)loss of professional license.

Question 29

The Stark Law was enacted to govern the practice of:

A)physician referrals to other providers such as physical and occupational therapists.
B)physician referrals of Medicare and Medicaid patients to facilities in which he or she has a financial interest.
C)medical office coding practices.
D)utilization of controlled substances in medical facilities.

Question 30

When each reported service is connected to a diagnosis that supports the procedure as medically necessary, the claim is referred to as:

A)accurate.
B)clean.
C)complete.
D)authorized.

Question 31

Using a procedure code that provides a higher reimbursement rate than the code that actually reflects the services provided is referred to as:

A)bundling.
B)unbundling.
C)upcoding.
D)downcoding.

Question 32

An action that misuses money the government has allocated is considered:

A)fraud.
B)abuse.
C)an error.
D)a mistake.

Question 33

To bill for a procedure that was NOT performed is considered:

A)fraud.
B)abuse.
C)unbundling.
D)upcoding.

Question 34

Misusing Medicare funds is considered:

A)abuse and illegal.
B)abuse but not illegal.
C)fraud and illegal.
D)fraud but not illegal.

Question 35

Billing the parts of a bundled procedure as separate procedures for higher reimbursement is referred to as:

A)bundling.
B)unbundling.
C)upcoding.
D)downcoding.

Question 36

Inaccurate coding and incorrect billing can result in:

A)delays in receiving payments.
B)prison sentences.
C)loss of the provider's license to practice medicine.
D)all of the above.

Question 37

The types of edits for National Correct Coding Initiative (NCCI) errors include all of the following EXCEPT:

A)modifier indicators.
B)diagnostic and procedure code linkages.
C)mutually exclusive edits.
D)comprehensive versus component edits.

Question 38

In physical therapy cases, if a coder bills for supervised attendance:

A)the therapist must be in constant attendance with the patient.
B)the therapist must be supervised by a physician.
C)one-on-one direct contact by the therapist is not required.
D)one-on-one direct contact by the therapist is required.

Question 39

Individuals suspected of medical fraud and abuse can be investigated and prosecuted by all of the following EXCEPT the:

A)U.S. Department of Justice.
B)Federal Bureau of Investigation (FBI).
C)Office of Inspector General (OIG).
D)Supreme Court.

Question 40

The Healthcare Fraud and Abuse Control Program was created by the:

A)Health Insurance Portability and Accountability Act (HIPAA).
B)Social Security Act.
C)Federal Civil False Claims Act.
D)Centers for Medicare and Medicaid Services (CMS).

Question 41

A progress note updates the patient's clinical course of treatment and itemizes all payment amounts due.

Question 42

Codes that report various types of transportation services would be found in HCPCS Level I.

Question 43

An appliance, apparatus, or product intended for use in assisting or treating a patient is sometimes covered by insurance and is billed as:

A)durable medical equipment (DME).
B)pharmaceuticals.
C)office supplies.
D)surgical supplies.

Question 44

HCPCS is the acronym for Healthcare Coding Procedures in a Common System.

Question 45

Compliance Program Guidance for Individual and Small Group Physician Practices can be found in the:

A)Health Insurance Portability and Accountability Act (HIPAA).
B)Office of Inspector General's Fraud Alerts.
C)Federal Register.
D)National Correct Coding Initiative (NCCI).

Question 46

The Compliance Program Guidance suggests that a physician's office implement a plan that includes all of the following EXCEPT:

A)conducting internal monitoring and auditing of claims.
B)developing open lines of communication.
C)conducting appropriate training and education of staff.
D)dismissing any employee who fails to understand the compliance plan.

Question 47

Healthcare payers base their decision to pay or deny claims on the:

A)diagnosis codes only.
B)procedure codes only.
C)diagnosis and procedure codes.
D)neatness of the claim.

Question 48

A compliance plan for a physician's office is:

A)not mandatory but suggested.
B)now mandatory.
C)required by 2015.
D)not necessary or practical.

Question 49

HCPCS Level II codes are assigned and maintained by individual state Medicare carriers.

Question 50

What document lists the year's planned projects for sampling types of billing to see if there are any problems?

A)OIG fraud alert
B)Federal Register
C)Medical Carrier's Manual
D)OIG work plan

Question 51

Codes for drugs administered other than by oral method would be found in HCPCS Level II.

Question 52

For Medicare patients, to indicate that a procedure was performed on the left side of the body, the modifier LT should be used.

Question 53

HCPCS is organized by code number rather than by service or supply name.

Question 54

If the coder determines that the code checked off by the physician on the encounter form does NOT match the medical record, the coder should:

A)ignore the encounter form and bill based on the medical record.
B)change the encounter form to match the medical record.
C)inform the physician of the issue and determine the correct code.
D)not bill for the questionable services.

Question 55

A coder can obtain information about coding and governmental regulations from:

A)the American Medical Association (AMA).
B)national specialty medical societies.
C)insurance carriers.
D)all of the above.

Question 56

The Current Procedural Terminology (CPT) codes are considered HCPCS Level I codes.

Question 57

If a provider requests an advisory opinion and fails to follow the advice of the Office of Inspector General (OIG), the provider:

A)would be treated leniently for asking the question.
B)could claim "not knowing."
C)could be prosecuted.
D)should not change its practices.

Question 58

HCPCS modifiers are required on all health insurance forms filed for private insurance patients.

Question 59

The best way to be sure that an intended action will NOT be subject to investigation as fraud is to:

A)base the decision on past practices.
B)obtain an advisory opinion from the Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS).
C)submit the claim, and request an explanation if denied.
D)get the advice of an attorney.

Question 60

Benefits of a voluntary compliance plan include:

A)minimizing billing mistakes.
B)reducing the chances that an audit will be conducted by the CMS or OIG.
C)avoiding conflicts with the self-referral and anti-kickback statutes.
D)all of the above.

Question 61

Coding __________ is part of the overall effort of medical practices and facilities to comply with regulations, including those related to the confidentiality of patients' personal and health information.

Question 62

If a person pretends to be a physician and treats patients without a valid medical license, it is considered abuse.

Question 63

When two or more codes can be combined and billed as a single code, they are referred to as mutually exclusive.

Question 64

A compliance program in a physician's office should include a process for conducting internal monitoring and auditing of claims.

Question 65

Each year a specific area of billing is audited for billing and coding accuracy by the Office of __________ .

Question 66

Inaccurate coding and incorrect billing could result in fines and other sanctions.

Question 67

The connection between the diagnostic and the procedural information on a claim is referred to as __________ .

Question 68

An advisory opinion from the CMS or OIG is considered legal advice on any question regarding healthcare business.

Question 69

Durable medical eDurable medical equipment (DME) is billed using Levelquipment (DME) is billed using Level __________ HCPCS codes.

Question 70

The Current Procedural Terminology codes are considered HCPCS Level __________ codes.

Question 71

Abuse against Medicare is considered illegal because taxpayer dollars have been misspent.

Question 72

An act of deception used to take advantage of another person or entity is __________ .

Question 73

Those found guilty of medical fraud can receive jail sentences as well as fines.

Question 74

Medicare requires that all physician offices have a seven-part compliance plan in place.

Question 75

When the services of two codes could NOT have both been reasonably done in a single encounter, the codes are considered __________ .

Question 76

In order for a medical practice to demonstrate that it is making good-faith efforts to prevent fraud and abuse, it should develop a(n) __________ plan.

Question 77

Medicare's policy on proper and accurate coding is called the National Correct Coding Initiative (NCCI).

Question 78

The Federal Civil False Claims Act prohibits submitting a(n) __________ claim.

Question 79

Diagnostic and procedure codes should be appropriate for the patient's age, nationality, and condition.

Question 80

The federal government will protect and reward people involved in qui tam, or whistle-blower, cases to identify Medicare fraud.