Question 1

Durable medical equipment (DME) is billed using Level ________ HCPCS codes.

Accepted Answer

The answer of Durable medical equipment (DME) is billed using...

Question 2

Match the following
-The use of a procedure code that provides a higher reimbursement rate than the code that actually reflects the services provided

Accepted Answer

A)   fraud
B)   assumption coding
C)   upcoding
D)   mutually exclusive
E)   HCPCS Level II codesF)  abuseG)  unbundlingH)  HCPCS Level I codesI)  HCPCS modifierJ)  advance beneficiary noticeK) A) and G)
L) E) and J)

Question 3

Match the following
-The notice that alerts a Medicare beneficiary that a service may NOT be medically necessary and is, therefore, NOT covered

Accepted Answer

A)   fraud
B)   assumption coding
C)   upcoding
D)   mutually exclusive
E)   HCPCS Level II codesF)  abuseG)  unbundlingH)  HCPCS Level I codesI)  HCPCS modifierJ)  advance beneficiary noticeK) A) and I)
L) B) and I)

Question 4

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

Accepted Answer

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.E) A) and D)
F) C) and D)

Question 5

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

Accepted Answer

A) True 
 B)False

Question 6

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

Accepted Answer

A)   C1300-C9899
B)   G0008-G9156
C)   T1000-T5999
D)   V2020-V2799E) A) and B)
F) C) and D)

Question 7

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

Accepted Answer

A)   Centers for Medicare and Medicaid Services (CMS) .
B)   Blue Cross/Blue Shield Association.
C)   Health Insurance Association of America (HIA
A)  .
D)   all of the above.E) None of the above
F) B) and C)

Question 8

What is an individual called who files a lawsuit on behalf of the federal government?

Accepted Answer

A)   plaintiff
B)   informant
C)   source
D)   relatorE) A) and D)
F) A) and C)

Question 9

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

Accepted Answer

A)   fraud.
B)   abuse.
C)   unbundling.
D)   upcoding.E) A) and B)
F) All of the above

Question 10

The Health Care Fraud Prevention and Enforcement Action Team (HEAT)  is comprised of all the following EXCEPT:

Accepted Answer

A)   U.S. Department of Justice (DOJ) .
B)   Department of Health and Human Services (HSS) .
C)   Office of Inspector General (OIG) .
D)   Federal Bureau of Investigation (FBI) .E) A) and D)
F) B) and D)

Question 11

An example of an HCPCS Level II code is:

Accepted Answer

A)   99213.
B)   250.00.
C)   E849.0.
D)   J0290.E) A) and D)
F) A) and C)

Question 12

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

Accepted Answer

A) True 
 B)False

Question 13

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.

Accepted Answer

The answer of In order for a medical practice to...

Question 14

HCPCS Level II codes are updated annually by the:

Accepted Answer

A)   Centers for Medicare and Medicaid Services (CMS) .
B)   American Dental Association (AD
A)  .
C)   American Medical Association (AM
A)  .
D)   World Health Organization (WHO) .E) A) and C)
F) A) and B)

Question 15

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

Accepted Answer

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

Question 16

Which organizations are represented on the HCPCS National Panel?

Accepted Answer

Representatives are from the B...

Question 17

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

Accepted Answer

A) True 
 B)False

Question 18

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

Accepted Answer

A)   fraud.
B)   abuse.
C)   inaccurate.
D)   incomplete.E) A) and D)
F) B) and C)

Question 19

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

Accepted Answer

A) True 
 B)False

Question 20

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

Accepted Answer

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

Exam 8: Hcpcs Coding and Compliance

Match the following -The notice that alerts a Medicare beneficiary that a service may NOT be medically necessary and is, therefore, NOT covered

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

HCPCS Level II codes are updated annually by the:

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Which organizations are represented on the HCPCS National Panel?

Correct AnswerverifiedRepresentatives are from the B...View AnswerShow Answer

An example of an HCPCS Level II code is:

Correct AnswerverifiedShow Answer

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.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Match the following -The use of a procedure code that provides a higher reimbursement rate than the code that actually reflects the services provided

Correct AnswerverifiedShow Answer

The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is comprised of all the following EXCEPT:

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Durable medical equipment (DME) is billed using Level ________ HCPCS codes.

Correct AnswerverifiedShow Answer

What is an individual called who files a lawsuit on behalf of the federal government?

Correct AnswerverifiedShow Answer

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Representatives are from the B...
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