Chapter 1: Reimbursement, HIPAA, and Compliance Elsevier: Buck's Step-by-Step Medical Coding, 2022 Edition TRUE/FALSE 1. The coder’s responsibility is to ensure that the data are as accurate as possible not only for classification and study purposes but also to obtain appropriate reimbursement. ANS: T PTS: 1 DIF: 1 TOP: THEORY 2. The Federal Register is the official publication for all “Presidential Documents,” “Rules and Regulations,” “Proposed Rules,” and “Notices.” ANS: T PTS: 1 DIF: 1 TOP: THEORY 3. Nationally, unit values have been assigned for each service by Medicare (CPT and HCPCS) and determined on the basis of the resources necessary for the physician’s performance of the service. ANS: T PTS: 1 DIF: 1 TOP: THEORY 4. Fraud is an intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes knowing that the deception could result in some unauthorized benefit to himself/herself or some other person. ANS: T PTS: 1 DIF: 1 TOP: THEORY 5. Kickbacks from patients are allowed under certain circumstances according to Medicare guidelines. ANS: F PTS: 1 DIF: 1 TOP: THEORY MULTIPLE CHOICE 6. The Medicare program was established in: a. 1955 c. 1965 b. 1960 d. 1970 ANS: C PTS: 1 DIF: 1 TOP: THEORY 7. Medicare Part A pays for: a. professional services and durable medical equipment b. hospital/facility care c. physician services and durable medical equipment d. hospital/facility care and durable medical equipment ANS: B PTS: 1 DIF: 1 TOP: THEORY 8. Medicare Part B pays for: a. durable medical equipment b. hospital/facility care c. physician services and durable medical equipment d. hospital/facility care and durable medical equipment ANS: C PTS: 1 DIF: 1 TOP: THEORY 9. Who handles the day-to-day operation of the Medicare program for the CMS? a. HCFA c. MACs b. peer review organization d. IPPS ANS: C PTS: 1 DIF: 1 TOP: THEORY 10. Medicare pays for what percentage of covered charges? a. 70% c. 80% b. 75% d. 85% ANS: C PTS: 1 DIF: 1 TOP: THEORY 11. The incentive to Medicare participating providers is: a. direct payment on all claims c. faster processing b. a 5% higher fee schedule d. all are correct ANS: D PTS: 1 DIF: 1 TOP: THEORY 12. Part B services are billed using: a. RBRVS, GPCI, and RVUs c. MS-DRGs b. ICD-10-CM, CPT, HCPCS d. APCs ANS: B PTS: 1 DIF: 1 TOP: THEORY 13. Who is the largest third-party payer in the nation? a. Blue Cross Blue Shield c. Cigna b. Aetna d. the government ANS: D PTS: 1 DIF: 1 TOP: THEORY 14. A major change took place in Medicare in with the enactment of the Omnibus Budget Reconciliation Act. a. 1989 c. 1997 b. 1992 d. 2000 ANS: A PTS: 1 DIF: 1 TOP: THEORY 15. The physician fee schedule is updated each April 15 and is composed of: a. the relative value units for each service b. a geographic adjustment factor to adjust for regional variations in the cost of operating a health care facility c. a national conversion factor d. all are correct e. none are correct