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Question 1 of 100
1. Question
What is Medicare?
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Question 2 of 100
2. Question
Medicare consists of how many parts?
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Question 3 of 100
3. Question
CMS means the Centers for Medicare and Medicaid.
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Question 4 of 100
4. Question
What does the acronym PDGM stand for?
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Question 5 of 100
5. Question
When did PDGM take effect?
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Question 6 of 100
6. Question
Home Health care focuses primarily on short term care, post -acute care, and post hospitalization care.
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Question 7 of 100
7. Question
What is a MAC?
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Question 8 of 100
8. Question
What are the Home Health and Hospice MACs and jurisdictions that process Home Health and Hospice Claims?
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Question 9 of 100
9. Question
The Director of Nursing and the Administrator role may be filled by the same person.
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Question 10 of 100
10. Question
___________________________relies on a network of MACs to serve as the primary operational contact between the Medicare FFS program and the healthcare providers enrolled in the program.
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Question 11 of 100
11. Question
OASIS is the acronym for Outcome Assessment Information Set.
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Question 12 of 100
12. Question
Answer the following fill-in the blank question.
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PHI stands for and is any health information that can tied to an individual, which under HIPAA means PHI that includes one or more 18 identifiers.
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Question 13 of 100
13. Question
What does the acronym HIPAA stand for?
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Question 14 of 100
14. Question
Which of the following include the Covered Entities?
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Question 15 of 100
15. Question
Medicare fraud and abuse are serious problems. Some examples of Medicare abuse include billing for unnecessary medical services, charging excessively for services or supplies, misusing codes on a claim such as upcoding or unbundling codes.
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Question 16 of 100
16. Question
Which of the following are considered Business Associates?
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Question 17 of 100
17. Question
Home Health Medicare pays for which of the following?
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Question 18 of 100
18. Question
What is considered Protected Health Information under HIPAA Law?
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Question 19 of 100
19. Question
Answer the following fill-in the blank question.
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The Act authorizes the United States, or private parties, known as “relators”, acting on behalf of the United States to recover monetary damages from parties who submit, or cause others to submit, fraudulent claims based for payment by the federal government.
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Question 20 of 100
20. Question
Answer the following fill-in the blank question.
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Both the Anti-Kickback Statute and the are designed to keep medical treatment decisions free from the influence of potential monetary gain. Kickbacks and other unlawful financial arrangements give providers reasons to send patients for services they might not actually need.
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Question 21 of 100
21. Question
What is the role of a Medical Biller?
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Question 22 of 100
22. Question
The Affordable Care Act (Section 6404) reduced the maximum period for submission of all Medicare Fee-For- Service claims to no more than 12 months (one calendar year) after the date services were furnished.
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Question 23 of 100
23. Question
Every provider who submits electronic claims to Medicare, whether directly or through a billing service or clearinghouse, must complete an EDI agreement.
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Question 24 of 100
24. Question
What type of software does a Medical Biller use?
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Question 25 of 100
25. Question
A PTAN is a Medicaid-only number issued to providers by MACs upon enrollment to Medicare. When a MAC approves enrollment and issues an approval letter, the letter will contain the PTAN assigned to the provider.
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Question 26 of 100
26. Question
The Home Health 36-month rule includes which of the following?
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Question 27 of 100
27. Question
What is PECOS?
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Question 28 of 100
28. Question
The UB-04 uniform billing form is the standard claim form that any institutional provider can use for the billing for medical and mental health claims.
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Question 29 of 100
29. Question
Which form do Home Health and agencies use to submit changes to their enrollment data?
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Question 30 of 100
30. Question
In medical billing, companies that function as intermediaries who forward claims information from healthcare providers to insurance payers are known as
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Question 31 of 100
31. Question
Answer the following fill-in the blank question.
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If a beneficiary is enrolled only in Part and qualifies for the Medicare home health benefit, then all of the home health services are financed under Part .
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Question 32 of 100
32. Question
Companies that function as intermediaries who forward claims information from healthcare providers to insurance payers are known as clearinghouses. These clearinghouses do NOT check the claim for errors nor do they verify that it is compatible with the payer software.
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Question 33 of 100
33. Question
The Outcome and Assessment Information Set (OASIS) is the patient-specific, standardized assessment used in Medicare home health care to do which of the following?
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Question 34 of 100
34. Question
Which of the following is a function of the National Provider Identifier?
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Question 35 of 100
35. Question
What are the six life cycles of a Medicare claim?
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Question 36 of 100
36. Question
Electronic claims can be generated in a provider management software system and then transmitted directly to the payer electronically in accordance with the health plan’s submission requirements or indirectly through an application service provider or cloud computing service, a clearinghouse, a billing service, or another third-party vendor.
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Question 37 of 100
37. Question
Please select at least three areas of eligibility concern for Home Health Beneficiaries:
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Question 38 of 100
38. Question
How many characters does the Medicare Beneficiary Identifier have?
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Question 39 of 100
39. Question
Answer the following fill-in the blank question.
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When services are furnished based upon a ‘s verbal orders, the order may be accepted and put in writing by personnel authorized to do so by applicable State and Federal laws and regulations.
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Question 40 of 100
40. Question
Which of the following is an example of the new PDGM HIPPS code format and what is allowed in each of the 5 fields of the HIPPS code?
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Question 41 of 100
41. Question
HETS is the HIPAA Eligibility Transaction System
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Question 42 of 100
42. Question
Who signs the Plan of Care?
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Question 43 of 100
43. Question
In most cases when a claim is being worked through by Medicare and it is in “suspense” does the provider need to take any action?
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Question 44 of 100
44. Question
The six types of OASIS include Start of Care (SOC), the Resumption of Care (ROC), Follow Up and Recertification (FU), Transfer (TRN), Discharge (DC) and Death at Home (Death).
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Question 45 of 100
45. Question
Which of the OASIS type(s) produce HIPPS codes?
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Question 46 of 100
46. Question
As part of the certification of patient eligibility for the Medicare home health benefit, a face-to face encounter (an in person visit) must be performed by one of the allowed provider types.
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Question 47 of 100
47. Question
RAP stands for Request for Anticipated Payment and obtains 20% of the anticipated payment at the beginning of a patient’s care episode/period.
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Question 48 of 100
48. Question
Condition Code 47 is for which of the following?
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Question 49 of 100
49. Question
Patient Status Code 30 means the patient is no longer a patient and services are no longer provided
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Question 50 of 100
50. Question
If the patient has a Medicare Secondary Payer on file in HETS, the RAP will show up as which of the following in the FISS/DDE system?
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Question 51 of 100
51. Question
If Medicare does not receive the final claim within how many days of the paid date RAP, it will auto-cancel the RAP, take back the RAP payment, and also will not pay the final claim.
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Question 52 of 100
52. Question
Values codes are not required on a RAP
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Question 53 of 100
53. Question
Answer the following fill-in the blank question.
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RTP Reason Code (RC) ; happens when you must Re-bill the RAP if auto-cancel AND ensure RAP is in P B9997 AND ensure “FROM” date, “ADMIT” date, first 4 position of HIPPS code, and 0023 date matches between RAP and claim for same episode
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Question 54 of 100
54. Question
Answer the following fill-in the blank question.
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The Home Health Medical Billing Code for a RAP Claim is
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Question 55 of 100
55. Question
According to what you have learned, which of the following are some of the most common billing errors?
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Question 56 of 100
56. Question
If your agency has what Medicare deems are too many auto cancellations, all RAPs will be set to pay at zero percent instead of 20%.
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Question 57 of 100
57. Question
Select the four fields that MUST match the RAP on a Final Claim.
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Question 58 of 100
58. Question
Per the Code of Federal Regulations (CFR) at 42 CFR 484.210(e), submission of an Outcome and Assessment Information Set (OASIS) assessment for all Home Health (HH) final claims are a condition of payment for HHAs effective for claims with dates of service on or after April 1, 2017.
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Question 59 of 100
59. Question
Answer the following fill-in the blank question.
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Once the episode of care is complete, Home Health Agencies can bill the final claim to Medicare. Upon adjudication, Medicare will pay the remaining amount of %.
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Question 60 of 100
60. Question
What are two optional occurrence codes?
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Question 61 of 100
61. Question
Answer the following fill-in the blank question.
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A payment occurs when a patient is transferred/discharged and readmitted to the same home health agency within a 60-day period.
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Question 62 of 100
62. Question
Answer the following fill-in the blank question.
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What are the required value codes for a RAP and a Final Claim? &
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Question 63 of 100
63. Question
Answer the following fill-in the blank question.
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On a final claim, Occurrence Code will be used to designate the OASIS completion date for the assessment associated with a claim and is required.
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Question 64 of 100
64. Question
OASIS reporting regulations require the OASIS to be transmitted within 60 days of completion.
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Question 65 of 100
65. Question
LUPA is the acronym for which of the following?
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Question 66 of 100
66. Question
Answer the following fill-in the blank question.
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Optional occurrence code , together with the applicable date will be used to designate a hospital discharge within 14 days of admission.
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Question 67 of 100
67. Question
LUPA Threshold depends on the Clinical Grouping the patient is in which can vary from 2-6 visits within the 30 day period. If a Clinical Grouping is a “4 visit LUPA”, this means 4 visits will result in a prorated payment.
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Question 68 of 100
68. Question
Therapy Code G0151 is NOT Qualified PT
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Question 69 of 100
69. Question
The Claims Correction Menu (FISS Menu option 03) allows you to do which of the following?
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Question 70 of 100
70. Question
When a claim is submitted, _______________________ processes it through a series of edits to ensure the information submitted on the claim is complete and correct.
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Question 71 of 100
71. Question
DDE stands for?
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Question 72 of 100
72. Question
You are not allowed to adjust a claim when it is in_____________________________.
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Question 73 of 100
73. Question
What does Common Status/Location Code T B9997 represent?
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Question 74 of 100
74. Question
What are the three MAC portals?
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Question 75 of 100
75. Question
The original bill must have processed and be in the “P” status code before a cancellation can be done.
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Question 76 of 100
76. Question
For Claim Type 327, the Adjustment Reason Code field is only a 4-digit field.
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Question 77 of 100
77. Question
Adjustments cannot be made to:
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Question 78 of 100
78. Question
Answer the following fill-in the blank question.
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For S/LOC the S represents .
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Question 79 of 100
79. Question
Type of Bill (TOB) 326 represents a canceled claim.
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Question 80 of 100
80. Question
Where do you go to suppress a claim?
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Question 81 of 100
81. Question
Answer the following fill-in the blank question.
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The acronym RTP stands for .
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Question 82 of 100
82. Question
Answer the following fill-in the blank question.
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More than one reason code may appear at the bottom of your screen. Pressing F displays the first reason code.
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Question 83 of 100
83. Question
With Electronic Funds Transfer (EFT), Medicare can send payments directly to a provider’s financial institution whether claims are filed electronically or via paper.
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Question 84 of 100
84. Question
Medicare-certified institutional providers are required to submit an annual cost report to a Medicare Administrative Contractor (MAC). The cost report contains provider information such as which of the following?:
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Question 85 of 100
85. Question
The CMS-838 is specifically used to monitor identification and recovery of “credit balances” owed to Medicare.
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Question 86 of 100
86. Question
Reason Code 37253 is assigned when:
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Question 87 of 100
87. Question
Status Code R stands for Return to Provider
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Question 88 of 100
88. Question
What are the 5 Levels of the Appeal Process?
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Question 89 of 100
89. Question
ADR Probe sample edits generally consist of 10-15 claims.
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Question 90 of 100
90. Question
Answer the following fill-in the blank question.
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ADR means
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Question 91 of 100
91. Question
Answer the following fill-in the blank question.
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Providers can enter data via the telephone systems operated by the MACs.
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Question 92 of 100
92. Question
Medicare fraud and abuse are serious problems. Some examples of Medicare abuse include billing for unnecessary medical services, charging excessively for services or supplies, misusing codes on a claim such as upcoding or unbundling codes.
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Question 93 of 100
93. Question
Providers are responsible for obtaining access to the PS&R System and ordering PS&R reports for use in preparing the cost report. What does PS&R mean?
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Question 94 of 100
94. Question
Please list three of the ways that you can submit a Credit Balance Report:
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Question 95 of 100
95. Question
Which of the following pages are associated with the Credit Balance Report:
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Question 96 of 100
96. Question
What is MEDPac?
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Question 97 of 100
97. Question
Answer the following fill-in the blank question.
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The Acronym for Program for Evaluating Payment Patterns Electronic Report? is
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Question 98 of 100
98. Question
The Home Health Final Rule comes out every other year in October of that year.
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Question 99 of 100
99. Question
Answer the following fill-in the blank question.
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MLN means
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Question 100 of 100
100. Question
Public comments affect the Home Health Final Rule by the notice-and-comment process enabling anyone to submit a comment on any part of the Home Health Proposed Rule for a period of time.