Final Exam: Home Health Billing

1. Question

What is Medicare?

Federal health insurance program for adults 65 years and older; certain youth with disabilities and people with end stage renal disease
Federal health insurance program for adults 60 years and older; all youth with disabilities and people with end stage renal disease
Federal health insurance program for adults 65 years and older; certain youth with disabilities and people with end stage liver disease
None of the above

2. Question

Medicare consists of how many parts?

2; A & B
3; A, B, & C
4; A, B, C, & D
5; A, B, C, D, & E
6; A, B, C, D, E & F

3. Question

CMS means the Centers for Medicare and Medicaid.

True
False

4. Question

What does the acronym PDGM stand for?

Patent-Driven Group Model
Patient-Driven Groupings Model
Pertinent-Driven Group Model
Patient-Determined Groupings Model
None of the above

5. Question

When did PDGM take effect?

January 1, 2020
January 15, 2020
February 1, 2020
February 15, 2020

6. Question

Home Health care focuses primarily on short term care, post -acute care, and post hospitalization care.

True
False

7. Question

What is a MAC?

Medicare Associate Curator, a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims or a Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries
Medicare Administrative Curator, a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims or a Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries
Medicare Administrative Contractor, a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims or a Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries
Medicare Administrative Contractor, a public health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims or a Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries

8. Question

What are the Home Health and Hospice MACs and jurisdictions that process Home Health and Hospice Claims?

Jurisdiction 6, National Government Services, Inc.; Jurisdiction 11, CGS Administrators, LLC; Jurisdiction N, Palmetto GBA, LLC and Jurisdiction L, National Government Services, Inc.
Jurisdiction 6, National Government Services, Inc.; Jurisdiction 13, CGS Administrators, LLC; Jurisdiction N, Palmetto GBA, LLC and Jurisdiction K, National Government Services, Inc
Jurisdiction 4, National Government Services, Inc.; Jurisdiction 13, CGS Administrators, LLC; Jurisdiction M, Palmetto GBA, LLC and Jurisdiction K, National Government Services, Inc
Jurisdiction 6, National Government Services, Inc.; Jurisdiction 15, CGS Administrators, LLC; Jurisdiction M, Palmetto GBA, LLC and Jurisdiction K, National Government Services, Inc.

9. Question

The Director of Nursing and the Administrator role may be filled by the same person.

True
False

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.

TMD
CMS
CMD
TMS
CMP

11. Question

OASIS is the acronym for Outcome Assessment Information Set.

True
False

12. Question

Answer the following fill-in the blank question.

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.

13. Question

What does the acronym HIPAA stand for?

Healthcare Insurance for Patients and Accountability Act
Health Insurance Portability and Accountability Act
Health Information & Patient Accountability Act
Home Instruction People & Individuals Act

14. Question

Which of the following include the Covered Entities?

Health Care Clearinghouses
Health Plans
Health Care providers who conduct certain standard administrative and financial transactions in electronic form
All of the above

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.

True
False

16. Question

Which of the following are considered Business Associates?

An entity that a Covered Entity contracts with to provide patients with access to a Personal Health Record
Health Information Organizations or Exchanges
E-prescribing gateways
A subcontractor to a Business Associate that creates, receives, maintains or transmits Protected Health Information on behalf of the Business Associate
All of the above

17. Question

Home Health Medicare pays for which of the following?

Physical therapy
Occupational therapy
Speech therapy
Medical social work
Medical supplies
Home Health Aide services
Skilled nursing care
Some of the above
All of the above
None of the above

18. Question

What is considered Protected Health Information under HIPAA Law?

Considered to be individually identifiable information relating to the present or future health status of an individual that is created, collected, transmitted, or maintained by a HIPAA-covered entity in relation to the provision of healthcare
Considered to be individually identifiable information relating to the present or future health status of an individual that is transmitted, or maintained by a HIPAA-covered entity in relation to the provision of healthcare
Considered to be individually identifiable information relating to the past, present or future health status of an individual that is created, collected, transmitted, or maintained by a HIPAA-covered entity in relation to the provision of healthcare
Considered to be individually identifiable information relating to the past or future health status of an individual that is created or maintained by a HIPAA-covered entity in relation to the provision of healthcare
Considered to be individually identifiable information relating to the or future health status of an individual that is maintained by a HIPAA-covered entity in relation to the provision of healthcare

19. Question

Answer the following fill-in the blank question.

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.

20. Question

Answer the following fill-in the blank question.

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.

21. Question

What is the role of a Medical Biller?

To daily contact the medical offices that you work with to provide a status update and collecting new files for billing
To daily contact the insurance companies to inquire about the status of previously submitted bills
To send insurance companies new claims
To process medical files from the medical offices, filling out insurance forms and checking that they are properly coded before submitting them to the appropriate insurance offices
All of the above

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.

True
False

23. Question

Every provider who submits electronic claims to Medicare, whether directly or through a billing service or clearinghouse, must complete an EDI agreement.

True
False

24. Question

What type of software does a Medical Biller use?

Billing
Clearinghouse
DDE
EMR
All of the above
None of the above

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.

True
False

26. Question

The Home Health 36-month rule includes which of the following?

Occurs when an individual or organization acquires more than a 50% direct ownership interest in a home health agency (HHA)
The 36 months following the HHA’s initial enrollment into the Medicare program
The 36 months following the HHA’s most recent change in majority ownership
All of the above
None of the above

27. Question

What is PECOS?

Provider Enrollment, Charge and Online System
Provider Enrollment, Chain and Only System
Provider Encouragement, Chain and Ownership System
Provider Enrollment, Chain and Online System
Provider Enrollment, Chain and Ownership System

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.

True
False

29. Question

Which form do Home Health and agencies use to submit changes to their enrollment data?

1300 Form
927 Form
855A Form
UB04 Form
CMS-588 Form

30. Question

In medical billing, companies that function as intermediaries who forward claims information from healthcare providers to insurance payers are known as

Clearinghouses
Insurance Adjusters
Intercessor
All of the above
None of the above

31. Question

Answer the following fill-in the blank question.

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 .

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.

True
False

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?

Plan care, Determine requirements, and Measure quality of care
Plan care, Determine reimbursement, and Measure quality of care
Plan care, Determine billing, and Measure quantity of care
Plan care, Determine reimbursement, and Measure quality of life
None of the above

34. Question

Which of the following is a function of the National Provider Identifier?

Issued by the National Plan and Provider Enumeration System
Covered health care providers and all health plans and health care clearinghouses must use the NPI in the administrative and financial transactions adopted under HIPAA
It does carry information about health care providers, such as the state in which they live or their medical specialty
All of the above

35. Question

What are the six life cycles of a Medicare claim?

Provider, Hardware, Claim file, FISS, Suspense, ERA
Provider, Software, Claim file, FISS, Suspense, ERA
Clearinghouse, Hardware, Claim file, FISS, Suspense, EAR
All of the above
None of the above

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.

True
False

37. Question

Please select at least three areas of eligibility concern for Home Health Beneficiaries:

Entitled to Medicare Part A, Part B, or both Part A and Part B
Ensure you have their correct physician information
Enrolled with another insurance that is primary over Medicare
In an open 90-day Home Health episode with another agency
A prior/current hospice election period
Verify their address
All of the above
None of the above

38. Question

How many characters does the Medicare Beneficiary Identifier have?

5 characters
7 characters
11 characters
13 characters
15 characters

39. Question

Answer the following fill-in the blank question.

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.

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?

_1-2_ _A-L_ _A-L_ _1-2_ _1-6_
_1-3_ _A-C_ _A-C_ _1-4_ _2_
_1-4_ _A-L_ _A-C_ _1-3_ _1_
_1-1_ _A-C_ _A-C_ _1-1_ _1_

41. Question

HETS is the HIPAA Eligibility Transaction System

True
False

42. Question

Who signs the Plan of Care?

Certified Nurse’s Aide
Director of Nursing
Physician
Home Health Aide
Insurance Company

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?

Yes
No

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).

True
False

45. Question

Which of the OASIS type(s) produce HIPPS codes?

SOC, TRN, and DC
SOC, ROC, and Death
SOC, DC, and Recertification
SOC, TRN, and Death
SOC, ROC, and FU & Recertification

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.

True
False

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.

True
False

48. Question

Condition Code 47 is for which of the following?

Treatment of nonterminal condition for hospice patient
No skilled Home Health visits in the billing period
Transfer from another Home Health Agency
All of the above
None of the above

49. Question

Patient Status Code 30 means the patient is no longer a patient and services are no longer provided

True
False

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?

A RAP
An OASIS
A Z-RAP
All of the above
None of the above

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.

15 days
30 days
60 days
90 days
120 days

52. Question

Values codes are not required on a RAP

True
False

53. Question

Answer the following fill-in the blank question.

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

54. Question

Answer the following fill-in the blank question.

The Home Health Medical Billing Code for a RAP Claim is

55. Question

According to what you have learned, which of the following are some of the most common billing errors?

Spelling the patient’s name incorrectly
Providing an incorrect MBI
The RAP and Final Claim not matching
HMO
Auto cancel
All of the above
None of the above

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%.

True
False

57. Question

Select the four fields that MUST match the RAP on a Final Claim.

Admit Date
From Date
HIPPS code
Diagnosis(es)
First billable visit
All of the above
None of the above

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.

True
False

59. Question

Answer the following fill-in the blank question.

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 %.

60. Question

What are two optional occurrence codes?

a) Occurrence Code 50
b) Occurrence Code 51
c) Occurrence Code 52
d) Occurrence Code 61
a & b
b & c
c & d
None of the above

61. Question

Answer the following fill-in the blank question.

A payment occurs when a patient is transferred/discharged and readmitted to the same home health agency within a 60-day period.

62. Question

Answer the following fill-in the blank question.

What are the required value codes for a RAP and a Final Claim? &

63. Question

Answer the following fill-in the blank question.

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.

64. Question

OASIS reporting regulations require the OASIS to be transmitted within 60 days of completion.

True
False

65. Question

LUPA is the acronym for which of the following?

Low Utilization Payment Adjustment
Low Utilization Processing Adjustment
Low Utilization Payment Assessment
Low Utilization Processing Assessment

66. Question

Answer the following fill-in the blank question.

Optional occurrence code , together with the applicable date will be used to designate a hospital discharge within 14 days of admission.

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.

True
False

68. Question

Therapy Code G0151 is NOT Qualified PT

True
False

69. Question

The Claims Correction Menu (FISS Menu option 03) allows you to do which of the following?

Correct claims in the return to provider status/location
Adjust paid or rejected claims
Cancel paid claims or Requests for Anticipated Payments (RAPs)
All of the above
None of the above

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.

FISS
OASIS
RAP
All of the above
None of the above

71. Question

DDE stands for?

Direct Distribution Entry
Direct Deposit Entry
Direct Data Entry
None of the above

72. Question

You are not allowed to adjust a claim when it is in_____________________________.

Medical Claims
Medical Review
Medical Billing
All of the above
None of the above

73. Question

What does Common Status/Location Code T B9997 represent?

Billing transaction needing correction by Provider
Denied claim
System processing
None of the above

74. Question

What are the three MAC portals?

NGS Connect, MyCGS, and e-Services
NGS Connex, MyCCS, and e-Services
NGS Connex, MyCGS, and e-Services
NGS Connex, MyCTS, and e-Services
NGS Connects, MyCTS, and e-Services

75. Question

The original bill must have processed and be in the “P” status code before a cancellation can be done.

True
False

76. Question

For Claim Type 327, the Adjustment Reason Code field is only a 4-digit field.

True
False

77. Question

Adjustments cannot be made to:

A line item that has been denied by Medical Review
A (RAP) Request for Anticipated Payment
Claims in status/location R B7501 or R B7516 (post-pay MSP review)
Claims in status/location R B9997 for eligibility, Medicare number change, untimely claims and/or duplicates
All of the above
None of the above

78. Question

Answer the following fill-in the blank question.

For S/LOC the S represents .

79. Question

Type of Bill (TOB) 326 represents a canceled claim.

True
False

80. Question

Where do you go to suppress a claim?

03 Claim corrections / 27 Home Health
01 Inquiries / 12 claims
03 Claims corrections /33 Home Health
02 Claims/Attachment /26 Home Health
03 Claim corrections /53 Home Health

81. Question

Answer the following fill-in the blank question.

The acronym RTP stands for .

82. Question

Answer the following fill-in the blank question.

More than one reason code may appear at the bottom of your screen. Pressing F displays the first reason code.

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.

True
False

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?:

facility characteristics
utilization data
cost and charges by cost center (in total and for Medicare)
Medicare settlement data, and financial statement data
All of the above
None of the above

85. Question

The CMS-838 is specifically used to monitor identification and recovery of “credit balances” owed to Medicare.

True
False

86. Question

Reason Code 37253 is assigned when:

A duplicate claim is found
A duplicate RAP is found
No OASIS is found
There is an overlapping episode of another Home Health Agency
All of the above
None of the above

87. Question

Status Code R stands for Return to Provider

True
False

88. Question

What are the 5 Levels of the Appeal Process?

MAC (Medicare Administrative Contractor)
QIC (Qualified Independent Contractors)
ALJ (Administrative Law Judge)
MAC (Medicare Appeals Council)
Federal District Court
All of the above
None of the above

89. Question

ADR Probe sample edits generally consist of 10-15 claims.

True
False

90. Question

Answer the following fill-in the blank question.

ADR means

91. Question

Answer the following fill-in the blank question.

Providers can enter data via the telephone systems operated by the MACs.

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.

True
False

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?

Provider Supplement & Reimbursement
Provider Statistical & Redetermination
Provider Statistical & Reimbursement
Provider Systematic & Reimbursement
All of the above
None of the above

94. Question

Please list three of the ways that you can submit a Credit Balance Report:

By Email, By Mail or By MAC portal
By Fax, By Email or By MAC portal
By Fax, By Mail or By MAC portal
By Fax, By Email or By all of the MAC portals
By Email, By Mail or By all of the MAC portals

95. Question

Which of the following pages are associated with the Credit Balance Report:

The Summation Page
The Front page
The Quarterly Review Page
All of the above
None of the above

96. Question

What is MEDPac?

an interdependent congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program
an independent congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program
an interdependent federal agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program
None of the above

97. Question

Answer the following fill-in the blank question.

The Acronym for Program for Evaluating Payment Patterns Electronic Report? is

98. Question

The Home Health Final Rule comes out every other year in October of that year.

True
False

99. Question

Answer the following fill-in the blank question.

MLN means

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.

True
False

Petria February 7, 2022

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

11. Question

12. Question

13. Question

14. Question

15. Question

16. Question

17. Question

18. Question

19. Question

20. Question

21. Question

22. Question

23. Question

24. Question

25. Question

26. Question

27. Question

28. Question

29. Question

30. Question

31. Question

32. Question

33. Question

34. Question

35. Question

36. Question

37. Question

38. Question

39. Question

40. Question

41. Question

42. Question

43. Question

44. Question

45. Question

46. Question

47. Question

48. Question

49. Question

50. Question

51. Question

52. Question

53. Question

54. Question

55. Question

56. Question

57. Question

58. Question

59. Question

60. Question

61. Question

62. Question

63. Question

64. Question

65. Question

66. Question

67. Question

68. Question

69. Question

70. Question

71. Question

72. Question

73. Question