Question 11 (1 point)

All of the following are examples of the way internal audits can help a facility or practice EXCEPT:

Question 11 options:

A)	improving the chance for an external audit by a payer
B)	reducing coding and billing fraud and improper payments
C)	improving patient care
D)	creating a robust culture of compliance

Question 12 (1 point)

Which type of compliance guidance is used by Medicare to describe the circumstances under which specific medical supplies, services or procedures are covered nationwide by Medicare.

Question 12 options:

A)	CMS program transmittals
B)	national coverage determination
C)	Medicare claims processing manual
D)	national correct coding initiative

Question 13 (1 point)

In Medicare's RBRVS payment system, which factor adjusts payments to physicians and health professionals for price differences among various parts of the country?

Question 13 options:

A)	conversion factor
B)	geographic practice cost index
C)	party liability
D)	scaling

Question 14 (1 point)

Which element of the relative value unit accounts for the operational costs of delivering healthcare services such as rent, wages of technical personnel, and supplies and equipment?

Question 14 options:

A)	work value
B)	professional liability insurance
C)	geographic practice cost index
D)	practice expense

Question 15 (1 point)

Upcoding is:

Question 15 options:

A)	the process in which individual component codes are submitted for reimbursement rather than a single comprehensive code
B)	the process of submitting more units of service that is allowed by the NCCI edits
C)	the process of providing codes that are not medically necessary
D)	the fraudulent process of submitting codes for reimbursement that indicate more complex or higher paying services than the patient actually received

Question 16 (1 point)

Under OPPS, outpatient services that are similar both clinically and in use of resources are assigned to separate groups called _________

Question 16 options:

Question 17 (1 point)

In which improper payment review program are Medicare contractors paid on a contingency fee?

Question 17 options:

A)	CERT program
B)	A/B MAC medical reviews
C)	recovery audit program
D)	OIG

Question 18 (1 point)

RACs are required to have a physician medical director on staff. Additionally, RACs are charged with utilizing certified coders for semi-automated and complex record reviews. Which component of the National Recovery Audit Program do these requirements support?

Question 18 options:

A)	ensure accuracy
B)	efficiency and effectiveness
C)	develop robust provider education
D)	minimize provider burden

Question 19 (1 point)

What is the name of the notice sent after the provider files a claim that details amounts billed by the provider, amounts approved by the payer, how much the payer paid, and what the patient must pay?

Question 19 options:

A)	EOMB
B)	EOB
C)	MSN
D)	ABN

Question 20 (1 point)

The difference between what is charged and what is paid is known as:

Question 20 options:

A)	costs
B)	charges
C)	reimbursement
D)	contractual allowance

Question 21 (1 point)

Which of the following compliance documents serves as day-to-day operating instructions for administering CMS programs?

Question 21 options:

A)	CMS program transmittals
B)	national coverage determinations
C)	Medicare claims processing manual
D)	national correct coding initiative