Certified Professional Coder Coding Test 2024 |
Questions with 100% Correct Answers | Latest
Updated 2024 | Download to score A+
What is a physican degree of education - ✔✔4 years of college, 4 years of medical school plus
3 to 5 years of residency.
What is a mid-level providers and who - ✔✔1. Mid-level providers are know as
physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
What are the requirement for a PA and what - ✔✔1. 26 1/2 month to complete
2. Lincense to practice medicine with physician supervision
NP must have - ✔✔A Master Degree in Nursing
How many payers in the most simplest form? - ✔✔2
Private insurance plans and government insurance plans
,Commerical carriers are considered what - ✔✔Private payers that offer both group and
individual plans.
Private Payers contracts may - ✔✔Vary but may include hospitalization, basic and
major medical coverage.
What is the most significant government insurer - ✔✔Medicare
What is Medicare - ✔✔Federal health insurance program- Administerd by the Center
for Medicare &Medicaid Services (CMS)
What is CMS and what does it provide - ✔✔Center for Medicare & Medicaid Services (CMS)
provides coverage for people over the age of 65, blind, or disabled individuals, people with
end -stage renal disease
CMS regulations often serves as ____ word in coding requirement for Medicare and Non-
Medicare payers alike - ✔✔Last
What are the parts of Medicare - ✔✔Medicare A
Medicare B
Medicare C
Medicare D
,What is Medicare Part A - ✔✔Covers inpatient hospital care, as well as care provided in skilled
nursing facilites, hospice care, and home health care
What is Medicare Part B - ✔✔Covered Medically necessary doctors' services, outpatient care,
other medical services (including some preventive service not covered under Medicare Part A
Medicare Part B is considered what - ✔✔A optional benefit for which the patient must pay
a premium and which generally requires a yearly copay
Where is Medicare Part B usually used - ✔✔Physician offices (Outpatient Facility)
What is Medicare Part C - ✔✔Combines the benefits of Medicare Part A, Part B, and
sometimes Part D.
What is Medicare Part C also called - ✔✔Medicare Advantage
What is PPO - ✔✔Preferred Provider Organizations
What is HMO - ✔✔Health Maintenace Organizations
Which plan covers PPO and HMO - ✔✔Medicare Part C
, What is the CMS-HCC - ✔✔Center for Medicare & Medicaid Services-Hierarchical condition
category
What does the CMS-HCC provide - ✔✔Risk adjument model provides adjusted payment
based on a patient's disease and demographic factors.
If a coder does not include all pertinent diagnoses and co-morbidities, the provider may lose
out on what - ✔✔additional reimbursement for which he/she is entitled.
What is Medicare Part D - ✔✔Prescription drug coverage program available to all
Medicare beneficiaries. Private companies approved by Medicare provide the coverage.
What is Medicaid - ✔✔A health insurance assistance program for some low income people
(especially children and pregnant women) sponsored by federal and state governments
Medicaid administed on - ✔✔a state-by-state basis and coverage varies- although each of
the state programs adheres to certain federal guidelines
When is a physican considered a "participating physician" - ✔✔When contracted with
a insurance carrier whether that be a private insurance company or a governmental.
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