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A 16-year-old patient is seen for an evaluation of left ankle pain. He has been a patient of Dr. Smith’s since infancy and Dr. Smith always performs the patient’s annual sports physical exam. During this visit the physician performs a medically appropriate history and examination, and medical decision making is of low complexity. Using the office equipment, a 2-view X-ray is taken of the left ankle which shows normal skeletal structures, no fractures identified. What are the CPT® codes for this encounter?   A.99202; 73590-LT B.99213; 73590-LT C.99213; 73600-LT D.99212; 73610-LT

When submitting a Medigap policy, which option is an example of how the patient’s ID number should appear in item 9a of the CMS-1500 claim form?   A.123456789 B.123456789A C.MGAP 123456789 D.AETNA 123456789 MEDIGAP

Which of the following scenarios would support billing incident-to services?     A.New patient seen by a mid-level provider who is an employee of the physician. B.Established patient seen by a mid-level provider for follow-up for blood pressure check, physician is in the office suite. C.Established patient seen by a mid-level provider for an established problem, the physician is performing hospital rounds. D.New patient to the practice, physician in exam room next door, mid-level provider is an employee of the physician.

To report the location, condition, or circumstances of an injury, poisoning, or adverse effect, which type of ICD-10-CM code is reported?   A.Z-code B.External cause code C.Combination code D.Manifestation code

An indicator that a practice has a successful billing process would be which of the following?   A.A low amount of contractual adjustments B.A high amount of contractual adjustments C.A high number of A/R days D.A low number of A/R days

Which do private companies contract with CMS to administer?   A. Medicare Part A & B B. Medicare Part B C. Medicare Part C D. Medicare Part A, B, & C

Which of the following statements is true regarding the non-PAR Medicare allowed fee schedule?   A.The non-PAR provider can bill the patient the difference between the charge and the Medicare allowable. B.The non-PAR limiting charge is 115% of the non-PAR Medicare Physician Fee Schedule. C.The non-PAR Physician Fee Schedule is 115% of the PAR Medicare Physician Fee Schedule. D.The non-PAR limiting charge is 95% of the PAR Medicare Physician Fee Schedule.

To compare units of service with CPT® and HCPCS level II codes, CMS added which of the following to the NCCI program?   A.Medically utilized edits B.Medically undetermined edits C.Medically unlikely edits D.Medically unusual edits

Case 3 Surgical Specialists-Outpatient Surgery Preauthorization Form Date: 08/01/20XX Surgeon: Brian Surgery, MD Assistant Surgeon: John Smith, MD Surgeon NPI: 8908900989 Member Name: Doe Jane A Last First Middle Date of Birth: 06/07/1971            Insurance Carrier: Medical Insurance Specialists Policy Number: 589908765 Group Number: 97809 Date of Surgery: 8/15/20XX Facility Name: General Outpatient Hospital Surgical Center Facility NPI: 4567891923 Facility Address: 1234 Main Street, Here, TX Diagnosis: Old disruption of posterior cruciate ligament Diagnosis code: M23.50 Procedure: Arthroscopic posterior cruciate ligament repair Procedure code: 29889 Fee for Procedure: $2500.00 Contracted Fee: $2000.00 Type of Care (select one): ____ Inpatient ____ 23 Hour Observation X Outpatient Type of Anesthesia (select one): X General ____ Local Preauthorization Number: 2348995786 Insurance Paid Percentage: 70% of the allowable rate after $1500 deductible is met. Patient Responsibility: Patient has $700 deductible remaining that must be met. After deductible is met, patient pays 30% of the allowable rate.   49.Based on the information obtained during the preauthorization, how much is patient responsibility if the claim is paid?   A.$910.00 B.$1500.00 C.$1650.00 D.$1090.00

Medicare Part A is available to individuals under the age of 65 who have which of the following?     A.Diabetes mellitus type I or II B.Chronic kidney disease (CKD) C.End-stage renal disease (ESRD) and meet certain requirements D.Any chronic health condition