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Part A Tier 2 Final Review Answer Key

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Review
#1 A beneficiary must be certified as _________ to receive Medicare Hospice benefits. Terminally ill
#2 This organization assigns Medicare provider numbers to certified facilities. The Centers for Medicare and Medicaid Services (CMS)
#3 This position in the Document Control Number (DCN) is where you find the digits that represent the Julian day. 4-6
#4 If the provider or supplier accepts assignment and he or she files a claim later than _____from the initial date of service, the provider or supplier will incur a 10% reduction in payment. 1 Year
#5 The following are examples of a ________claim: Claims that require further review, claims that have missing information, claims that are potential duplicates Suspended
Claim Filing
#1 Usually, preadmission diagnostic services are performed _____ days before a beneficiary is admitted to a hospital. These are considered inpatient services and included in the inpatient payment. 3
#2 When Skilled Nursing Facility (SNF) benefits are exhausted, the SNF can bill for _____. Ancillary
#3 Providers submit a Request for Anticipated Payment (RAP) and a Final Claim (FC) for each __________ Home Health Prospective Payment System (HHPPS) episode. 60 day
#4 This is how many Home Health episodes are billed in a Low Utilization Payment Adjustment (LUPA). 4 or less
#5 If a beneficiary experiences a change in condition that was not originally anticipated in his or her plan of care, this is known as a ________. Significant Change In Condition (SCIC)
Codes
#1 This Type of Bill (TOB) is represented by 131. Hospital Outpatient Admit-Through-Discharge claim
#2 This Type of Bill (TOB) is used to bill for an inpatient hospital service. TOB 112 Inpatient Interim First claim
#3 Reason code 38158 represents this type of claim. A duplicate Home Health claim.
#4 Reason code 38019 represents this type of claim. An overlap of a Skilled Nursing Facility (SNF) claim that was previously submitted.
#5 Reason code 34022 represents this situation. When Medicare is the primary payer and a positive disability record exists in the Common Working File (CWF),
Coverage
#1 The following are considered to be _________ charges (payable through part B if someone exhausts their Part A Inpatient benefits): an X-Ray, a neck brace, and physical therapy. Ancillary
#2 The following are covered _______services: bereavement services, medical social services, and physical therapy. Hospice
#3 Medicare covers up to ______ sessions of cardiac rehabilitation. 36
#4 Psychiatric partial hospitalization provides a specific treatment plan for psychiatric outpatient treatment of less than ____ hours of daily care. 24
#5 The CMS- _____ form is used to notify the Centers for Medicare and Medicaid Services (CMS) and the Fiscal Intermediary or Part A and Part B (A/B) Medicare Administrative Contractor (MAC) of the dialysis method selection. The dialysis facility must submit this form to the contractor before payment can be made. CMS-382
MISC
#1 If a patient only has Medicare because of kidney failure, Medicare coverage ends ____ months after the dialysis treatments end. 12
#2 he initial End-Stage Renal Disease (ESRD) coordination period is ______ long. 30 months
#3 In NGD you can find how long a claim has been suspended in the __________ applet. Audit Trail
#4 This view tab in NGD is where you can find End-Stage Renal Disease (ESRD) payment method information. Medical Summary
#5 This condition code represents that a semiprivate room is not available. 38
Final Question
A(n) __________ must be submitted for every Home Health Prospective Payment System (HHPPS) episode and is subject to all claim requirements including: the claims payment floor, applicable interest, Medical Review (MR), and Medicare Secondary Payer (MSP). Final Claim (FC)


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