Question 1
What are the two types of forms used for health services billing?
CMS 1500 and CMS 1450
UB 04
CMS 1100 and CMS 1450
UB-05 and UB-1450
Question 2
Describe how Medicaid payments to providers are limited by the federal government.
The payments to providers are not limited by the federal government but rather by state agencies that have predetermind estimates.
The law requires that Medicaid payments to qualified hospitals, nursing facilities, ICF/MRs, and clinics not exceed a reasonable estimate of the amount that Medicare would pay for equivalent services in the aggregate within state-owned or operated, non-state-owned or operated, and private facilities.
CMS reviews state payment methodologies and supporting documentation to ensure that the state plan methodology may be audited and is comprehensively described and that payment rates are economic, efficient, and sufficient to attract willing and qualified providers.
All of the statements are correct.
None of the statements are correct
Question 3
What is charge explosion?
When charges increase dramatically over a set period of time
When the set of charges is explained in line item fashion on a master bill
When a uniform set of supplies is utilized for a services or procedure
When charge masters are delivered to a large group all at once
Question 4
How does the False Claims Act (FCA) impact providers of health care services?
Under the FCA, health care providers who knowingly make false or fraudulent claims to the government are fined $5,500 to $11,000 per claim plus up to three times the amount of the damages caused to the federal program.
Under the FCA, health care providers who knowingly make false or fraudulent claims to the government are fined $1,500 to $110,000 per claim plus up to three times the amount of the damages caused to the federal program.
Under the FCA, health care providers who knowingly make false or fraudulent claims to the government are fined $5,500 to $11,000 per claim plus up to five times the amount of the damages caused to the federal program.
Under the FCA, health care providers who knowingly make false or fraudulent claims to the government are fined $5,500 to $10,000 per claim plus up to 10 times the amount of the damages caused to the federal program.
Question 5
What are the elements that should be present, at a minimum, in all charge masters?
The six elements are: charge code, item description, department number, charge (price), revenue code, and CPT/HCPCS code.
Only three are required. Those are charge code, item description, and charge (price).
The five elements are charge code, item description, department number, charge (price), and CPT/HCPCS code.
The six elements are: charge code, item description, physician, charge (price), revenue code, and CPT/HCPCS code.