CCA Exam Preparation Domains 1, 2, 3, 4, 5, & 6 Practice Test ALL SOLUTION & ANSWERS 100% CORRECT SPRING FALL-2023/24 EDITION GUARANTEED GRADE A+

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1. A patient is admitted with spotting. She had been treated two weeks previously for a miscarriage with sepsis. The sepsis had resolved, and she is afebrile at this time. She is treated with an aspir... ation dilation and curettage and products of conception are found. Which of the following should be the principal diagnosis? a. Miscarriage b. Complications of spontaneous abortion with sepsis c. Sepsis d. Spontaneous abortion with sepsis a. Miscarriage 2. If a patient has an excision of a malignant lesion of the skin, the CPT code is determined by the body area from which the excision occurs and which of the following? a. Length of the lesion as described in the pathology report b. Dimension of the specimen submitted as described in the pathology report c. Width times the length of the lesion as described in the operative report d. Diameter of the lesion as well as the most narrow margins required to adequately excise the lesion described in the operative report d. Diameter of the lesion as well as the most narrow margins required to adequately excise the lesion described in the operative report 3. A patient is admitted to the hospital with shortness of breath and congestive heart failure. The patient subsequently develops respiratory failure. The patient undergoes intubation with ventilator management. Which of the following would be the correct sequencing and coding of this case? a. Congestive heart failure, respiratory failure, ventilator management b. Respiratory failure, intubation, ventilator management c. Respiratory failure, congestive heart failure, intubation, ventilator management d. Shortness of breath, congestive heart failure, respiratory failure, ventilator management a. Congestive heart failure, respiratory failure, ventilator management 4. Which of the following is a standard terminology used to code medical procedures and services? a. CPT b. HCPCS c. ICD-10-PCS d. SNOMED CT a. CPT 5. What is the correct CPT code assignment for hysteroscopy with lysis of intrauterine adhesions? a. 58555, 58559 b. 58559 c. 58559, 58740 d. 58555, 58559, 58740 b. 58559 6. What is the correct CPT code assignment for destruction of internal hemorrhoids with use of infrared coagulation? a. 46255 b. 46930 c. 46260 d. 46945 b. 46930 7.00Identify the diagnosis code(s) for melanoma of skin of right shoulder. a. D03.61, C43.61 b. C43.61 c. C43.60 d. D03.61 b. C43.61 8. A female patient is admitted for stress incontinence. A urethral suspension to reposition the urethra via open approach is performed. Assign the correct ICD-10-CM diagnosis and/or procedure codes. a. N39.3, 0TJB8ZZ b. N23, 0TSD0ZZ c. N39.3, 0TSD0ZZ d. R32, 0TSD4ZZ c. N39.3, 0TSD0ZZ 9. A patient is admitted to the hospital with abdominal pain. The principal diagnosis is cholecystitis. The patient also has a history of hypertension and diabetes. In the DRG prospective payment system, which of the following would determine the MDC assignment for this patient? a. Abdominal pain b. Cholecystitis c. Hypertension d. Diabetes b. Cholecystitis 10. Reference codes 49491 through 49525 for inguinal hernia repair. Patient is 47 years old. What is the correct code for an initial inguinal herniorrhaphy for incarcerated hernia? a. 49496 b. 49501 c. 49507 d. 49521 c. 49507 11. A patient was admitted for abdominal pain with diarrhea and was diagnosed with infectious gastroenteritis. The patient also has angina and chronic obstructive pulmonary disease. Which of the following would be the correct coding and sequencing for this case? a. Abdominal pain; infectious gastroenteritis; chronic obstructive pulmonary disease; angina b. Infectious gastroenteritis; chronic obstructive pulmonary disease; angina c. Gastroenteritis; abdominal pain; angina d. Gastroenteritis; abdominal pain; diarrhea; chronic obstructive pulmonary disease; angina b. Infectious gastroenteritis; chronic obstructive pulmonary disease; angina 12. A 65-year-old female was admitted to the hospital. She was diagnosed with sepsis secondary to Staphylococcus aureus and abdominal pain secondary to diverticulitis of the colon. What is the correct code assignment? a. A41.89, K57.92, R10.9 b. A41.01, K57.92 c. A41.89, K57.92, A49.01 d. A41.9, K57.92 b. A41.01, K57.92 13. Coding accuracy is anticipated to improve due to which ICD-10-CM enhancement? a. Less combination codes b. Increased cross referencing c. Removal of laterality d. Expanded codes that capture more detail d. Expanded codes that capture more detail 14. Patient with flank pain was admitted and found to have a calculus of the kidney. A ureteroscopy with placement of bilateral ureteral stents was performed to expand the lumen so the stone could pass naturally. Assign the correct ICD-10-CM/PCS diagnosis and procedure codes. a. N20.0, N23, 0T788DZ b. N23, N20.0, 0TC68ZZ, 0TC78ZZ c. N20.0, 0T768DZ, 0T778DZ d. N20.0, 0T788DZ d. N20.0, 0T788DZ 15. Code only a confirmed diagnosis of Zika virus (A92.5, Zika virus disease) as documented by the provider. In this context, "confirmation" __________. a. Does not require documentation of the type of test performed; the physician's diagnostic statement that the condition is confirmed is sufficient b. Requires the documentation of the type of test in addition to the physician's diagnostic statement c. Must be provided by the laboratory findings report d. Requires that the Public Health Agency be contacted a. Does not require documentation of the type of test performed; the physician's diagnostic statement that the condition is confirmed is sufficient 16. A 7-year-old patient was admitted to the emergency department for treatment of shortness of breath. The patient is given epinephrine and nebulizer treatments. The shortness of breath and wheezing are unabated following treatment. What diagnosis should be suspected? a. Acute bronchitis b. Acute bronchitis with chronic obstructive pulmonary disease c. Asthma with status asthmaticus d. Chronic obstructive asthma c. Asthma with status asthmaticus 17. A patient is admitted with acute exacerbation of COPD, chronic renal failure, and hypertension. a. J44.1, J44.9, I12.9, N18.9 b. J44.1, N18.9, I10 c. J44.9, N18.9, I10 d. J44.1, I12.9, N18.9 d. J44.1, I12.9, N18.9 18. What does the fourth character of an ICD-10-CM diagnosis code capture? a. Anatomic site b. Severity c. Etiology d. Supplemental information c. Etiology 19. Identify the diagnosis code(s) for carcinoma in situ of vocal cord. a. D02.0 b. C32.0 c. D49.1 d. D14.1 a. D02.0 20. To help clarify terms that currently have overlapping meaning, ICD-10-PCS has defined root operations. What is an example of the root operation of Excision? a. Partial nephrectomy b. Total nephrectomy c. Total lobectomy d. Total mastectomy a. Partial nephrectomy 21. The assignment of a diagnosis code is based on __________. a. The coder's assessment of the health record. b. The provider's statement that the patient has a particular condition. c. Clinical criteria used by the provider to establish the diagnosis. d. Its inclusion in the discharge summary b. The provider's statement that the patient has a particular condition. 22. Which of the following is a condition that arises during hospitalization? a. Case mix b. Complication c. Comorbidity d. Principal diagnosis b. Complication 23. A patient is admitted to an acute-care hospital for alcohol abuse and uncomplicated alcohol withdrawal syndrome due to chronic alcoholism. His blood alcohol level on admission was 10mg/100mL. a. F10.230, F10.10, Y90.0 b. F10.230 c. F10.10, Y90.0 d. F10.230, Y90.0 d. F10.230, Y90.0 24. Assign the correct CPT code for the following procedure: Reposition of the pacemaker electrode. a. 33226 b. 33243 c. 33217 d. 33215 d. 33215 25. A 35-year-old male was admitted with heartburn that has not improved with over-the-counter medications. An esophagoscopy and closed esophageal biopsy at the upper esophagus was performed. The physician documented esophageal reflux with esophagitis as the final diagnosis based on pathological examination. Identify the correct diagnosis and procedure codes. a. K23, 0DJ07ZZ b. K20.9, 0DB58ZX c. K21.0, 0DB18ZX d. K21.9, 0DB18ZX c. K21.0, 0DB18ZX 26. Which volume of ICD-10-CM contains the Tabular and Alphabetic Index of procedures? a. Volume 1 b. Volume 2 c. Volume 3 d. None of the above d. None of the above 27. Patient has been diagnosed with acute depression, sleep-related teeth grinding and psychogenic dysmenorrhea. The appropriate code assignment is: a. F32.8, F45.8 b. F32.9, F45.8 c. F32.9, F45.8, G47.63 d. F32.9, G47.53 c. F32.9, F45.8, G47.63 18. A physician correctly prescribes Coumadin. The patient takes the Coumadin as prescribed but develops hematuria as a result of taking the medication. Which of the following is the correct way to code this case? a. Poisoning due to Coumadin b. Unspecified adverse reaction to Coumadin c. Hematuria; poisoning due to Coumadin d. Hematuria; adverse reaction to Coumadin d. Hematuria; adverse reaction to Coumadin 29. An 80-year-old female is admitted with fever, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. The patient has more than 100,000 organisms of Escherichia coli per cc of urine. The attending physician documents "urosepsis." How should the coder proceed to code this case? a. Code sepsis as the principal diagnosis with urinary tract infection due to E. coli as secondary diagnosis. b. Code urinary tract infection with sepsis as the principal diagnosis. c. Query the physician to determine if the patient has sepsis due to the symptomatology. d. Query the physician to determine if the patient has septic shock so that this may be used as the principal diagnosis. c. Query the physician to determine if the patient has sepsis due to the symptomatology. 30. A patient was admitted to the hospital with symptoms of a stroke and secondary diagnoses of COPD and hypertension. The patient was subsequently discharged from the hospital with a principal diagnosis of cerebral vascular accident and secondary diagnoses of catheter-associated urinary tract infection, COPD, and hypertension. Which of the following diagnoses should not be tagged as POA? a. Catheter-associated urinary tract infection b. Cerebral vascular accident c. COPD d. Hypertension a. Catheter-associated urinary tract infection 31. A skin lesion is removed from a patient's cheek in the dermatologist's office. The dermatologist documents "skin lesion" in the health record. Before billing, the pathology report returns with a diagnosis of basal cell carcinoma. Which of the following actions should the coding professional do for claim submission? a. Code skin lesion b. Code benign skin lesion c. Code basal cell carcinoma d. Query the dermatologist c. Code basal cell carcinoma 32. Identify the correct diagnosis code(s) for adenoma of left adrenal cortex with Conn's syndrome. a. D35.02, E26.01 b. D35.02 c. E26.01 d. E26.01, D35.7 a. D35.02, E26.01 33. The patient was admitted to the outpatient department and had a bronchoscopy with bronchial brushings performed. a. 31622, 31640 b. 31622, 31623 c. 31623 d. 31625 c. 31623 34. A patient is admitted with abdominal pain. The physician documents the discharge diagnosis as pancreatitis versus noncalculus cholecystitis. Both diagnoses are equally treated. The correct coding and sequencing for this case would be: a. Sequence either the pancreatitis or noncalculus cholecystitis as principal diagnosis b. Pancreatitis; noncalculus cholecystitis; abdominal pain c. Noncalculus cholecystitis; pancreatitis; abdominal pain d. Abdominal pain; pancreatitis; noncalculus cholecystitis a. Sequence either the pancreatitis or noncalculus cholecystitis as principal diagnosis 35. Identify the CPT code for a 42-year-old diagnosed with ESRD who requires home dialysis for the month of April. a. 90965 b. 90964 c. 90966 d. 90970 c. 90966 36. An encoder that takes a coder through a series of questions and choices is called a(n): a. Automated codebook b. Automated code assignment c. Logic-based encoder d. Decision support database c. Logic-based encoder 37. Patient admitted with left senile cortical cataract, diabetes mellitus, and extracapsular cataract extraction with simultaneous insertion of synthetic intraocular lens, via percutaneous approach. a. H25.012, E11.36, 08DK3ZZ, 08RK3JZ b. E11.9, H25.012 c. E11.9, H25.092 d. H25.012, E11.9, 08RK3JZ d. H25.012, E11.9, 08RK3JZ 38. The physician performs an exploratory laparotomy with bilateral salpingo-oophorectomy. What is the correct CPT code assignment for this procedure? a. 49000, 58940, 58700 b. 58940, 58720-50 c. 49000, 58720 d. 58720 d. 58720 39. The patient was admitted with major depression current episode severe, recurrent. What is the correct ICD-10-CM diagnosis code assignment for this condition? a. F33.2 b. F33.40 c. F32.9 d. F31.81 a. F33.2 40. An exception to the Excludes 1 definition is the circumstance when the two conditions __________. a. Are unrelated to each other. b. Are related to each other. c. Will not be assigned as the principal diagnosis. d. Are injuries with external cause codes. a. Are unrelated to each other. 41. A patient is seen in the emergency department for chest pain. After evaluation of the patient it is suspected that the patient may have gastroesophageal reflux disease (GERD). The final diagnosis was "chest pain versus GERD." The correct ICD-10-CM code is: a. Z03.89 Encounter for observation for other suspected diseases and conditions ruled out b. R10.11 Right upper quadrant abdominal pain c. K21.9 Gastro-esophageal reflux disease d. R07.9 Chest pain, unspecified d. R07.9 Chest pain, unspecified 42. Patient was admitted through the emergency department following a fall from a ladder while painting an interior bathroom in his farmhouse. He had contusions of the scalp and face and a displaced open fracture of the anterior wall of the right acetabulum. The fracture site was excisionally debrided and the fracture was reduced by open procedure with an internal fixation device inserted. Which is the correct code assignment? a. S32.411A, W11XXA, Y92.012, 0QS404Z, 0QB40ZZ b. S32.411B, S00.03XA, S00.83XA, W11.XXXA, Y92.012, Y93.E9, Y99.8, 0QS404Z, 0QB40ZZ c. S32.414A, W11.XXA, Y93.E9, Y99.8, 0QS304Z, 0QB50ZZ d. S32.411B, W11.XXA, Y92.012, Y93.E9, 0QS404Z, 0QB50ZZ b. S32.411B, S00.03XA, S00.83XA, W11.XXXA, Y92.012, Y93.E9, Y99.8, 0QS404Z, 0QB40ZZ 43. According to the UHDDS, which of the following is the definition of "other diagnoses"? a. Is recorded in the patient record b. Is documented by the attending physician c. Receives clinical evaluation or therapeutic treatment or diagnostic procedures or extends the length of stay or increases nursing care and monitoring d. Is documented by at least two physicians and the nursing staff c. Receives clinical evaluation or therapeutic treatment or diagnostic procedures or extends the length of stay or increases nursing care and monitoring 44. To which of the following do notes appearing under a three-character code apply? a. Only to category codes that are exactly three-characters long b. To all codes within that category c. Only to one specific code d. To all codes within that chapter b. To all codes within that category 45. Patient had carcinoma of the anterior bladder wall fulgurated three years ago. The patient returns yearly for a cystoscopy to recheck for bladder tumor. Patient is currently admitted for a routine check. A small recurring malignancy is found and fulgurated during the cystoscopy procedure. Which is the correct code assignment? a. C67.3, Z85.51, 0T5B8ZZ, 0TJB8ZZ b. C79.11, 0T5B8ZZ c. C67.3, 0T5B8ZZ d. C79.11, C67.3, 0T5B8ZZ c. C67.3, 0T5B8ZZ 46. If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, __________. a. Code E10, Type 1 diabetes mellitus, should be assigned. b. Code E11, Type 2 diabetes mellitus, should be assigned. c. Query the endocrinologist or attending physician. d. Check the physician orders or medical order record for additional information. b. Code E11, Type 2 diabetes mellitus, should be assigned. 47. Which of the following organizations is responsible for updating the procedure classification of ICD-10-PCS? a. Centers for Disease Control (CDC) b. Centers for Medicare and Medicaid Services (CMS) c. National Center for Health Statistics (NCHS) d. World Health Organization (WHO) b. Centers for Medicare and Medicaid Services (CMS) 48. Which of the following is not a way that ICD-10-CM improves coding accuracy? a. Reduces sequencing problems by combining conditions into one code b. Provides laterality options c. Captures more details for injuries, diabetes, and postoperative complications d. Increases cross-referencing d. Increases cross-referencing 49. A 45-year-old female is admitted for blood loss anemia due to dysfunctional uterine bleeding. a. D50.0, N93.8 b. D62, N93.8 c. N93.8, D50.0 d. D50.0, D25.9 a. D50.0, N93.8 50. Identify the appropriate ICD-10-CM diagnosis code for right cerebral contusion with 15-minute loss of consciousness, initial encounter for care. a. T14.8 b. S06.371A c. S06.311A d. S06.310A c. S06.311A 51. Identify the two-digit modifier that may be reported to indicate a physician performed the postoperative management of a patient, but another physician performed the surgical procedure. a. −22 b. −54 c. −32 d. −55 d. −55 52. Assign the correct CPT code for the following: A 58-year-old male was seen in the outpatient surgical center for an extensive destruction of penile lesion by laser. a. 54065 b. 54060 c. 54057 d. 54050 a. 54065 53. Which character in an ICD-10-CM diagnosis code provides information regarding encounter of care? a. Fourth b. Fifth c. Sixth d. Seventh d. Seventh 54. According to CPT, a repair of a laceration that includes retention sutures would be considered what type of closure? a. Simple b. Intermediate c. Complex d. Not specified c. Complex 55. These codes are used to assign a diagnosis to a patient who is seeking health services but is not necessarily sick. a. C codes b. E codes c. M codes d. Z codes d. Z codes 56. For the body mass index (BMI), depth of non-pressure chronic ulcers, pressure ulcer stage, coma scale, and NIH stroke scale (NIHSS) codes, code assignment may be based on __________ a. Medical record documentation from clinicians who are not the patient's provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient's diagnosis). b. Only the attending physician's documentation. c. Consulting physicians' report. d. The history and physical report. a. Medical record documentation from clinicians who are not the patient's provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient's diagnosis). 57. A patient was discharged with the following diagnoses: "Cerebral artery occlusion, hemiparesis, and hypertension. The aphasia resolved before the patient was discharged." Which of the following code assignments would be appropriate for this case? G81.90 Hemiparesis affecting unspecified side G81.91 Hemiparesis affecting right dominant side G81.92 Hemiparesis affecting left dominant side G81.94 Hemiparesis affecting left nondominant side I66.9 Cerebral artery occlusion unspecified, without mention of cerebral infarction I63.50 Cerebral artery occlusion unspecified with cerebral infarction I10 Hypertension I50.9 Congestive heart failure R47.01 Aphasia a. I63.50, G81.94, R47.01, I10 b. I66.9, G81.90, R47.01, I10 c. I66.9, G81.91, I10 d. I66.9, G81.92, R47.01, I10 b. I66.9, G81.90, R47.01, I10 58. ICD-10-CM codes must be a minimum length of how many characters? a. Three b. Five c. Six d. Seven a. Three 59. A patient is admitted for chest pain with cardiac dysrhythmia to Hospital A. The patient is found to have an acute ST elevation (STEMI) inferior myocardial infarction with atrial fibrillation. After the atrial fibrillation was controlled and the patient was stabilized, the patient was transferred to Hospital B for a CABG X3. Coumadin therapy and monitoring for the atrial fibrillation continued at Hospital B. Using the codes listed here, what are the appropriate ICD-10-CM codes and sequencing for both hospitalizations? I21.09 Myocardial infarction of anterior wall, initial I21.19 Myocardial infarction of inferior wall, initial I22.0 Myocardial infarction of anterolateral wall, subsequent I22.1 Myocardial infarction of inferior wall, subsequent I48.0 Paroxysmal atrial fibrillation I48.2 Chronic atrial fibrillation I48.91 Unspecified atrial fibrillation R07.9 Chest pain, unspecified 021209W Aortocoronary bypass, Three Sites from Aorta with Autologous Venous Tissue, Open Approach a. Hospital A: I48.91, R07.9, I21.19; Hospital B: I22.1, I48.91, 021209W b. Hospital A: I21.09, I48.0; Hospital B: I22.0, I48.2, 021209W c. Hospital A: I21.19, I48.91; Hospital B: I21.19, I48.91, 021209W d. Hospital A: I21.19, I48.91; Hospital B: I22.1, I48.91, 021209W Certified Coding Associate (CCA) Exa c. Hospital A: I21.19, I48.91; Hospital B: I21.19, I48.91, 021209W 60. The patient presented to the physical therapy department and received 30 minutes of water aerobics therapeutic exercise with the therapist for treatment of arthritis. What is the appropriate treatment code(s) or modifier for a Medicare patient on a physical therapy plan of care in an outpatient setting? a. 97113 b. 97113-50 c. 97113, 97113 d. 97110 c. 97113, 97113 61. An epidural was given during labor. Subsequently, it was determined that the patient would require a C-section for cephalopelvic disproportion because of obstructed labor. Assign the correct ICD-10-CM diagnostic and CPT anesthesia codes. (Modifiers are not used in this example.) a. O65.4, 64479 b. O65.4, O33.0, 01961 c. O65.4, 01967, 01968 d. O65.4, O33.9, 01996 c. O65.4, 01967, 01968 62. Which of the following purpose and use goals does not apply to ICD-10-PCS? a. Improved accuracy and efficiency of coding b. Reduced training effort c. Improved communication with physicians d. Improved collection of data about nursing care d. Improved collection of data about nursing care 63. Patient returns during a 90-day postoperative period from a ventral hernia repair, now complaining of eye pain. What modifier would a physician setting use with the Evaluation and Management code? a. −79, Unrelated procedure or service by the same physician during the postoperative period b. −25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service c. −21, Prolonged evaluation and management services d. −24, Unrelated evaluation and management service by the same physician during a postoperative period d. −24, Unrelated evaluation and management service by the same physician during a postoperative period 64. A 65-year-old patient, with a history of lung cancer, is admitted to a healthcare facility with ataxia and syncope and a fractured arm as a result of falling. The patient undergoes a closed reduction of the fracture in the emergency department and undergoes a complete workup for metastatic carcinoma of the brain. The patient is found to have metastatic carcinoma of the lung to the brain and undergoes radiation therapy to the brain. Which of the following would be the principal diagnosis in this case? a. Ataxia b. Fractured arm c. Metastatic carcinoma of the brain d. Carcinoma of the lung c. Metastatic carcinoma of the brain 65. The next generation of consumer-directed healthcare will be driven by a design where copayments are set based on the value of the clinical services rather than the traditional practices that focus only on costs of clinical services. What new design will focus on both the benefit and cost? a. Value-based insurance design (VBID) b. Cost-based reimbursement (CBR) c. Pay for performance design (PPD) d. Prospective payment system (PPS) a. Value-based insurance design (VBID) 66. The MS-DRG system creates a hospital's case-mix index (types or categories of patients treated by the hospital) based on the relative weights of the MS-DRG. The case mix can be figured by multiplying the relative weight of each MS-DRG by the number of ________ within that MS-DRG. a. Admissions b. Discharges c. CCs d. MCCs b. Discharges 67. In processing a bill under the Medicare outpatient prospective payment system (OPPS) in which a patient had three surgical procedures performed during the same operative session, which of the following would apply? a. Bundling of services b. Outlier adjustment c. Pass-through payment d. Discounting of procedures d. Discounting of procedures 68. Sometimes hospital departments must work together to solve claims issue errors to prevent them from happening over and over again. What departments would need to work together if an audit found that the claim did not contain the procedure code or charge for a pacemaker insertion? a. Health Information and Business Office b. Health Information and Materials Management c. Health Information, Business Office, and Cardiac Department d. Health Information and Radiology c. Health Information, Business Office, and Cardiac Department 69. The goal of coding compliance programs is to reduce: a. Liability in regards to fraud and abuse b. Delays in claims processing c. Billing errors d. Inaccurate code assignments a. Liability in regards to fraud and abuse 70. Medicare's newest claims processing payment contract entities are referred to as _____. a. Recovery audit contractors (RACs) b. Medicare administrative contractors (MACs) c. Fiscal intermediaries (FIs) d. Office of Inspector General contractors (OIGCs) b. Medicare administrative contractors (MACs) 71. The government sponsored supplemental medical insurance that covers physicians and surgeons services, emergency department, outpatient clinic, labs and physical therapy is: a. Medicaid b. Medicare Part B c. Medicare Part A d. Medicare Part D c. Medicare Part B 72. What system assigns each service a value representing the true resources involved in producing it, including the time and intensity of work, the expenses of practice, and the risk of malpractice? a. DRGs b. RVUs c. CPT d. SVR b. RVUs 73. Medicare defines fraud as _____. a. Billing practices that are inconsistent with generally acceptable fiscal policies b. Making unintentional billing errors c. Accurately representing the types of services provided, dates of services, or identity of the patient d. Intentional deception or misrepresentation that results in an unauthorized benefit to an individual d. Intentional deception or misrepresentation that results in an unauthorized benefit to an individual 74. What is one way that physicians can prevent or minimize potentially abusive or fraudulent activities? a. Developing a compliance plan b. Upcoding c. Unbundling d. Billing for noncovered services a. Developing a compliance plan 75. Prospective payment systems were developed by the federal government to: a. Increase healthcare access b. Manage Medicare and Medicaid costs c. Implement managed care programs d. Eliminate fee-for-service programs b. Manage Medicare and Medicaid costs 76. When clean claims are submitted, they can be adjudicated in many ways through computer software automatically. Which statement is not one of the outcomes that can occur as part of auto-adjudication? a. Auto-pay b. Auto-suspend c. Auto-calculate d. Auto-deny c. Auto-calculate 77. Which of the following is not reimbursed according to the Medicare outpatient prospective payment system? a. CMHC partial hospitalization services b. Critical access hospitals c. Hospital outpatient departments d. Vaccines provided by CORFs b. Critical access hospitals 78. Which governmental agency develops an annual work plan that delineates the specific target areas for Medicare that will be monitored in a given year? a. Centers for Medicare and Medicaid (CMS) b. Federal Bureau of Investigation (FBI) c. Office of Inspector General (OIG) d. Defense Criminal Investigative Service (DCIS) c. Office of Inspector General (OIG) 79. Fee schedules are updated by third-party payers: a. Annually b. Monthly c. Semiannually d. Weekly a. Annually 80. The government sponsored program that provides expanded coverage of many health care services including HMO plans, PPO plans, special needs and Medical Savings accounts is: a. Medicare Advantage b. Medicare Part A c. Medicare Part B d. Medigap a. Medicare Advantage 81. Medical necessity for inpatient services does not always include: a. LCDs b. Related monetary benefits to payers c. Uniform written procedures for appeals d. Concurrent review a. LCDs 82. 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