Mixed Deck — All CMC Topics Flashcards
100 cards from real CMC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 20 Mixed Deck — All CMC Topics flashcards as text
Which HCPCS Level II code category covers enteral and parenteral nutrition therapy and supplies?
Answer: B codes
B codes (B4034–B9999) cover enteral and parenteral nutrition therapy products, equipment, and related supplies in HCPCS Level II.
Which federal regulation governs the Medicare Advantage (Part C) program's coding and risk adjustment requirements?
Answer: 42 CFR Part 422
42 CFR Part 422 governs Medicare Advantage organizations, including risk adjustment data validation (RADV) audits and coding accuracy requirements.
How should a CMC professional handle a situation where evidence-based practice & research methods protocols conflict with practical constraints?
Answer: Document the conflict and seek guidance from appropriate authorities
When protocols conflict with practical constraints, the professional approach is to document the conflict and seek guidance, ensuring transparency and compliance while working toward a resolution.
When coding a neoplasm, what information from the medical record is most critical for selecting the correct code?
Answer: Behavior (malignant, benign, uncertain, unspecified) and site
The Table of Neoplasms requires both the anatomical site and behavior classification to assign the correct code.
What type of tissue connects muscles to bones?
Answer: Tendons
Tendons are strong, fibrous connective tissues that specifically attach muscles to bones. They are crucial for transmitting the force generated by muscle contractions to the bones, enabling movement. In contrast, ligaments connect bones to other bones, and cartilage provides cushioning and flexibility.
A hospital bills Medicare for an inpatient admission that a RAC auditor later determines should have been billed as outpatient observation. This is an example of:
Answer: An improper payment due to patient status error
Billing an inpatient admission when documentation supports only outpatient observation status is an improper payment resulting from incorrect patient status determination.
The term 'bradycardia' refers to which condition?
Answer: Abnormally slow heart rate
Brady- means slow, and -cardia refers to the heart, so bradycardia is an abnormally slow heart rate (below 60 bpm).
The combining form 'hepato-' refers to which organ?
Answer: Liver
Hepato- refers to the liver, as in hepatitis (inflammation of the liver) and hepatomegaly (enlarged liver).
What is the correct sequence if both acute and chronic conditions are coded?
Answer: Acute before chronic
When both acute and chronic conditions are present and coded, the acute condition should be sequenced before the chronic condition. This sequencing rule applies when there is no specific combination code available for both. For example, acute exacerbation of chronic bronchitis would be coded with the acute condition first.
Which CMS program targets improper payments by using data analytics to identify and stop fraudulent claims before payment is made?
Answer: Fraud Prevention System (FPS)
The Fraud Prevention System (FPS) uses predictive analytics to identify potentially fraudulent Medicare fee-for-service claims and can suspend payments before they are made.
When implementing communication & interprofessional collaboration practices, what should a CMC professional prioritize first?
Answer: Compliance with established standards and protocols
Compliance with established standards and protocols must be the first priority, as it ensures safety, quality, and legal adherence in professional practice.
Which of the following is considered a 'covered entity' under HIPAA?
Answer: A health plan that pays for medical services
HIPAA defines covered entities as health plans, healthcare clearinghouses, and healthcare providers that transmit health information electronically.
In ICD-10-CM, what does a code listed as the 'default code' in the Alphabetic Index represent?
Answer: The most common or unspecified condition when no further detail is provided
The default code is the most frequently associated code for a condition when the record lacks sufficient detail to assign a more specific code.
What does the OIG do in relation to medical coding?
Answer: Monitors healthcare fraud and abuse
The Office of Inspector General (OIG) within the Department of Health and Human Services (HHS) is responsible for protecting the integrity of HHS programs, including Medicare and Medicaid. A key part of their role is to monitor and investigate healthcare fraud and abuse. They work to identify and prosecute individuals and organizations that engage in illegal activities like false claims or kickbacks.
How does continuing education relate to professional ethics & legal compliance for CMC certified professionals?
Answer: It ensures professionals stay current with evolving standards and best practices
Continuing education ensures CMC professionals stay current with evolving standards, technologies, and best practices in professional ethics & legal compliance, maintaining competency throughout their careers.
What is the purpose of the CMS-1500 form?
Answer: To file medical claims with insurance
The CMS-1500 form is the standard paper claim form used by physicians and other non-institutional providers to bill Medicare, Medicaid, and private insurance carriers for professional services. It contains essential patient, provider, and service information required for claim processing. This form is critical for reimbursement in outpatient settings.
What does the term 'capitation' mean in managed care reimbursement?
Answer: A fixed per-member per-month payment regardless of services rendered
Capitation is a payment model in which a provider receives a fixed monthly payment per enrolled patient regardless of the number or type of services provided.
What ethical consideration is most relevant to communication & interprofessional collaboration in CMC practice?
Answer: Maintaining confidentiality and acting in the best interest of stakeholders
Maintaining confidentiality and acting in the best interest of stakeholders is the cornerstone ethical consideration for communication & interprofessional collaboration in professional practice.
Which Medicare claim form is used to submit outpatient and professional service claims?
Answer: CMS-1500
The CMS-1500 form is the standard claim form used by non-institutional providers to bill Medicare Part B and most commercial insurers.
Which code set is primarily used for reporting procedures and services?
Answer: CPT
Current Procedural Terminology (CPT) codes are a standardized set of five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. These codes are essential for accurate billing and reporting of procedures performed. They ensure consistent communication between providers and payers.