HAC Medicare & Medicaid Billing 2

Question 1

Which Medicare part covers inpatient hospital stays, skilled nursing facility care, and hospice services?

Accepted Answer

Medicare Part A

Answer

Medicare Part A is hospital insurance covering inpatient hospital stays, SNF care, home health, and hospice.

Question 2

Under the Medicare Inpatient Prospective Payment System (IPPS), payment is primarily determined by:

Accepted Answer

The assigned Diagnosis-Related Group (DRG)

Answer

IPPS pays hospitals a predetermined rate based on the patient's DRG, regardless of actual costs incurred.

Question 3

A Medicaid claim is rejected because the patient's eligibility lapsed on the date of service. What is the best next step?

Accepted Answer

Verify eligibility and bill the patient as self-pay if confirmed ineligible

Answer

If Medicaid eligibility cannot be confirmed for the date of service, the provider should bill the patient directly as self-pay after verification.

Question 4

The Medicare Remittance Advice (RA) denial code CO-4 indicates:

Accepted Answer

The procedure code is inconsistent with the modifier

Answer

CO-4 means the service billed is inconsistent with the modifier used, requiring a corrected claim with the appropriate modifier.

Question 5

Which form is used to bill Medicare for outpatient and professional services?

Accepted Answer

CMS-1500

Answer

The CMS-1500 form is used by physicians and other healthcare professionals to bill Medicare for outpatient and professional services.

(HAC) Healthcare Accounting Certification Practice Test