HAC Medicare & Medicaid Billing 3

Question 1

What is the primary function of a Medicare Administrative Contractor (MAC)?

Accepted Answer

To process and pay Medicare Part A and Part B claims for a geographic jurisdiction

Answer

MACs are private contractors that process Medicare fee-for-service claims and perform related administrative functions within designated jurisdictions.

Question 2

Which modifier is appended to a CPT code to indicate that only the professional component of a service was performed?

Accepted Answer

Modifier 26

Answer

Modifier 26 indicates the professional component only, while modifier TC indicates the technical component only for split-billing of diagnostic services.

Question 3

A hospital bills Medicare for a patient who also has employer group health insurance (EGHI) through a current employer. Which payer is primary?

Accepted Answer

The EGHI plan is primary because it is employer-sponsored

Answer

Medicare Secondary Payer (MSP) rules require EGHI through a current employer to be primary when the employer has 20 or more employees.

Question 4

Under Medicaid, the Federal Medical Assistance Percentage (FMAP) represents:

Accepted Answer

The federal government's share of each state's Medicaid expenditures

Answer

FMAP is the ratio at which the federal government matches state Medicaid spending, varying by state based on per capita income.

Question 5

A claim is submitted with an ICD-10-CM code as the principal diagnosis, but CMS considers it a 'symptom' that should be replaced by its underlying cause. This is an example of a violation of which guideline?

Accepted Answer

UHDDS principal diagnosis selection guidelines

Answer

UHDDS guidelines for inpatient claims require the principal diagnosis to be the condition established after study that caused the admission, not a sign or symptom.

(HAC) Healthcare Accounting Certification Practice Test

(HAC) Healthcare Accounting Certification Practice Test

HAC Medicare & Medicaid Billing 3