All medical professionals must be knowledgeable with medical insurance, including

Local coverage determinations (LCD) describe when and under what circumstances which of the following is met: Question 101 options: MACs Medical necessity NCDs Proper administration of benefits Question 102 (1 point) The practice of undercoding can affect a hospital’s MS-DRG case mix in which of the following ways? Question 102 options: Makes it lower than warranted by the actual service and resource intensity of the facility Makes it higher than warranted by the actual service and resource intensity of the facility Hospital’s MS-DRG case mix is never monitored so there is no impact Coding has nothing to do with a hospital’s MS-DRG case mix Question 103 (1 point) If a physician does not provide a diagnosis to justify the medical necessity of a service, the provider may obtain payment from the patient: Question 103 options: For the balance due after Medicare has paid Only if both Medicare and any supplemental insurance have been billed and settled Never—providers may not bill Medicare patients for amounts unpaid by Medicare Only if a properly executed ABN was obtained before the service was provided Question 104 (1 point) The utilization manager’s role is essential to: Question 104 options: Analyze the estimate of benefits (EOBs)

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