1. Which statement is false regarding a DRG? A DRG …

2. The Medicare Part B program

3. Prescription drug cost is covered under which Medicare program?

4. To have success in the business of hospital-based medicine, one must

5. Time is now one mode of billing a patient for care. The following tasks can be counted for the total time performed by the billing provider EXCEPT:

6. Which of the following does not qualify for drug therapy requiring intensive monitoring for toxicity?

7. A patient comes in for a blood pressure follow-up. Your nurse notes that the patient has seen a cardiologist since the last encounter with you and she takes it upon herself to reach out and get records.  This process takes her 16 minutes in additional work to get the patient ready.  You can

8. A 76-year-old Medicare Advantage patient is seen for diabetes and HTN. Care is delivered and the patient is told to keep taking medications and to follow-up in 6 months for a repeat encounter.  No labs were ordered or analyzed today.  What level of MDM based on the 2021 guidelines?

9. Regarding the 2021 E&M ambulatory billing rules, regarding the DATA component of Medical Decision Making (MDM), true statements about the categories used to delineate the “moderate” and “high” MDM. ALL of the following are correct EXCEPT:

10. You spend 10 minutes today in review of the record, notes from the GI provider, and checking lab results. You spend 20 minutes FTF with the NEW patient and then 12 minutes to do the note.  The appropriate billing code for this patient, if we used TIME, would be

11. A longstanding 77 yo former smoker-COPD patient presents to see you due to SOB and worsening cough with purulent sputum production of six days duration. Saturations on RA are 89% with ambulation, 92% at rest (96% baseline).  CXR is negative, but given the presentation, you recommend a short stay in the hospital to get “tuned up”.  He refuses, but agrees to follow-up with you in the AM or call tonight if things worsen.  You agree with the plan and prescribe appropriate medications.  Based on the MDM, this would be billed

12. A 63-year-old male new patient comes in for evaluation. Today his BP is 159/99 with a recheck BP of 161/101 after your visit is completed.  He states that his entire family has hypertension.  His father died after a CVA at the age of 61 and “my three brothers are on pressure pills”.  He was told his BP was elevated 3 years ago, the last time he saw a “plant doctor at work” for a yearly check-up.  He has had his BP checked at a local pharmacy twice in the last 3 months, both times the “top and bottom numbers were over 100”.  His only complaint is rare, occasional dizziness.  You feel that he needs medication management and labs to be drawn for this condition.  The billing for this encounter would be

13. The Interval Detailed History

14. Which one of the following is TRUE?

15. Regarding the 99222 and 99223 (Initial Inpatient Care) admission codes…

16. Correct statements for the “Two Midnight Rule” include (choose ALL that are correct):

17. Procedure A is one you do routinely, and it is on the “inpatient only list”. A patient comes in today at 0600 and then goes to the OR where you perform Procedure A.  The patient does extremely well and asks to go home at 515 pm.  You agree and therefore discharge the patient to home.  You would bill this patient for the Procedure A how….?

18. A Medicare patient is placed in the hospital with observation services for heart failure. What is needed on day two for her care? (Choose all that are correct)

19. Documentation on day two to merit inpatient admission includes (Choose all that are correct)

20. All the following are FALSE about the Medicare Wellness Visits available to beneficiaries EXCEPT:

21. Medicare Wellness Visits (choose the best option)

22. Things NOT recommended to be covered at the stand-alone Medicare Wellness Visit

23. A 65 yo patient receives the IPPE in 02/2017. They return 13 months later and have not had a Medicare Wellness Exam since 02/2017.  They should

24. To bill a Transitional Care Management visit, which of the following must occur (choose the best answer)?

25. TCM services are appropriate after discharge from all these scenarios, except:

26. CPT 99495 requires what amount of medical decision making?

27. TCM documentation requires:

28. The number of providers allowed to bill for TCM services is

29. All of the following needs to be performed/documented with the Advance Care Plan (ACP) note for appropriate billing of the code EXCEPT (choose the best answer)……

30. Which of the following is FALSE with respect to Advance Care Planning?

31. Which of the following is TRUE with respect to Advance Care Planning if documentation supports?

32. You do a 99213 encounter and spend an additional 11 minutes discussing end of life issues with the patient. She wishes to go home and call you to make sure her daughter is on board with her wishes.  That call with you occurs over lunch today for an additional 14 minutes.  You can optimally bill (assuming documentation supports)

33. Which statement is false regarding a DRG? A DRG …

34. A 65 year old female developed a nodule on the left thyroid gland and it was removed surgically after FNA showed malignancy. It was completely excised and lymph nodes were removed and all negative.  She was released from ENT back to her PCP for long term management.  This occurred last year and you are seeing her for the first time this year and you diagnose her with a “History of Papillary Thyroid Cancer”.  Which of the following is correct?

35. Which of the following is a Major Comorbid Condition (MCC)?

36. True comments related to the “risk score” in clinical documentation include all EXCEPT:

37. The Maslach Burnout Inventory (MBI) is divided up in dimensions or domains. Which of the following is NOT one of the domains? 

38. Which is a true statement regarding anxiety and depression levels in the US because of the pandemic?

39. One strategy recommended in the session to help patients cope with the pandemic was noted to have an “apparently protective role”. Having patients engage in this strategy was noted in some studies to allow patients to develop an “inner peace in times of trial”.  The modality referenced was

40. Acute MI is when a troponin is elevated in a clinical scenario. True statements about the troponin include (choose ALL that apply):

41. Documentation to show an inpatient medical necessity for a stroke includes which of the following (choose all that pertain)?

42. On day two of a hospital stay where the patient was admitted as inpatient, what would help secure this as inpatient on day two?

43. Which of the following COPD scenarios would most likely merit INPATIENT hospitalization from initial presentation?

44. The Medical Decision Making that is a base minimum for critical care is indicative of some vital organ system failure (CNS, cardiometabolic, pulmonary, etc.). The medical decision making that is to be documented in the record to support such is

45. The 99291 code time is billable

46. The NPP sees a patient at 0645 and delivers 22 minutes of critical care. You (the Attending Physician) see the patient at 1130 and deliver care of 19 minutes that you also feel merits critical care.  On evening rounds, you deliver critical care for 10 minutes.  The amount of critical care billable for today is billed under the

47. The following visits CAN be shared with a physician and NPP in 2022 (select each correct answer):

48. The standards of clinical care set forth by CMS

49. The reimbursement that a Physician Assistant gets from a Medicare patient is

50. The billing of split/shared services in 2022 can be determined by (select all that apply)