CMS Fundamentals Practice Exam

These questions are part of the practice quiz. Start practicing

• Which statement about claims scrubbing is accurate?
• Which concept is used as the baseline infection control approach for all patients, including hand hygiene and PPE as needed?
• If an unrelated service is not encompassed by the global surgical package, how should it be billed?
• In MIPS, performance data collection serves to determine what outcome related to payments?
• PHI stands for
• What does MA-PD stand for?
• What is the best indicator of fluid balance?
• Which precaution requires an N95 respirator for TB measles and varicella?
• Recognizing cues in patient data primarily involves
• What term describes the person legally empowered to make decisions on someone's behalf?
• The MIPS framework ties reimbursement to performance results across which domains?
• The purpose of generating solutions is to
• Which statement about MIPS is true?
• Used for contact with nonsterile body fluids is referred to as which?
• What practice involves gently closing the eyes after death occurs?
• In the CMS framework discussed, payment adjustments are ultimately driven by what outcome?
• What practice requires Don before contact with client and remove before leaving room?
• Which item is not considered cost sharing in Medicare?
• What is the purpose of the National Correct Coding Initiative (NCCI) edits?
• Which principle means avoiding harm to the patient?
• Always a high priority concern refers to which category?
• In the Medicare appeals process, what role does a Qualified Independent Contractor (QIC) play?
• Which postmortem task involves documenting valuables and the time of care?
• Which practice involves continuing standard precautions in postmortem care?
• Cost sharing in Medicare includes which components?
• Protects immunocompromised clients from infection is known as what?
• Assigning tasks based on scope of practice is called?
• Inanimate objects that transmit microorganisms are called what?
• What is the purpose of a CMS Compliance Program?
• Which standard practice should be continued to prevent infection after death?
• Which item is used to identify the deceased and ensure proper release?
• Which term describes the transfer of microorganisms by inanimate objects?
• Which item requires immediate nursing response?
• In assessment, which action is typically required for expected findings?
• Skilled Nursing Facility benefits are paid under which Medicare part?
• What do Local Coverage Determinations (LCDs) specify?
• Elevating the head of the bed moves fluid into which area?
• Which organism is listed in the material?
• Which statement correctly describes the role of DRGs in IPPS?
• Never recap used needles to prevent injury is an example of which safety concept?
• Which consideration involves respecting beliefs surrounding death?
• Which statement correctly distinguishes deductible and coinsurance?
• When the patient's condition changes, which process should occur?
• What is the difference between an appeal and a grievance?
• Which term refers to data such as measurements like blood pressure collected during assessment?
• Which concept involves increased medication use raising the risk for adverse effects?
• Which term describes using hands to assess temperature, texture, or tenderness during physical examination?
• Which term is used to describe the assessment of edema severity?
• What is the difference between the global surgical package and a separate procedure?
• Which term denotes information provided by the client about symptoms or history?
• What is the primary mechanism by which MIPS affects clinician reimbursement?
• How do modifiers influence Medicare payment?
• What is the difference between IPPS and OPPS in Medicare payment systems?
• Which data categories are used to measure performance in CMS quality programs like MIPS?
• Which concept requires understanding and voluntary agreement to a procedure?
• What is a remittance advice (RA) in CMS?
• Which term indicates required precautions and PPE in isolation contexts?
• What is a DRG in Medicare payment terminology?
• Which statement best describes Part C?
• What is the purpose of Coverage Determination in CMS?
• Which finding should always be reported because it is not part of normal aging?
• In Maslow's hierarchy, which need comes immediately after Safety Needs?
• Which term denotes covering the body in a respectful manner according to facility protocol?
• Which step involves linking data to the clinical condition?
• Hypertonic Fluids are described as doing which of the following?
• Act quickly and notify the provider is most appropriate in which situation?
• Rapid Weight Gain is a sign of which condition?
• Which fluid type requires monitoring of lab values?
• Which is the federal law protecting health information privacy?
• Which entity processes Medicare claims and supports program integrity?
• Which term is defined as barrier protection such as gowns, gloves, masks, and eye protection?
• True or false: HIPAA in CMS context includes data standardization for electronic transactions.
• Which principle is defined by acting in the client's best interest?
• Which term best matches the description of preventing disease by vaccination or education?
• For Unexpected Findings, the first action should be to
• Which statement best describes Medicaid compared to Medicare?
• Which term describes listening to body sounds with a stethoscope?
• The scale from plus one to plus four is used to grade what condition?
• Which term describes the chain including infectious agent, reservoir, portal of exit, transmission, portal of entry, and susceptible host?
• Which concept focuses on protecting private health information?
• Which type of data consists of measurable and observable findings?
• Which sequence correctly shows the progression of steps in this assessment framework?
• Which statement best describes the relationship between performance results and payment in MIPS?
• The sign or label that indicates required precautions and PPE in patient areas is called what?
• Which statement about Durable Medical Equipment (DME) coverage is true?
• Which condition involves fluid in the lungs causing breathing difficulty?
• Which term is used to describe gloves used for nonsterile body fluids?
• Which term describes edema, crackles, hypertension, and weight gain?
• Which care is provided after death to maintain dignity?
• Which Medicare component is prescription drug coverage?
• Which option is NOT part of the CMS performance data categories used in MIPS?
• Edema Grading indicates what?
• The process of reassessing the care plan when a patient's condition changes is called?
• What is a Local Coverage Determination (LCD)?
• Assessment, teaching, and evaluation fall under which responsibility?
• Which action best corresponds to implementing planned nursing care?
• Which term denotes the right to make decisions about one's own care?
• Which term denotes an infection acquired in a healthcare setting?
• Which is ineffective against C. diff spores?
• What is the overarching goal of CMS's measurement and incentive approach in programs like MIPS?
• Medicaid is means-tested.
• Which statement best describes responsibility for data collection and basic interventions?
• Which term describes following facility policy when removing devices?
• Which term describes the prevention level aimed at preventing disease through vaccines or education?
• Which coding systems are used to report diagnoses and procedures to CMS?
• Which term refers to increased fall risk in older adults due to balance or mobility issues?
• ADLs and routine care are typically performed by which personnel?
• What triggers the late enrollment penalty for Medicare Part B?
• What is the role of a Medicare Administrative Contractor (MAC)?
• What is prior authorization in Medicare?
• DMEPOS is an acronym used in Medicare terms. What does it stand for?
• Which category of precautions baseline is used for all clients and includes hand hygiene and PPE as needed?
• Which term is required before body transport?
• CMS measures program quality by collecting performance data in which three areas?
• Which statement best describes Part A versus Part B eligibility criteria for Medicare?
• In the initial assessment priority, which component is addressed second after ensuring airway patency?
• Which precautions require gown and gloves on entry and are used for organisms like C. diff and MRSA?
• Which term defines heightened risk for falls among older adults due to reduced balance or mobility?
• The mechanism for reporting concerns up the chain in an organization
• What is a Skilled Nursing Facility (SNF) benefit and under which Medicare program is it paid?
• What is an APC in Medicare payment terminology?
• Which term means detecting disease early through screening?
• Which term describes the need to restart sterile procedures after lapse?
• Which term indicates increased risk due to decreased balance or mobility in older adults?
• Which term describes tapping body surfaces to assess density?
• What is the primary purpose of CMS in the U.S. healthcare system?
• Means-tested means eligibility based on what?
• What is described as the most effective method to prevent infection transmission?
• Which term describes a Medicare Advantage plan that includes prescription drug coverage?
• Which term denotes the care provided after death to maintain dignity?
• Which label matches the responsibility for ADLs and routine care?
• Which restriction improves breathing with fluid excess?
• Which term defines the standard body positioning after death?
• Which measure describes maintaining dignity and respectful care after death?
• Which concept is about keeping promises to the client?
• What does 'medical necessity' mean in Medicare coverage decisions?
• In CMS enrollment, which action is described as an exclusion?
• Which term refers to reporting concerns through leadership in an organization?
• Hypertonic Fluids do what?
• A break in sterility requires restarting what procedure?
• Which Medicare Part primarily covers inpatient hospital services?
• What is the role of CMS's Program Integrity activities?
• Which step involves determining if goals were met?
• Which term describes data that are observable and measurable obtained during assessment?
• Elevating the head of the bed is described as moving what?
• Which term refers to the obligation to tell the truth to patients?
• Which action ensures personal belongings are documented and released to the family?
• Which of the following is an example of PHI?
• Which best describes how CMS uses the collected data to influence financial incentives?
• Which intervention decreases fluid retention?
• Which three performance dimensions are explicitly targeted by MIPS data collection?
• Which concept refers to actions taken to reduce complications once a disease exists?
• Which task involves recording care valuables and the time?
• Which statement about HCPCS is true?
• What tracks fluid status in a patient?
• Which precaution is used for airborne pathogens like measles or varicella?
• Which principle emphasizes avoiding harm to patients?
• A method used to monitor hydration by recording intake and output
• What is the overarching goal of the priority framework described?
• What does the acronym FWA stand for in CMS terminology?
• In a scenario with two payers where Medicare is the secondary payer, how is payment determined?
• What is the standard body position after death?
• Which action involves documenting and releasing items to the family?
• What is Medicare Part C commonly called?
• What are MSP rules in Medicare?
• Which term is defined as protecting client rights and safety?
• Which term refers to the process where a client repeats information to verify understanding?
• What term means a formal record documenting unusual events?
• Exclusion from CMS programs is best described as?
• Which entity issues Local Coverage Determinations (LCDs) within CMS?
• In the CMS context, HIPAA is intended to protect privacy and security and ensure data standardization for electronic transactions.
• Medicare Part D is what type of benefit?
• If a nurse asks who is responsible for ADLs, which role applies?
• Which measure is used to maintain proper positioning to prevent deformity?
• Which concept protects private health information?
• After finalizing hypotheses, the next step is to
• Which principle requires providing fair treatment to all clients?
• What term refers to disposal methods used for contaminated waste materials?
• Which term describes a conflict between ethical principles?
• Which principle is the obligation to tell the truth?
• What best describes the difference between a beneficiary's rights and protections under CMS and the appeals process?
• Under MIPS, providers are rewarded or penalized based on their performance results that affect what?
• Which statement best describes Isotonic Fluids?
• The patient status that requires priority attention due to instability is:
• Which term refers to written instructions about future healthcare wishes?
• Which precaution requires a surgical mask within close range for infections like influenza or strep?
• Which term refers to the protective equipment used to protect healthcare workers (gown, gloves, mask, eye protection) as needed?
• Who handles reconsiderations after the initial redetermination?
• Which document designates a person to make medical decisions for someone else?
• What is the purpose of the Medicare Beneficiary Identifier (MBI)?
• Which statement best describes the relationship between DRGs and IPPS?
• What term describes the visual examination of the client during assessment?
• Which term represents the client right to make healthcare decisions?
• Which finding is a concerning sign in older adults?
• Which statement best describes the relationship between NCD and LCD?
• What does Durable Medical Equipment (DME) coverage in Medicare include?
• Which term is used to reduce complications of an existing illness?
• Which statement reflects the guideline about prioritizing problems in this framework?
• According to Maslow's hierarchy, physiological needs must be met before psychosocial needs.
• What term refers to inserts used to maintain facial structure for viewing?
• Which concept uses clean technique to reduce microorganism spread?
• Which is a sign of fluid overload?
• What is the homebound requirement for Medicare home health coverage?
• Which term refers to a client's ability to understand health information?
• Which documents are commonly used to submit a CMS claim for professional services?
• In case of incapacity, which document appoints someone to make healthcare decisions?
• Which term embodies keeping promises to the client?
• Which statement best describes the data elements typically required on a CMS professional claim?
• Which element is explicitly used to compute adjustments to reimbursement in MIPS?
• Which type of data is information reported by the client?
• In the process to appeal a Medicare claim denial, which sequence correctly describes the typical path?
• Which concept uses sterile technique to eliminate all microorganisms?
• What is the primary purpose of collecting performance data under MIPS?
• Hypotonic Fluids pull fluid into which space?
• An infection acquired in a healthcare setting is termed what?
• Analyzing cues is used to
• What is 'claims scrubbing'?
• What is a National Coverage Determination (NCD)?
• How is hospice care coverage handled under Medicare?
• Which term describes allowing time for family before transferring the body?
• A formal record documenting unusual events
• Crackles are an early sign of which condition?
• What is the role of a provider enrollment specialist?
• Which of the following are Medicare enrollment periods?
• Which statement best describes Local Coverage Determinations (LCDs) and their relation to MACs?
• For Unexpected Findings, the recommended action is to
• What does NCCI stand for?
• In the Medicare appeal process, which entity handles the initial redetermination?
• Which step involves wrapping the body per facility protocol?
• Which concept is described by a client repeating information to verify understanding?
• Act quickly and notify the provider corresponds to which situation?
• What is the difference between Medicare Advantage and Original Medicare?
• Who officially pronounces and documents the time of death?
• Data collection and basic interventions are the responsibility of which role?
• Which Medicare Part covers most outpatient services, doctor visits, and preventive care?
• Which practice involves cleaning hands to remove pathogens and reduce transmission?
• Which term describes a situation that occurs if a sterile field is wet touched or out of sight?
• Hypotonic Fluids do what?
• Why is proper NPI and Tax ID alignment important in CMS claims?