OCS : Ophthalmic Coding Specialist 2025 Exam

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OCS
Ophthalmic Coding Specialist
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Question: 38
Which of the following is always the payer of last resort?
A. Medicare
B. Medicaid
C. Worker’s Compensation Insurance
D. Commercial Insurance
Answer: B
Medicaid is always the payer of last resort. This means that if a patient has more
than one type of insurance coverage, and one of the insurances is Medicaid, then
the biller must bill the other insurance first and Medicaid second. Medicaid will
never pay first, if the patient has more than one type of insurance coverage.
Question: 39
HCPCS J-Codes are used to represent:
A. Drugs administered by methods other than the oral method
B. Durable medical equipment
C. Dental procedures not found in the CPT manual
D. Temporary national codes for Medicare
Answer: A
HCPCS J-Codes are used to represent drugs administered by methods other than
the oral method. The J-codes are used to bill drugs administered to the patient,
while in the office. Other sections in the HCPCS manual represent durable
medical equipment and temporary national codes. Dental procedures are not
represented at all in the CPT manual, and are reported with D-codes.
Question: 40
What does HIPAA stand for?
A. Health Insurance Portability and Accountability Act
B. Health Insurance Protection and Accountability Association
C. Health Insurance Post-Payment Auditing Association
D. Health Insurance Accountability and Auditing Act
Answer: A
HIPAA stands for Health Insurance Portability and Accountability Act. HIPAA is
an Act of Congress, not an association or organization. Those that do not follow
HIPAA requirements can be prosecuted. HIPAA also joins with other
organizations to ensure that everyone involved in patient healthcare follow its
stipulations.
Question: 41
Appendix 1 in the HCPCS Level II manual contains:
A. An alphabetized list of HCPCS modifiers
B. A table of drugs
C. A list of changes, additions, and deletions
D. A short list of CPT codes to use with HCPCS codes
Answer: B
Appendix A in the HCPCS Level II manual contains a table of drugs. This table
lists all of the drugs in alphabetical order and can be found in the HCPCS manual.
The listings are also organized according to the drugs administration route and
unit information.
Question: 42
In order for a physician to appropriately code for a consultation service, three
things must be documented. What are those three things?
A. The referral or request from the PCP, the rendering of the opinion by the
specialist or consultant, and the written report or findings sent from the specialist
to the PCP
B. The rendering of the specialty service to the patient, the referral of the patient
from the specialist to an additional specialist, and the written report of the
findings provided to the specialist
C. The specialist request of a second opinion regarding the patient, the PCP’s
advice regarding which second specialist the patient should see, and the second
specialist’s report or findings
D. The referral from the PCP to the specialist, an additional referral from the
specialist to another specialist, and the written report or findings sent from the
specialist to the PCP
Answer: A
In order for a physician to appropriately code for a consultation service, three
things must be documented. These three things are: the referral or request from
the PCP, the rendering of the opinion by the specialist or consultant, and the
written report or findings sent from the specialist to the PCP. These three things
can be easily remembered by the “Three R’s:” “Referral to Specialist,”
“Rendering of Service” and “Report to PCP.”
Question: 43
When listing both CPT and HCPCS modifiers on a claim, you:
A. List the HCPCS modifier first
B. Do not list the HCPCS modifier at all
C. Only list the CPT modifier
D. List the CPT modifier first
Answer: D
When listing both CPT and HCPCS modifiers on a claim, you list the CPT
modifier first. When you report a procedure code with more than one modifier,
you must list the modifier that will affect the payment first on the claim.
Typically, CPT modifiers will affect the payment of a claim, but HCPCS
modifiers may not.
Question: 44
In the RBRVS calculation, the GPCI takes into account:
A. The geographic location of a practice or provider
B. The type of provider specialty
C. The malpractice risk of a procedure
D. The overhead cost of the practice
Answer: A
In the RBRVS calculation, the GPCI takes into account the geographic location of
a practice or provider. GPCI stands for Geographic Practice Cost Index, and it
takes into account the relative price differences in geographical location. The
GPCI is a part of the RBRVS (Resource Based Relative Value Scale), which
calculates a reasonable fee for procedures.
Question: 45
HIPAA was created to:
A. Protect patient privacy
B. Enact ways to uncover fraud and abuse
C. Create standards of electronic transactions
D. All of the above
E. Only options A and B
Answer: D
All of the above, HIPAA was created to protect patient privacy, enact ways to
uncover fraud and abuse, and to create standards of electronic transactions.
HIPAA protects patient privacy through its strict standards of confidentiality,
allows organizations like the OIG to uncover fraud and abuse, and gives these
organizations the power to investigate and prosecute suspected fraud and abuse
cases. HIPAA also creates standards of electronic transactions, such as the ANSI
5010 update and requires encryption and passwords on websites that contain
patient data.

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