question

"Under Medicare prospectie payment system for skilled nurising facilities, which healthcare service is excluded from the consolidated payment?"

answer

Radiation Therapy

question

What tool does CMS require that skilled nursing facilities use to collect and to report clinical data on residents?

answer

Minimum Data Set (MDS)

question

What tool does the SNF PPS use to annually adjust the base rate for differences in local markets?

answer

Market Basket Index

question

"In medicares prospective payment system for skilled nursing facilities, what classification is used to adjust for case mix?"

answer

RUGs

question

"In Medicares prospective payment system for skilled nursing facilities, which data set determines a residents classification into a resource utilization group?"

answer

MDS

question

"CMS analysts divide admission to skilled nursing facilities into upper and lower categories. To which of the following categores does the ""presumption of coverage"" apply?"

answer

"Rehabilitation Plus Extensive, Rhabilitaion"

question

What tool does CMS regire that long-term care hospitals use to collect and to report clinical data on patients?

answer

Long-term care hospitals Coninuity Assessment and Record Evaluation (CARE) data set

question

"In Medicares prospective payment system for long-term care hospitals, what classification is used to adjust for case mix?"

answer

MS-LTC-DRG

question

A patient with which condition is an appropriate candiate for an LTCH?

answer

Ventilator-dependent emphysema

question

"Under Medicares prospective payment system for long-term care hospitals, all of the following elements used to group patients into a MS-LTC-DRG except::"

answer

Qualifying diagnosis at acute inpatient hospital prior to admission to LTCH

question

What cost-sharing applies to a Medicare beneficiary who did NOT have an immediately proceding admission at an acute care hospital AND resides in a LTCH for 90 days?

answer

"Inpatient deductible for the 90 day benefit period, Daily coinsurance payment for days 61-90."

question

"In most situations, for a facility to be defined as an LTCH, the lengths of stay of its Medicare patient must be at least how long?"

answer

25 days

question

"True or False? Even though Medicare-severity Long-term care diagnosis related groups (MS-LTC-DRGs) are based on the same general factors as the acute-care MS-DRGs for the IPPS, MS-LTC-DRGS differ from acute-care MS-DRGs because MS-LTC-DRGs have different relative weights and use quintiles for low volumes."

answer

TRUE

question

What converts the MS-LTC-DRG into an unadjusted payment amount?

answer

Standard federal rate

question

"In medicares prospective payment system for impatient rehabilitation facilities , what classification is used to adjust for case mix?"

answer

CMGs

question

All of the following types of diagnosis are used in the IRF PPS except:

answer

Principal

question

All of the following elements are part of the IRF PPS except:

answer

Major diagnostic category

question

"What is the term used in a rehabilitation facility to mean ""a patients ability to perform activities of daily livings""?"

answer

Fuctional status

question

"What tool, that drives payment, is used to collect information about Medicare patients in the IRF PPS?"

answer

Inpatient rehabilitation facility patient assesssment instrument (IRF PAI)

question

"True or False? For inpatient rehabilitation facility patients, codes on the IRF PAI should follow the UHDDS and the UB-04 guidelines?"

answer

FALSE

question

Coders in inpatient rehabilitation facilities (IRFs) use ICD codes for all the following purposes except:

answer

Reason for admission to the IRF

question

"In IRFs, all tof the following reasons are purposes for codes except:"

answer

Documenting patients fuctional statuses

question

"In an IRF, on what tool is are patients abilites to perform activities of daily living recorded?"

answer

Fuctional Independence Measure (FIM) Assessment

question

True or False? Ifacilities transmit IRF PAIs to the Centers for Medicare and Medicaid Services using CMS free IRVEN software.

answer

TRUE

question

What tool does CMS require that home healht agencies use to collect and to report clinical data on patients?

answer

Outcome Asessment and Information Set (OASIS)

question

Which discounted fee-for-service health care payment method does Medicare use to reimburse physicians?

answer

RBRVS

question

All of the following methods are types of episode-of-care reimbursement except:

answer

self-insured plan

question

"In the health care industry, what is the term for receiving compensation for health care services that were previously provided?"

answer

Reimbursement

question

Payers that use per-diem payment rates reimburse the provider a fixed rate for each day a covered member is hospitalized.

answer

TRUE

question

Where and when did health insurance become established in the US?

answer

"Texas, 1929"

question

There are 3 parties in healthcare reimbursement. Who is the third party?

answer

Payer

question

"In the heatlh care industry, what is another term for ""fee""?"

answer

Charge

question

"The bill that the pathologist office submitted for a laboratory test was $54.00. In its payment notice (remittance advice), the health care plan lists its payment for the laboratory test as $28.-00. What does the amount of $54.00 represent?"

answer

Charge

question

What is the purpose of managed care?

answer

"To reduce the cost of healthcare services, To improve the quality of care for patients"

question

The federal government funds significant portions of which groups healthcare?

answer

"Seniors, People with disabilities, endstage renal disease, low-income persons on state medicaid, Active duty and retired military personnel and their families, Native Americans"

question

Which national model for the delivery of health care services is financed by general revenue funds from taxes?

answer

National Health Service (Beveridge) model

question

"Which of the following phrases mean ""per head"""

answer

Per capita

question

Which type of reimbursement methodology does the health insurance company have the greatest degree of risk?

answer

Retrospective

question

"Which type of reimbursement methodology is associated with the abbreviation ""PMPM"""

answer

Capitated Payment

question

Why do health insurers pool premium payments for all the insureds in a group and use actuarial data to calculate the group's premiums?

answer

To assure that the pool is large enough to pay losses of the entire group

question

"In the heatlhcare sector, what does UCR stand for?"

answer

"Usual, Customary and Reasonable"

question

Which of the following payment methods are global?

answer

"Block grants, Surgical Packages, Bundling"

question

There are 3 parties in healthcare reimbursement. Who is the second party?

answer

Provider of services

question

"The constant trend of increased national spending on healthcare is a concern beause as spending on health care increase, the money available for other sectors of the economy decrease"

answer

TRUE

question

"In the US, What is healthcare insurance?"

answer

Reduction of a persons or a groups exposure to risk for unknown healthcare costs by the assumption of that risk by an entity

question

"In the accounting system of the physicians office, the account is categorized as ""self-pay"". How should the insurance analyst interpret this category?"

answer

The guarantor will pay the entire bill

question

Which statement describes the per diem payment method?

answer

Fixed rate for each day a covered member is hospitalized

question

To which of the following factors is health insurance status most closely linked?

answer

Employement

question

In which type of reimbursement methodology do health care insurance companies determine payment to providers before the services have been delivered?

answer

Prospective Payment

question

There are three parties in healthcare reimbursement. Who is the first party?

answer

Patient or quarantor

question

Which type of RAC review combines data analysis and submission of medical records to the RAC?

answer

Semi-automated

question

Which of the following is not a common cause of improper payments?

answer

Implementation of a documentation improvement program

question

The coding system that is used primarily for reporting diagnoses for hospital inpatient is known as:

answer

ICD-10-CM

question

Recovery audit Contractors are different from other improper payment review contractors because:

answer

RACs are reimbursed on a contingency-based system

question

The RAC appeals process has ___________levels

answer

5

question

Which of the following is an example of fraud?

answer

Billing for services not furnished as represented on the claim

question

The polocies and procedures section of a coding compliance plan should include:

answer

"Upcoding, Coding medical records without complete documentation,m Correct use of encoding software"

question

Which of the follwing entities does not perform improper payment reviews for CMS?

answer

None of the above

question

Which of the following coding systems was created for reporting procedures and services performed by physicians in clinical practice?

answer

CPT

question

Which of the following is the correct format for HCPCS Level 11 codes?

answer

A1234

question

"In the healthcare industry, all of the following benefits terms mean the amount during a timeframe beyond which all covered healthcare services for an insured or dependent are paid 100% by the insurance plan except?"

answer

Rider

question

"Which of the following entities is also known as a ""group plan""?"

answer

Employer-based healthcare insurance plan

question

Which of the following characteristics is representative of commericial healthcare insurance?

answer

For-profit in the private sector

question

All of the following specifications are types of limitations on healthcare polocies except?

answer

Geographic plan

question

Which type of healthcare insurance policy provides benefits to a resident requiring nursing home care and services?

answer

Long term or extended care insurance

question

All the following are cost-sharing provisions except?

answer

benefit

question

which type of prescription drug is the LEAST costly for insureds using their drug benefit?

answer

preferred generic

question

"All of the following phenomena are considered ""life events"" except: "

answer

Illness

question

All of the following data elements are on a RA except:

answer

Claim attachment

question

"In the healthcare industry, what is the term for the written report that insureres use to notify insureds about the extent of payments made on a claim?"

answer

Explanation of Benefits

question

"In the healthcare sector, when a patients healthcare services are covered under a voluntary healthcare insurance plan, the person who pays the remiander of the healthcare bill, after the heatlhcare insurance company has paid, is called the guarantor"

answer

TRUE

question

"Both parents of a dependent child had employer based group health insurance. Per the ""birthday rule"" the primary payer for the dependent child is the insurance of the parent whose birthday comes first in the calender year"

answer

TRUE

question

What healthcare organization is one of the most influential in the healthcare sector because it insures nearly one in three americans?

answer

BCBSA

question

Which type of healthcare insurance policy provide benefits to pay for Medicare deductibles and coinsurance?

answer

Medigap

question

Out of pocket costs for subscribers and patients are decreasing

answer

FALSE

question

What is the term for the contract between the healthcare insurance company and the individual or group for whom the company is assuming the risk?

answer

Policy

question

"In the healthcare sector, what is the term for the fixed dollar amount that the guarantor pays?"

answer

copayment

question

which type of health insurance policy provides benefits to an insured who is blinded as the result of an accident?

answer

accidental dealth and dismemberment insurance

question

Which of the following characteristics is the greates advantage of group healthcare insurance?

answer

Greater benfits for lower premiums

question

Which type of health care insurance policy provides benefits to a homeowner who requires an 8 month recuperation after a fall down her basement stairs?

answer

disability income protection insurance

question

"What is the term for a group of individual entities, sushc as individual persons, employers, or associations, whose healthcare costs are combined for evaluating financial history and estimating future costs?"

answer

risk pool

question

Which type of healthcare insurance policy offers the widest ranging coverage but requires the insured to pay coinsurance until the maximun out-of-pocket costs are met?

answer

Comprehensive

question

"All of the following phenomena are typically exlusions found in insurance plan riders, except?"

answer

emergency care under the prudent lyperson standard

question

Which government-sponsored program provides coverage for the dependents of active members of the armed forces?

answer

TRICARE

question

which of the following is/are true of CHIP?

answer

"It is a federal/state program, It varies from state to state"

question

Which of the following statements about Veterans Health Administration is False?

answer

Basic eligibility includes all veterans who served in active military service regardless of the separtation condition

question

Medicare Part C is a _________ option known as Medicare Advantage

answer

managed care

question

Which government sponsored program is desinged to help needy families achieve self sufficiency?

answer

Temporary Assistance for Needy Families Program (TANF)

question

In states where there is not a mandated fund for workers compensation which of the following is an option for employers?

answer

"Purchase workers compensation insurance from a private carrier, Provide workers compensation self-insurance coverage"

question

All fo the following are ture of state medicaid programs except:

answer

Services offered to beneficiaries are the same in each state

question

Which part of the medicare program does not include a cost sharing provision?

answer

all parts of medicare include a cost sharing provision

question

The civilian health and medical program of the Department of Veterans affairs (CHAMPVA) is available for:

answer

"Spouse or widower of a veteran meeting specific criteria, Children of a veteran meeting specific criteria."

question

For what reasons do MCOs survey their members for feedback?

answer

All the above

question

For what type of care should the physician practice manager expect to work with a case manager?

answer

workers compensation

question

Alll of the following functions are way that MCOs work toward their goal of quality patient care EXCEPT:

answer

Applying PMPM payment system

question

Which of the following activites do MCOs use as financial incentives to control costs?

answer

All the above

question

Episode of care management includes capitated reimbursement and global payment

answer

TRUE

question

"What is the term that means evaluating, for a healthcare service, the appropirateness of its setting and its level of service?"

answer

utilization review

question

Which type of MCO allows patients to choose how they will receive services at the time that the patients need the service

answer

POS

question

"A patient who was a Medicaid recipient, asked about the types of ifnancial incentives that the MCO used. What should the MCOs administrator do?"

answer

release summaries of the financial incentives

question

Access to mental or behavioral health or medial specialists is through referral. What is the term for the individual who makes the referral?

answer

"PCP, gatekeeper"

question

Which of these are NOT an element of prescription management?

answer

links to electronic banking

question

All of the following types of organizations represents ways of integrating health organizations EXCEPT:

answer

solo physician practice

question

All of the following activites are steps in medical necessity and utilization review EXCEPT:

answer

administrative review

question

The patient belongs to a managed care plan. The patient wants to make an appointment with an out-of-network. What should the patient expect?

answer

the paitents out of pocket costs will be increased

question

Who are dual eligibles?

answer

individuals who are eligible Medicare and Medicaid

question

Disease management is closely associated with coordination of are tools of MCOs because efforts of multiple providers must be synchronized in disease management

answer

TRUE

question

"What term means a network of organizations that directly provides or arranges to provide a coordinated continuum of services to a defined population and takes accountability for the cost, quality and outcomes of care?"

answer

integrated delivery system

question

Evidence based clinical guidelines orignate from all the following sources EXCEPT:

answer

physicians personal clinical experiences

question

Which of the following types of care represent healthcare services delivered by MCOs?

answer

all the above

question

All of the following actions reflect the roles of PCPs in MCOs EXCEPT:

answer

refer patients to colleagues for immunizations and other general care

question

What was the purpose of the Health Maintenance Act of 1973?

answer

to encourage the delivery of affordable quality healthcare

question

What is the term for an MCO that serves Medicare beneficiaries?

answer

Medicare Advantage

question

In which type of HMO are the physicians employees?

answer

Staff Model

question

"All of the following types of services or populations are common examples of ""carve outs"" EXCEPT:"

answer

immunizations and well-baby care

question

What is the average of the sum of the relative weights of all patients treated during a specified time period?

answer

case mix index

question

Which of the following is not a facility-level adjustment under the IPF PPS?

answer

electroconvulsive therapy

question

Which of the follwing concepts is a guiding principle of prospective payment?

answer

payment rates are established in advance of the healthcare delivery and are fixed for the fiscal period to which they apply

question

"What is the basis of the ""labor-related share""?"

answer

"facilities costs related to payroll, benefits, and professional fees"

question

What is the first step in determinings an MS-DRG assingment for an encounter?

answer

Pre-MDC procedure

question

Mart smith was admitted to IPF hospital A on April 1. She is discharged on April 5. Mary smith is readmitted to IPF hospital B on April 7 and continues the hospital stay until April 10. What lengh of stay adjustment day should be used to calculate the payment for the first day payment for IPF Hospital B?

answer

Day 5

question

"Within the IPF PPS, which of the following statements is true?"

answer

the cost for psychiatric cases decreases as the length of stay increases

question

Which reimbursement methodology is used in the Inpatient Psychiatric Facility PPS?

answer

per diem rate

question

What is the general term for software that assins inpatient DRGs?

answer

grouper

question

"In the IPPS, what is the term for each hopsitals unique standardized amount based on its costs per Medicare discharge?"

answer

base payment rate

question

When comparing Medicares IPPS and IPF PPS which of the following statements is false?

answer

Both PPS utilize a case rate reimbursement methodology

question

The MS-DRG payment includes reimbursement for all the following inpatient services EXCEPT:

answer

physican hospital visit

question

"In which governement publication are the details about the various PPS introduced, commented on and finalized?"

answer

federal register

question

What is the correct formula for wage index adjustment?

answer

(payment rate*labor portion*WI) + (payment rate*non-labor portion)

question

What medicare contractor reimburses acute care hospitals on behalf of Medicare?

answer

Medicare administrative contractor (MAC)

question

What is the rate year (RY) for IPPS?

answer

October-September

question

What is NOT a patient level adjustment used in the IPF PPS?

answer

full serivice emergency department

question

Which piece of legislation called for the first hospital inpatient PPS? This piece of legislation also allowed some hospitals settings to retain their cost based payment system?

answer

(TEFRA) Tax Equity and Fiscal Responisbility Act

question

A medicare paient was discharged from one acute IPPS and admistted to another acute IPPS hospital on the same day. How will the two acute IPPS hospitals be reimbursed?

answer

the first hospital receives a per-diem payment rerived from the potential MS-DRG and the second hospital receives the full MS-DRG

question

Under IPF PPS which states are included in the cost of living adjustment (COLA)?

answer

Hawaii and Alaska

question

"In MS-DRGs, for what is the case-mix index a proxy?"

answer

consumption of resources

question

Which IPPS provision is provided to facilities that experience a financial hardship because they provide treatment to patients who are unable to pay for the services?

answer

disproportionate share hospital

question

Define Principal diagnosis

answer

"the reason ""established after study to be responsible for occasioning the admission of the patient to the hospital for care"" "

question

Under ESRD PPS how many treatments does a facility need to provide within a year to qualify for low volume facility adjustment?

answer

"less than 4,000"

question

"Under the hospice payment system, which category of daily rate is the LOWEST?"

answer

routine home care

question

"Under OPPS, outpatient services that are similar both clinically and in use of resources are assinged to separate groups called?"

answer

APCs

question

"Medicare-certified ASCs must accept assignment, meaning:"

answer

An ASCs must accept Medicare pyament as payment in full

question

Which researcher is associated with Medicares RBRVS payment system?

answer

Hsaio

question

"In the APC system, an outlier payment is paid when which of the following occurs?"

answer

the cost of the service is greater than the APC payment by a fixed ratio and exceeds the APC payment plus a threshold amount

question

What is the maximum number of APCs that may be assigned per encounter?

answer

unlimited

question

"In Medicare's RBRVS payment system, which site of care is considered a facility?"

answer

dialysis center

question

"Under the Ambulance Fee Schedule, What is used to determine the level of service for ground transport?"

answer

EMS provider skill set used during the transport

question

What is the labor percentage utilized in the Ambulance Fee Schedule wage index adjustment?

answer

70%

question

Which federal law authorized payemtn for the Medicare Hospice benefit?

answer

TEFRA

question

"In Medicares RBRVS system , what is the term for the national dollar amount that is annually designated to convert relative value units into dollars?"

answer

Conversion factor

question

"In Medicares RBRVS system , which factor adjusts payment to physicians and health professionals for price differences among various parts of the country?"

answer

geographic practice cost index

question

Which APC component is a measure of the resource intensity of a particular procedure or service?

answer

relative weight

question

Under the ASC PPS medicare payemtn equals ________ percent and the beneficiary copayment equals _______of the total reimbursement of services provided.

answer

80/20

question

"Which element of the ralative unit accounts for the operational costs of delivering healthcare services, such as rent, wages of technical personnel, and supplies and equipment?"

answer

Practice expense

question

Which university is associated with the development of Medicares RBRVS payment system?

answer

Harvard

question

"What is the term for an urban, nonprofit, patient-governed, and community-directed health care entities receiving federal grant funding under Section 330?"

answer

federally-qualified health centers

question

"In Medicares resource based relative value scale payment system, to which type of code has a relative value unit been assigned?"

answer

CPT (healthcare common procedure coding system)

question

What is not a separate payment service under the ASC PPS?

answer

laboratory services

question

For which clinician is Medicare's RBRVS payment system modified by a formula that includes base units and time?

answer

Anesthesiologist

question

Which type of service includes an APC per diem rate that includes payments for all services provided in a single day of service under OPPS?

answer

partial hospitalization

question

What payment methodology is utilized in the ESRD PPS?

answer

case rate per treatment session

question

"When a patient is pronounced dead prior to an ambulance being called, which of the following provisions is followed under the Ambulance Fee Schedule?"

answer

no Payment is made to the ambulance supplier/provider

question

Which type of APC is used to increase bundling and move toward an episode of care based payment system?

answer

Composite APCs

question

"In Medicares prospective payment system for home health services, what classification is used to adjust for case mix?"

answer

HHRGs

question

"Within a 60 day episode of care, what home health care services are consolidated into a single payment to home health agencies?"

answer

"All therapy, Skilled nurising visits, Medical social services"

question

True or False? DME is EXCLUDED from the HHPPS

answer

TRUE

question

"In Medicares prospective payment system for home health services, what software is used to electronically submit data?"

answer

Home Assistance Validation and Entry (HAVEN)

question

All of the following dimensions are used to calculate an HHRG except:

answer

Type of clinician providing service

question

"True or False? HIPPS codes are ""itelligent"" because the number or letter in each position provides information. "

answer

TRUE

question

"In the HHPPS, what does the abbreviation LUPA Stand for?"

answer

Low-utilization payment adjustment

question

"In Medicares PPS for home health services, under the LUPA provision, what is the maximum number of visits for which an agency may receive reimbursement??"

answer

4

question

for what variations in resources consumption does Medicare PPS for home health services account?

answer

# of therapy visits by therapist

question

"Under medicares PPS for post acute care, which component is directly adjusted by the local wage index?"

answer

Labor portion

question

Which of Medicares PPS for postacute care is per diem?

answer

Skilled nursing facility PPS

question

"Value Based Purchasing and Pay for Performance and system typically link all the following components except:Quality, Setting of care, Performance, Payment"

answer

Setting of Care

question

"What is the term that means making available to the public, in a reliable and understandable manner, information on a healthcare organizations quality, efficiency, and consumer experience with care, which includes price and quality data, so as to influence the behavior of patients, providers, payers, and others to achieve better outcomes?"

answer

Transparency

question

When did P4P systems first emerge in the healthcare sector?

answer

1970

question

What reports drove the establishment of value-based purchasing and P4P and system in the healthcare sector?

answer

"Crossing the Quality Chasm, Rewarding Provider Performance: Aligning Incentives in medicare"

question

"Since the 2000s, what terms characterize the rate of establishing value based purchasing and P4P and systems in the healthcare sector?"

answer

Wide-Spread implementation

question

True or False? P4P and VBP are phenomena unique to the US healthcare delivery system.

answer

FALSE

question

What are the two major categories of P4P models?

answer

Reward based models and penalty based models

question

"What is the term for a model of primary care that seeks to meet the heatlhcare needs of patients and to improve patient and staff experiences, outcomes, safety, and system efficiency?"

answer

Patient-centered medical home

question

"In value based purchasing and P4P systems, what is the term for the process of identifying the clinician who provided the care, is responsible for the cares quality, and is accountable for the cares cost?"

answer

attribution

question

"In VBP and P4P systems, which incentive is financial?"

answer

Higher fee schedule

question

"In the healthcare sector, why are incremental implementations of VBP and P4P systems preferable to full-scale implementations?"

answer

Sponsors can evaluate policies and procedures

question

What targets should be the focus of P4P and VBP systems?

answer

"Most significant problems in terms of quality or cost, Proportion of populations covered by the service or provider, Availabitlity of valid and reliable performance measures"

question

"In VBP and P4P systems, which attribute should adopted performance measures characterize?"

answer

Relevant

question

Which piece of legislation initaiated the Reporting of Hosptial Quality Data for Annual Payment Update (RHQDAPU) program?

answer

Medicare Modernization Act

question

Which component of Medicares VBP plan monitors the action of reporting data in the proper format within the given timeframe?

answer

Pay for Reporting

question

What is the payment reduction for hospital and faclities that fail to successfully meet requirements of Medicares Pay for Reporting Programs?

answer

2% reduction

question

Within the Medicare VBP framework improving efficiency means

answer

Reducing the cost to treat each beneficiary

question

"All of the following elements are found in a charge description master, except: "

answer

ICD-10-CM Code

question

What is the definition of revenue cycle management?

answer

"Coordination of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue."

question

"The term ""soft coding"" refers to: "

answer

CPT codes that are coded by coders

question

"In heatlhcare setting, the record of the case the facility will receive for the services it has provided is known as?"

answer

Accounts Receivable

question

The remittance advice is provided to which party?

answer

Facility

question

Most facilites begin counting days in accounts receivable at which of the following times

answer

The date the bill drops

question

The amount of money owed a healthcare facility when claims ar pending is called:

answer

Dollars in accounts receivable

question

The dollar amount the facility actually bills for the services its provideds is known as:

answer

Charge

question

The difference between what is charged and what is paid is known as:

answer

Contractual allowance

question

"What is the name of the notice sent after the provider files a claim that details amounts billed by the providers, amounts approved by the payer, how much the payer paid, and what the patient must pay?"

answer

EOB (Explanation of Benefits)

question

"Which is a characteristic of the ""old"" RCM approach?"

answer

Silo mentality

question

Which entity is responsible for processing Part A claims and hospital based Part B claims for intitutional services on behalf of medicare?

answer

Medicare administrative contractor (MAC)

question

"In a typical acute-care setting, Admitting is located in which revenue cycle area?"

answer

Pre-claims submission

question

"In a typical acute care setting, Aging of Accounts reports are monitored in which revune cycle area?"

answer

Accounts Receivable

question

Charge Entry is located in which revenue cycle area?

answer

Claims processing

question

Which revenue cycle area uses an internal auditing system (scrubber) to ensure that error free claims (clean claims) are submitted to third-party payers?

answer

Claims processing

question

What CDM data element is nationally recognized?

answer

revenue code

question

Which of the following compliance documents services as day to day operating instructions for administering CMS programs

answer

Medicare Claims Processing Manual

question

scrubbers are used by hospitals to identify which of the following errors that can cause claims rejections or denials?

answer

"Incompatible dates of service, Nonspecific or inaccurate diagnosis and procedure codes, Lack of medical necessity, (all the above)"

question

Which type of compliance guidance is used by Medicare to communicate policies and procedures for the specific PPS manuals?

answer

CMS programs Transmittals

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