Reimbursement – Final

Flashcard maker : Lily Taylor
Information technology includes the use of computers, communications ___________, and computer literacy.
a. data controls
b. networks
c. tags
d. none of the above
An electronic device that can accept data as input, process it according to a program, store it, and produce information as output is called a/an ___________.
a. adding machine
b. calculator
c. computer
d. copy machine
Step by step instructions are called a ___________.
a. menu
b. program
c. computer
d. copy machine
A __________ is a computer continued in a touch screen.
a. supercomputer
b. tablet
c. mainframe
d. none of the above
A tiny ___________ can be put into a human being and can dispense medication among other things.
a. Embedded computer
b. personal digital assistant (PDA)
c. supercomputer
d. all of the above
__________ take data that humans understand and digitize it, that is, translate it into binary form of ones and zeroes.
a. input devices
b. output devices
c. storage devices
d. none of the above
A/an __________ manipulates data, doing arithmetic or logical operations on it.
a. input device
b. output device
c. processing unit
d. storage device
____________ identifies people by their body parts. It includes fingerprints, handprints, face recognition, and iris scans.
a. biometrics
b. all security systems
c. both a and b
d. none of the above
In the United states, what is healthcare insurance?
a. Federal program to provide medical care and services indigent US citizens
b. State programs to provide medical care and services to deserving individuals
c. Reduction of a person’s or a group’s exposure to risk for unknown healthcare costs by the assumption of that risk by an entity
d. Set of negotiated guarantees that all healthcare expenses of a risk pool will be covered by employers
The physician’s office sent a request for payment to United Insurance Company. The term used in the healthcare industry for this request for payment is a:
a. allowance
b. charge
c. claim
d. contracted amount
A patient saw a neurosurgeon for treatment of a nerve that was severed during a workplace accident. The patient works for Acme manufacturing company where the accident occurred. Acme carries workers’ comp insurance. Which entity is the “third party” and will pay the neurosurgeon fees?
a. acme manufacturing
b. neurosurgeon
c. patient
d. workers comp insurance
In which type of reimbursement methodology do healthcare insurance companies reimburse providers after the costs have been incurred?
a. prospective payment
b. per diem payment
c. retrospective payment
d. global payment
In the healthcare industry, what is the term for receiving compensation for healthcare services?
a. actuarial compensation
b. accounts payable
c. global payment
d. reimbursement
The financial manager of the physician group practice explained that the third party payer would be reimbursing the practice for its treatment of the exacerbation of COPD that Mrs. Jones experienced. The exacerbation, treatment, and resolution covered approximately five weeks. The payment covered all the services that Mrs. Jones incurred during the period. What method of reimbursement is being used?
a. traditional
b. episode of care
c. per diem
d. fee for service
The health plan reimburses Dr. Smith $20 per patient per month. In January, Dr. Smith saw 200 patients, but he received $5000 from the health plan. What method is the health plan using to reimburse Dr. Smith?
a. traditional retrospective
b. capitated rate
c. relative value
d. discounted fee schedule
To which of the following factors is health insurance status most closely linked?
a. community rating
b. demographics
c. employment
d. historical context
In which type of reimbursement methodology does the health insurance company have the greatest degree of risk?
a. capitated payment
b. global payment
c. block grant
d. retrospective
Which of the four models for health systems predominates in the United States?
a. social insurance (Bismark) model
b. national health service (beveridge) model
c. national health insurance model
d. private health insurance model
In which type of healthcare payment method does the healthcare plan pay for each service that a provider renders?
a. episode of care
b. block grant
c. fee for service reimbursement
d. global payment
In the healthcare industry, what is another term for charge?
a. capitated rate
b. contractual allowance
c. fee
d. reimbursement
In the accounting system of the physician office, the account is categorized as “self pay”. How should the insurance analyst interpret this category?
a. The guarantor will pay the entire bill
b. The physician, himself or herself, will pick up the balance of the bill
c. The employer’s self insured healthcare insurance plan will cover the account.
d. The patient will pay deductibles and non-covered charges
What is the term for a predetermined list of charges?
a. fee schedule
b. chart of accounts
c. line item register
d. claim inventory
How could a group of physicians increase the monthly payments the group receives from a healthcare plan that uses capitation?
a. renegotiate the contract
b. refer patients to physicians outside the group
c. increase the volume of services per patient per visit
d. augment the complexity of services per visit
In its payment notice (remittance advice), the healthcare plan lists that the payment for the individual laboratory test is $39.00. The bill that the pathologist’s office submitted for the laboratory test was $45.00. What does the amount of $39.00 represent?
a. cost
b. allowable fee
c. premium
d. capitated rate
Which healthcare payment method does Medicare use to reimburse physicians based on the cost of providing services in terms of effort, overhead, and malpractice insurance?
a. global payment
b. capitated rate
c. CPR
d. resource based relative value scale
In the US health system, which payer has the greatest influence on payment methods?
a. State of California
b. Federal government
c. Medicare payment advisory commission
d. universal coverage
In which type of healthcare payment method does the healthcare plan oversee both the costs of healthcare and the outcomes of care?
a. traditional retrospective
b. case based
c. resource based relative value scale
d. managed care
In which type of healthcare payment method, does the healthcare plan recompense providers each month with a set amount of money for each individual enrolled in the healthcare plan.
a. traditional retrospective
b. capitated rate
c. relative value
d. discounted fee schedule
Medicare’s payment system for home health services consolidates all types of services, such as speech, physical, and OT into a single lump sum payment. What type of healthcare payment method does this lump sum payment represent?
a. global payment
b. capitated rate
c. CPR
d. resource based relative value scale
In which type of healthcare payment method does the healthcare plan recompense providers with a fixed rate for each day a covered member is hospitalized?
a. traditional
b. episode of care
c. per diem
d. fee for service
From the patient’s healthcare insurance plan, the rehabilitation facility received a fixed, pre-established payment for the patient rehabilitation after a total knew replacement. What type of healthcare payment method was the patient’s healthcare insurance plan using?
a. traditional retrospective
b. case based
c. resource based relative value scale
d. managed care
The coding system that is used primarily for reporting diagnoses for hospital inpatients is known as:
a. CPT
b. ICD-9-CM
c. ICD-10PCS
d. HCPCS Level II
Which of the following coding systems was created for reporting procedures and services performed by physicians in clinical practice?
a. CPT
b. IC-9-CM
c. ICD-10-PCS
d. HCPCS Level II
Under MS-DRGs all of the following factors influence a facility’s case mix index, except:
a. the productivity standard for coders
b. changes in services offered by the facility
c. changes made by CMS to MS DRG relative weights
d. accuracy of documentation and coding
Which of the following is not a reason to perform case-mix analysis?
a. analyze reimbursement fluctuations
b. determine the correct MS DRG assignment for an encounter
c. describe a population to be served
d. identify differences in practice patterns or coding complexity
e. none of the above
The practice of under coding can affect a hospital’s MS DRG case mix in which of the following ways?
a. makes it lower than warranted by the actual service/resource intensity of the facility
b. makes it higher than warranted by the actual service/resource intensity of the facility
c. does not affect the hospital’s MS DRG case mix
d. coding has nothing to do with a hospital’s MS DRG case mix
The policies and procedures section of a coding compliance plan should include:
a. physician query process
b. unbundling
c. assignment of discharge destination codes
d. all of the above
Recovery Audit Contractors are different from other improper payment review contractors because:
a. RACs audit inpatient and outpatient claims
b. RACs are charged with finding overpayment and underpayments
c. RACs are reimbursed on a contingency based system
d. all of the above
All of the following entities are voluntary healthcare insurance except:
a. private healthcare insurance plans
b. commercial healthcare ins. plans
c. health alliance plan
d. workman’s compensation
Which of the following entities is also known as a “group plan”?
a. a. employer based healthcare insurance plan
b. health alliance plan
c. private individual healthcare insurance plan
d. Medicaid
Which of the following characteristics is the greatest advantage of group healthcare insurance?
a. more stringent preexisting condition restrictions
b. greater benefits for lower premiums
c. larger risk pool
d. higher out of pocket expenses
In regards to healthcare insurance, the percentage that the guarantor pays is called the:
a. guaranteed amount
b. deductible
c. copayment
d. coinsurance
which of the following services has the highest likelihood of being a “covered service”?
a. preexisting condition
b. experimental
c. medically necessary
d. cosmetic
The guarantor had paid $2000 as coinsurance on various medical bills. Per the healthcare insurance policy, the healthcare insurance plan would not pay 100 percent of remaining bills with no coinsurance being assessed to the guarantor. What type of provision does this clause in the policy represent?
a. stop loss benefit
b. maximum out of pocket cost
c. catastrophic expense limit
d. all of the above
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?
a. benefit
b. policy
c. rider
d. carve out
All of the following are cost sharing provisions except:
a. guarantor
c coinsurance
d. deductible
Which part of the Medicare program was created under the Medicare Modernization Act of 2003 (MMA)?
a. part A
b. part B
c. Part C
d. Part D
The program TRICARE, which provides coverage for the dependents of active members of the armed forces, was formerly known as:
c. health e vets
d. USA pride
Which government sponsored program replaced the Aid to Families with Dependent children (AFDC program in 1996?
a. Medicare part A
b. state children’s health insurance program (CHIP)
c. women infants and children (WIC)
d. temporary assistance for needy families program (TANF
Which of the following is not a function of the Indian Health Services (IHS)?
a. assists in the development of their own health programs
b. facilitates and assists in coordinating health planning
c. provides only telemedicine healthcare services
d. promotes using health resources available at federal, state and local levels
The civilian health and medical program of the department of veterans affairs (CHAMPVA) is available for:
a. veterans of the armed forces
b. spouse or widow of a veteran meeting specific criteria
c. children of a veteran meeting specific criteria
d. any spouse, widower or children of a veteran
e. B and C
Which of the following is not true of CHIP?
a. it is a state/local program
b. It is a federal/state program
c. It varies from state to state
d. none of the above
The Medicare program is divided into ______ parts.
a. 2
b. 4
c. 6
d. 26
Medicare part C is a _____ option known as Medicare advantage.
a. free
b. retrospective fee for service
c. self insured
managed care
all of the following are true of state Medicaid programs except:
a. federal funds allocated to each state are based on the average family size
b. the program must cover infants born to Medicaid eligible pregnant women
c. states may offer a managed care option
d. services offered to beneficiary vary per state
A common error that providers make when submitting claims is:
a not spelling name correctly or using nickname
b. inverted numbers in a social security number
c. failure to check box for assignment of benefits
d. A and B
e. all of the above
A document issued by an insurance company providing details such as patient name, name of provider, allowable charges, write offs and rejection and denial codes is referred to as an:
a. EOB
b. NPP
c. UBO4
d. EFT
A 26 year old healthy patient is involved in a car accident driving to work one morning. The primary insurance responsible for the costs for this episode of care will be:
a. workman’s comp
b. patients automobile insurance
c. Medicare
This information system uses computers to manage both laboratory tests and their results:
a. pathologic
b. financial
c. administrative
d. laboratory
Responsible for overseeing the adoption and meaningful use of EHRs setting standards, and judging the impact:
a. office of the national coordinator
b. HL7
c. joint commission
d. institute of medicine
A longitudinal electronic record of patient health information that is generated by multiple licensed providers in any care delivery setting:
a. EMR
b. PHR
c. EHR
Considered the building b locks of a national health information network:
a. RHIOs
b. HIEs
c. ISOs
d. A and B
e. all of the above
PACS i8s associated with which information system:
a. pathology
b. clinical
c. radiology
d. administrative
The original purpose of HIPAA was to:
a. make health information portable from one physician to another
b. create 15 forms through the administration simplification act
c. allow for health insurance portability between jobs
d. all of the above
Protected health information that is senty over the internet should be this:
a. De-identified
b. encrypted
c. A and B
d. PHI should never be sent over the internet
Practices submit electronic claims to this business, which does a preliminary check of information prior to sending to the various insurance carriers:
a. clearinghouse
b. covered entity
c. third party payer
d. CMS
Generated by a practice management system to show patient’s outstanding balances:
a. patient day sheet
b. procedure day sheet
c. practice analysis report
d. patient aging report
Which of the following is NOT a transaction:
a. charges
b. fee schedule
c. payments
d. adjustments
Technology used in teleradiology is called:
a. store and receive and forward
Technology used to link electronic devices such as a pacemaker with a cell phone:
a. a. teleconferencing
b. fiber optic cables
c. blue tooth
d. none of the above
Which of the following conditions has been found to benefit from teleneurology:
a. CVAs
b. epilepsy
c. Parkinson disease
d. all of the above
When a physician provides a telemedicine consultation to a patient using a video camera and a telecommunications link, he is using which form of technology:
a. store and forward
b. teleconferencing
In which type of HMO are the physicians employees?
a. group model
b. independent practice association (IPA) model
c. staff model
d. network model
Why did Congress pass the health maintenance organization act of 1973
a. To deter the privatization of the Blue cross plans
b. to increase the number of physicians in primary care
c. to encourage the delivery of affordable, quality healthcare
d. to standardize the costs of healthcare across the nation
All of the following are characteristics of managed care organizations except:
a. coordination of care across the continuum
b. integration of financing and delivery of health
c. management of costs and outcomes
d. freedom of choice and autonomous decision making
Access to mental or behavioral health or medical specialists is through referral. What is the term for the individual who makes the referral?
a. gatekeeper
b. primary care physician
c. primary care practitioner
d. all of the above
e. none of the above
All of the following are characteristics of disease management except:
a. focus on single specialist for acute disease
b. prevention of exacerbations of chronic disease
c. promotion of healthy life choices
d. monitoring of adherence to treatment plans
All of the following are tools managed care organizations use to promote quality care in their healthcare plans except:
a. discernment in selection of providers
b. emphasis on health of populations
c. incentive to meet fiscal targets
d. maintenance of accreditation
Which of the following services is most likely to be considered medically necessary?
a. caregivers convenience or relief
b. cosmetic improvement
c. investigational cancer prevention
d. standard of care for health condition
What is the term that means evaluating, for a healthcare service, the appropriateness of its setting and its level of service?
a. coordination of service benefits
b. community rating
c. outcomes assessment
d. utilization review
all of the following services are typically reviewed for medical necessity and utilization except:
a. inpatient admissions
b. mental health and chemical dependency care
c. rehabilitative therapies
d. well baby check
Gatekeepers determine the appropriateness of all of the following components except:
a. rate of capitation or reimbursement
b. healthcare service itself
c. level of healthcare personnel
d. setting in the continuum of care
The patient belonged to a managed care plan. Prior approval for the surgery was received. What number should the insurance analyst record?
a. credit score
b. drug enforcement administration
c. precertification
d. social security
The patient belonged to a managed care plan. The patient had an elective surgery. Prior approval for the elective surgery had not been obtained. What should the patient expect?
a. delay in scheduling the post operative visit
b. reduction in future coverage of surgical services
c. denial of reimbursement for the surgery
d. increase in premium for the next enrollment period
For what type of care should the physician practice manager expect to work with a case manager?
a. acute appendicitis
b. pre athletics exam
c. well baby check
d. workers compensation
All of the following are elements of prescription management except:
a. links to electronic banking
b. formulary
c. patient education
d. alerts for interactions
All of the following attributes characterize episode of care reimbursement except:
a. capitation
b. global payment
c. retrospective fee for service
d. aggregation of utilization of health members and chronically ill members
The primary care physician did not meet the MCOs target for counseling cardiac patients about smoking cessation. The primary care physician could expect any of the following results except:
a. bonus
b. exemption from the surplus withholds
c. loss of physician contingency reserve
d. reduction in salary
The patient belongs to a managed care plan. The patient wants to make an appointment with an out of network specialist. The plan has approved the appointment as out of plan. What should the patient expect?
a. the front office of the out of network specialist will delay and obstruct the making of the appointment
b. the patients out of pocket costs for the out of plan appointment will be equal to the out of pocket costs for in plan care because the prior notification was completed.
c. The patient’s out of pocket costs will be increased
d. the patient can permanently transfer his or her care to the out of plan specialist because the initial appointment was approved
What is meant by the phrase “point of service” in “point of service healthcare insurance plan”?
a. charges are captured at the site and time they are incurred.
b. decision making is decentralized to the primary care providers who are empowered to determine the care across the continuum during the encounter
c. computer linkages allow immediate decisions during an encounter regarding approvals or denials across the entire IDS
d. members choose the reimbursement model (HMO, PPO, fee for service)when they need healthcare services rather than during the open enrollment period
What is the term for an MCO that serves Medicare beneficiaries?
a. part A
b. social foundation
c. Medicare advantage
d. exclusive provider organization
In the 1970s, what factors affected the Medicare program?
a. the increase in Medicare expenditures for inpatient hospital care jeopardized Medicare’s ability to fund other health programs
b. deductibles had remained stagnant, generating insufficient income
c. increased incomes of US citizens and concomitantly, their increased payroll deductions paid into the Medicare program assured its financial solvency
d. The clear and succinct cost based reporting requirements generated enthusiasm for the Medicare program in the provider community
Which of the following points is a guideline for the acute hospital prospective payment system?
a. incentive for cost control because hospitals retain profits or suffer losses based on differences between payment rate and actual costs
b. retrospective, charge based payment
c. directly tied to past or current actual charges
d. partial payments with add-ons for severity of illness
What is the average of the sum of the relative weights of all patients treated during a specified time period?
a. case mix index
b. mean qualifier
c. outlier pool
d. share
The MS DRG payment includes reimbursement for all of the following inpatient services except:
a. medications
b. progress notes
c. laboratory tests
d. dressings and other supplies
Select the highest level of the IPPS hierarchy:
a. diagnosis related group
b. major diagnostic category
c. multiple significant trauma
d. surgical section
What is the general term for software that assigns inpatient diagnosis related groups?
a. aligner
b. encoder
c. grouper
d. scrubber
What is Medicare’s term for a facility with a high percentage of low income patients?
a. disproportionate share hospital
b. financial hardship hospital
c. percentage income payment facility
d. underserved facility
What condition does CMS require be me for a facility to receive the indirect medical education adjustment?
a. medical residents in an approved graduate medical education program
b. medical residents and nurses in approved educational programs
c. medical residents, nurses, and allied health personn3el in approved educational programs
d. any type of health personnel in training including the above listed types s well as other types, such as medical social workers, pharmacists, dentists, recreational and music therapists, and child and family development specialists
In MS DRGs what does the case mix index signify?
a. consumption of resources
b. difficulty of treatment
c. prognosis
d. risk or mortality
In the IPPS, what is the term for each hospital’s unique standardized amount based on its costs per Medicare discharge?
a. base payment rate
b. carrier amount
c. cost outlier
d. diagnosis related group
What is the basis of the “labor related share”?
a. cost of living adjustment
b. facilities costs related to payrolls, benefits, and professional fees
c. market basket index
d. disproportionate share percentage
Which of the following is not a provision of the IPPS?
a. disproportionate share hospital adjustment
b. high cost outlier
c. indirect medical education
d. length of stay outlier
Under the IPF IPPS which states are included in the cost of living adjustment (COLA)?
a. Alaska and Hawaii
b. California and Alaska
c. California and Hawaii
d. Hawaii and new York
Medicare inpatient reimbursement levels are based on:
a. charges accumulated during the episode of care
b. CPT codes reported during the encounter
c. MS DRG calculated for the encounter
d. usual and customary charges reported during the encounter
What is the term for an index based on relative differences in the cost of a market basket of goods across bundle
b. cost to charge
c. CPI
All of the following elements are used to calculate a Medicare payment under RBRVS except:
a. work value
b. malpractice expenses
c. extent of the physical exam
d. practice expenses
Which one of the following statements characterized the RBRVS payment system? intent of the RBRVS payment system was to decrease the number of family practitioners
b. ICD-9-CM codes trigger payment in the RBRVS payment system
c. RVUs can easily be rescaled as changes in technology occur
d. RBRVS payment system reflects the skill and resources required for each procedure
Which element of the RVU accounts for the costs of the medical practice, such as office rent, wages of non physician personnel, and supplies and equipment?
a. extent of the physical exam
b. malpractice expenses
c. practice expenses
d. work value
All of the following items are packaged under the Medicare Hospital outpatient prospective payment system (OPPS) except:
a. recovery room
b. supplies, other than pass through
c. anesthesia
d. medical visits
which of the following statements is true about APCs?
a. APCs are based solely on the patient’s principal diagnosis
b. ICD-9-CM procedure codes are used to group patients
c. severity of illness is taken into consideration when grouping APCs
d. APCs are based on the CPT or HCPCS code reported
Medicare certified ASCs must accept assignment, meaning:
a. an ASC can balance bill the patient after Medicare has paid their portion of the bill
b. An ASC can charge a Medicare patient more than other patients
c. An ASC bills the Medicare patient for a 40 percent copayment and any deductible that is required
d. An ASC must accept Medicare payment as payment in full
This PPS has been adopted for use by many third party payers (that is, Medicaid) for reimbursement of outpatient visits. It is not the methodology used by Medicare.
a. ASC (ambulatory surgery centers) groups
b. APGs (ambulatory patient groups)
c. DRGs (Diagnosis related groups
d. APCs (ambulatory payment classifications
Under the OPPS, outpatient services that are similar both clinically and in use of resources are assigned to separate groups called _______.
a. APCs
c. APGs
d. DRGs
e. none of the above
When analyzing a facilities case mix index, a low case mix can indicate what?
a. inaccurate code assignments
b. poor physician documentation
c. more resources required for treatmebnt
d. both A and B
e. all of the above
Under the ambulance fee schedule, the ________ is used to determine the level of service for ground transport.
a. EMS provider skill set used during the transport
b. length of the transport in miles
c. patients medical condition using ICD-9-CM diagnosis code
d. type of transport vehicle
When a patient is pronounced dead prior to an ambulance being called, which of the following payment provisions is followed under the ambulance fee schedule?
a. no payment is made to the ambulance supplier/provider
b. A BLS base rate for ground transport will be paid
c. payment rules are the same as if the patient were alive
d. 50 percent of the payment rate is paid
46Under the ASC list, multiple procedures performed during the same surgical session are reimbursed at which of the following rate?
a. all procedures receive full (100%) payment
b. the procedure in the highest level group receives full payment and the remaining procedures receive half (50%) payment.
c. the procedure in the lowest level group receives full payment and the remaining procedures receive half (50%) payment
d. the procedure in the highest level group receives full payment and the remaining procedures receive one third (33%) payment
Under the SNF PPS wghich one of the following healthcare services is excluded from the consolidated payment?
a. laboratory tests
b. routine cares
c. medications
d. radiation therapty
Which classification system is used to case mix adjust the SNF payment rate?
b. geographic cost index
c. resource utilization groups
d. wage index
What is not a consequence of an outdated charge description master?
a. lost reimbursement
b. claim rejections
c. timely claims reimbursement
d. overpayment
The therapist in the skilled nursing facility is treating multiple patients who are each performing different therapies. How does CMS classify this mode of delivery?
a. concurrent
b. group
c. individual
d. modalitic
In the PAC payment systems, which tool does CMS use to adjust its payment rates to account for geographic variations in costs?
a. national episode amount
b. neutrality adjustor
c. cost reports
d. market basket
In which of the PAC payment systems is the unit of payment the 60 day episode of care?
a. skilled nursing facility
b. long term care hospital
inpatient rehavilitation facility
d. home health agency
Generally, what is the average length of stay of long term care hospitals?
a. more than 15 days
b. more than 25 days
c. more than 30 days
d. more than 60 days
CMS analysts divide SNF admissions into upper and lower categories. Which of the following categories requires the residents admission to be justified on an individual basis?
a. reduced physical function
b. rehabilitation and extensive
c. clinically complex
d. special care
Patients with all the following conditions are appropriate candidates for LTCHs except:
a. acute myocardial infarction
b. chronic tuberculosis
c. sequelae of head trauma
d. vehnilator dependent emphysema
In terms of their composition, hjow tdo the groups of the MS LTC DRGs compare to the groups of the acute care MS DRGs?
a. fewer groups with wider range of conditions in each
b. exactly the same
c. refined with greater specificity
d. none of the above
In terms of grouping and reimbursement how are the MS LTC DRGs and acute care MS DRGs similar?
a. relative weights
b. based on principal diagnosis
c. categorization of low volume groups into quintiles
d. classification of short stay outliers
In the LTCH PPS what is the standard federal rate?
a. constant that converts the MS LTC DRG wight into a payment
b. relative weight based on the market basket of goods
c. geographic wage index
d. adjustment mandated by the benefits improvement and protection act (BIPA) of 2000
In the IRF PPS what 85 item tool collects the data that drives reimbursement?
a. PAI
b. MDS
All of the following elements are part of the IRF PPS except:
a. major diagnostic category
b. impairment group code
c. rehabilitation impairment category
d. patient assessment instrumentf
To meet the definition of an IRF facilities must have an inpatient population with at lease a specified percentage of patients with certain conditions. Which of the following conditions is counted in the definition?
a. brain injury
b. chronic myclogenous leukemia
c. acute myocardial infarction
d. cancer
All of the following types of diagnoses are used in the IRF PPS except:
a. principal
b. admitting
c. etiologic
d. complication or comorbidity
In the IRF PPS what is the tool for data collection that drives payment?
a. medicare provider analysis review
b. inpatient rehabilitation validation and entry
c. activities of daily living
d. patient assessment instrument
What data set provides the underpinning of the HHPPS?
All of the following services are consolidated into a single payment under the HHPPS except:
a. home health aide visits
b. routine and nonroutine medical supplies
c. durable medical equipment
d. nursing and therapy services
All of the following domains are part of the HHPPS case mix except:
a. clinical severity
b. functional status
c. service utilization
d. medical malpractice
Which of the following is the definition of revenue cycle management?
a. the regularly repeating set of events that produces revenue or income
b. the method by which patients are grouped together based on a set of characteristics
c. the systematic comparison of the products services, and outcomes of one organization with those of a similar organization
d. coordination of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue
_____________ are programmable mannequins on which students can practice medical procedures
a. human patient simulators
b. virtual human beings
c. virtual mannequins
d. human mannequins
For what variations in resource consumption does the HHPPS account?
a. type of health personnel, such as nurse versus therapist
b. labor versus non labor
c. number of therapy visits by a therapist
d. all of the above
Which of the following elements is directly adjusted by the local wage index?
a. labor portion
c. national standard episode amount
d. product
In which of the PAC payment systems, is the adjusted rate multiplied by the patient’s number of medicare days to determine the reimbursement amount?
a. skilled nursing facility
b. long term care hospital
c. inpatient rehabilitation facility
d. home health agency
What is the term used in a rehabilitation facility to mean “a patient’s ability to perform activities of daily living”?
a. compliance threshold
b. etiologic diagnosis
c. functional status
d. normalization
All of the following elements are found in a charge description master, except:
a. ICD-9-CM code
b. procedure/service charge
c. HCPCS/CPT code
d. narrative description of procedure/service
The term “hard coding” refers to:
a. CPT codes that are coded by the coders
b. CPT codes that appear in the hospital’s charge master
c. ICD-9-CM codes that are coded by the coders
d. ICD-9-CM codes that appear in the hospital’s charge master
In healthcare settings, the record of the cash the facility will receive for the services it has provided is known as which of the following terms?
a.dollars billed
b. aging of accounts
c. accounts receivable
d. cash balance
Healthcare facilities should think of the collection process as part of the complete billing process and should educate staff to the fact that not all money billed is
a. pending
b. charged
c. reimbursable
d. collected
Aging of accounts is the practice of counting the days, generally in _____ increments, from the time a bill has been sent to the payer to the current day.
a. 7 day
b. 14 day
c. 30 day
d. 90 day
Most facilities begin counting days in accounts receivable at which of the following times?
a. the date the patients registers
b. the date the patient is discharged
c. the date the bill drops
d. the date the bill is received by the payer
The amount of money owed a healthcare facility when calims are pending is called:
a. dollars in accounts receivable
b. bad debt
c. the write off account
d. delayed revenue
The dollar amount the facility actually bills for the services it provides is known as:
a. cost
b. charge
c. reimbursement
d. contractual allowance
The difference between what is charged and what is paid is known as:
a. costs
b. charges
c. reimbursement
d. contractual allowance
What is the name of the notice sent after the provider files a claim that details amounts billed by the provider, amounts approved by medicare, how much medicare paid, and what the patient must pay?
a. EOB
c. MSN
d. ABN
which is not a characteristic of the “old” RCM approach?
a. proactive
b. linear and unidirectional
c. silo mentality
d. front end and back end
which of the following is not a function area of the revenue cycle?
a. volunteer services
b. patient financial services
c. admitting
d. medical record coding
which entity is responsible for processing part A claims and hospital based Part B claims for institutional services on hebalf of medicare?
a. medicare administrative contractor
b. medicare carrier
c. third party paryer
d. claim editor
which of the following is not used to reconcile accounts in the patient accounting department?
a. explanation of benefits
b. medicare code editor
c. remittance advice
d. medicare summary notice
In a typical acute care setting, admitting is located in which revenue cycle area?
a. pre claims submissions.
b. claims processing
c. accounts receivable
d. claims reconciliation/collections
In a typical acute care setting, aging of accounts reports are monitored in which revenue cycle area?
a. pre claims submissions.
b. claims processing
c. accounts receivable
d. claims reconciliation/collections
In a typical acute care setting charge entry is located in which revenue cycle area?
a. pre claims submissions.
b. claims processing
c. accounts receivable
d. claims reconciliation/collections
In a typical acute care setting patient education of payment policies is located in which revenue cycle area?
a. pre claims submissions.
b. claims processing
c. accounts receivable
d. claims reconciliation/collections
In a typical acute care setting the EOB, Medicare summary notice, and remittance advice documents (provided by the payer) are monitored in which revenue cycle area?
a. pre claims submissions.
b. claims processing
c. accounts receivable
d. claims reconciliation/collections
In a typical acute care setting which revenue cycle area uses an internal auditing system (scrubber) to ensure that error free claims (clean claims) are submitted to third party payers
a. pre claims submissions.
b. claims processing
c. accounts receivable
d. claims reconciliation/collections
In the United States, the __________ oversees the safety and efficacy of new medications
a. federal drug administration
b.. food and drug administration
c. federal safety administration
d. none of the above
___________ requires drug companies to pay fees to support the drug review process
a. prescription drug user fees act
b. prescription drug and food act
c. prescription drug understanding and food act
d. none of the above
__________ sees the human body as a collection of molecules and seeks to understand and treat disease in terms of these molecules
a. bioinformatics
b. medical computing
c. biotechnology
d. none of the above
Developing drugs by design requires mapping the structure and creating a three dimensional graphical model of the target molecule. This is called ________ drug design.
a. reasonable
b. rational
c. graphical
d. none of the above
__________ cells are cells that can develop into different types of body cells; theoretically, they can repair the body.
a. stem
b. developmental
c. both A and B
d. none of the above
The ________ Project is an international project seeking to create mathematical models of human organs
a. human model
b. human physical
c. human physiome
d. none of the above
________ (CPOE) can lower prescription errors
a. computerized physician order entry system
b. computer pharmacy order email system
c. computer and physician email system
d. none of the above
Computer warning systems can be used to prevent _______ (ADEs).
a. any deviant event
b. adverse drug events
c. any drug eventuality
d. none of the above
Centralized computerized pharmacies identify medications by their ___________j.
a. color
b. shape
c. density
d. barcode
__________(RFID) tags include an antenna,, a decoder to interpret data, and the tag that includes information. The antenna sends signals. When the tag detects the signal, it sends back information. The tags can be used to keep track of anything including:
a. response frequency identification
b. radio pharmacy identification
c. radio frequency identification
d. none of the above
_____________ involves using a computer, a network connection, and a drug dispensing unit to allow patients to obtain drugs outside of a traditional pharmacy, at for example, a doctor’s office or clinic
a. Telepharmacy
b. phone pharmacy
c. computer pharmacy
d. none of the above
Some medications can currently be delivered on an implanted _________ that is surgically implanted in a patient and releases the drug or drugs.
a. barcode
b. chip
c. both A and B
d. none of the above
________ errors typically occur when a patient changes status – that is, is admitted to, moved within, or released from a hospital
a. medication reconciliation
b. surgical
c. both a and b
d. none of the above
The electronic dental chart is standardized, easy to search, and easy to read. It will include _________.
a. administrative applications
b. the patients conditions
c. treatments
d. all of the above
The fiber-optic camera is analogous to the _________ used in surgery. It is used to view an area that is normally difficult to see.
a. endoscope
b. knife
c. robot
d. none of the above
In dentistry as in other fields, expert systems or __________ (CDSS) can help.
a. clinical decision support systems
b. clinical dentistry support systems
c. computerized dentistry support systems
d. none of the above
Hospitals are beginning to use “electronic informed consent programs.” __________ is used at the VA and at 190 US hospitals
a. iconcent
b emedconsent
c. Imedconsent
d. none of the above
__________ among dentists is rising; for example, some dentists deal with geriatrics, others with diagnostics, and others with cosmetic dentistry
a. the percent of generalists
b. prevention
c. specialization
d.. none of the above
__________ is currently used to diagnose cavities. An electric current is passed through a tooth and the tooth’s resistance is measured. A decayed tooth has a different resistance reading than a healthy tooth
a. electrical conductance
b. current conductance
c. electrical dentistry
d. none of the above
____________invasive dentistry emphasizes prevention and the least possible intervention
a. less
b. minimally
c. maximally
d. none of the above
Teledentristry programs have been developed to help __________
a. fill cavities over the telephone
b. dentists access specialists
c. both A and B
d. none of the above
The ________ Project is a computerized library of human anatomy at the National library of medicine.
a. visible human
b. visible anatomy
c. human anatomy
d. none of the above
A project called the _____________ is digitizing some of the 7,000 human embryos lost in miscarriages, which have been kept by the national museum of Health and medicine of the armed forces institute of pathology since the 1880s.
a. visible embryo project
b. virtual human
c. virtual human embryo
d. none of the above
Program attached to another file which replicates itself and does damage to the host computer
regularly repeating set of events that produces cash flow
revenue cycle
composit measure used to represent physician work, practice expenses, and malpractice fees
relative value unit
assigned weight that reflects the relative resource consumption associated with a payment classification
relative weight
amount of money periodically paid in return for healthcare insurance
determination of reimbursement based on a member’s insurance benefits
outpatient classification system that groups patients by diagnosis and treatment for reimbursement purposes
amount adjusted for location, inflation, case mix, and other factors; unique to each facility
base payment rate
fixed amount paid to provider per patient per set period/time frame
single value that represents the complexity of illness of the organizations patient population
case mix index
provides payment for outpatient drug coverage for an additional premium
medicare part D
process of collecting all services, procedures, and supplies provided during patient care
charge capture
cost sharing measure in which a set amount is paid per service
provides payment for inpatient hospital services
medicare part a
system that enables physicians to enter orders and prescriptions while comparing to external and internal databases for safety
cost sharing measure of an annual amount that must be paid out of pocket before benefits kick in
list of preferred or approved drugs
person ultimately responsible for paying final remainder of bill
Use of an EHR to achieve significant improvement in health services
meaningful use
provision of insurance policy that requires policyholders to pay for a portion of their healthcare
cost sharing
robot used in performing surgeries such as mitral valve repair and prostatectomies
use of charge description master to code repetitive services
hard coding
comprehensive online database of current medical research
database used to house the price list for services provided to patients can be used to automate charge capturing
calculated list of charges, in an office setting generated based on third party payer contracted amounts and used to determine charges
fee schedule

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