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Question 1

  1. Which statement below was NOT a primary issue that Congress focused on when creating the 1996 legislation known as HIPAA?


      Hospitals own hospital records


    Courts have ruled that patients have no right to own the x-rays or slides


    Physicians own the portion of the hospital record on which they document care


    Patients have right of access to medical records but do not own the original record

5 points  

Question 2

  1. PHI includes information which is created or received by several types of organizations. Which of the following organizations is (are) not one of those that creates PHI?




    Health insurer




    All of the above create PHI

5 points  

Question 3

  1. According to the Department of HHS website, which of the following privacy rule compliance issues are not among those most often investigated?


    Impermissible use and disclosure of PHI


    Lack of patient access to their PHI


    Transferring PHI through electronic means


    Distributing more than the minimal information necessary for the purpose

5 points  

Question 4

  1. How did one court rule in a case that involved a hospital where nurses were permitted to ‘chart by exception’ in postoperative monitoring?


    The court found that the record keeping was incomplete, which inferred negligence


    The court found that the patient was not informed and the hospital was negligent


    The court found that charting by exception was adequate as the practice was common at the hospital and was documented in hospital policies and procedures


    The court found that paper notes kept by the nurse in her pocket were an adequate means of record keeping and communicating with others

5 points  

Question 5

  1. Computerized recordkeeping provides advantages and disadvantages that include


    More standardization of datakeeping


    They assist in the reduction of medical errors


    Computerized systems are costly


    All of the above

5 points  

Question 6

  1. When a provider accepts a pre-established amount to provide services over a period of time, this is known as a method of payment called









5 points  

Question 7

  1. When the provider agrees to accept as payment in full whatever amount the insurance allows or approves, the provider is agreeing to


    accept assignment


    assignment of benefits


    authorize services


    coordination of benefits

5 points  

Question 8

  1. Which document is used to generate the patient’s financial and medical record?


    Encounter form


    Patient insurance card


    Patient ledger


    Patient registration form

5 points  

Question 9

  1. Case law is based on court decisions that establish precedent, and is also called ______ law.









5 points  

Question 10

  1. The recognized difference between fraud and abuse is









5 points  

Question 11

  1. The ICD-9-CM system classifies




    mortality data


    provider services


    supplies and services

5 points  

Question 12

  1. The following is true about Medicare


     It is a two part program with Part A and B and the program includes Parts C and D


    It only consists of Parts A and B


    It is a two part program where Part A pays for doctor’s services


    It consists of Part A only

5 points  

Question 13

  1. The Medicare physician fee schedule amount for code 99213 is $100. The participating provider’s usual charge for this service is $125. Calculate the Medicare reimbursement amount.









5 points  

Question 14

  1. A claim is being adjudicated when &..


    The claim is being transmitted to the payers and clearing hours for processing


    The claim is being sorted into groups based on the payer of the claim


    The claim is denied and is being resubmitted


    The claim is being compared to the payer edits and the patient’s benefits for verification

5 points  

Question 15

  1. The first-listed diagnosis reported on a CMS-1500 claim form is


    used in the outpatient setting


    is determined in accordance with ICD-9-CM’s rules and general coding guidelines


    a and b


    none of the above

5 points  

Question 16

  1. The concept of linking diagnosis codes with procedure/service codes is


    medical matching


    medical necessity


    prospective payment



5 points  

Question 17

  1. Medicare is available to an individual who has worked at least


    5 years in Medicare-covered employment, is at least 65 years old, and is a permanent resident of the United States.


    10 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the United States


    10 years in Medicare-covered employment, is at least 65 years old, and is a citizen or permanent resident of the United States


    25 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the United States

5 points  

Question 18

  1. Which statement below is correct about a managed care contract and gag clause?


    Medicare and many states prohibit managed care contracts from containing gag clauses


    There is federal law that restricts any type of gag clauses in all medical contracts.


    Only HMO’s are allowed to have gag clauses, but the law only covers restricting discussion between a doctor and patient about of surgery’s that the plan does not cover.


    There are no specific laws about if a managed care company may or may not have gag clauses in the contracts between the doctor and the company.

5 points  

Question 19

  1. The government agency that functions as the insuring body to cover workers’ compensation claims is called the


    Office of Federal Employees’ Compensation Act


    Office of Federal Employment Liability Act


    Office of State Insurance Fund.


    Office of Workers’ Compensation Board

5 points  

Question 20

  1. The OWCP administers programs for those injured at work and


    that provide wage replacement benefits


    that provide medical treatment


    that provide vocational rehabilitation


    all of the above


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