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quiz

Question 1

  1. When a provider receives a fixed amount to provide only the care that an individual needs from the provider, this is known as a _____________ payment.

     

    capitation

     

    fixed

     

    premium

     

    sub-capitation

4 points  

Question 2

  1. The healthcare industry is heavily regulated by ____ and ____ legislation.

     

    city; local

     

    state; city

     

    county; state

     

    federal; state

4 points  

Question 3

  1. When a patient signs a release of medical information at a physician’s office, that release is generally considered to be valid

     

    for six months

     

    for a single visit to the physician

     

    for one year from the date entered on the form

     

    until the patient changes insurance companies

4 points  

Question 4

  1. When the provider is required  to receive as payment in full whatever amount the insurance reimburses for services, the provider is agreeing to

     

    accept assignment

     

    assignment of benefits

     

    authorize services

     

    coordination of benefits

4 points  

Question 5

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

     

    encounter form

     

    patient insurance form

     

    patient ledger

     

    patient registration form

4 points  

Question 6

  1. The person responsible for paying the charges for services rendered by the provider is the

     

    beneficiary

     

    guarantor

     

    guardian

     

    subscriber

4 points  

Question 7

  1. Which federal legislation was enacted in1995 to restrict the referral of patients to organizations in which providers have a financial interest?

     

    Federal Anti-Kickback Law

     

    Hill-Burton Act

     

    HIPAA

     

    Stark II laws

4 points  

Question 8

  1. The recognized difference between fraud and abuse is the

     

    cost

     

    intent

     

    payer

     

    timing

4 points  

Question 9

  1. The specified amount of annual out-of-pocket expenses for covered health care services that the insured must pay annually for health care is called the

     

    coinsurance

     

    copayment

     

    deductible

     

    premium

4 points  

Question 10

  1. Which three components constitute the RBRVS payment system?

     

    fee schedule, practice expense, and malpractice expense

     

    physician work, practice expense, and geographical location

     

    physician work, practice expense, and malpractice insurance espense

     

    practice expense, malpractice insurance expense, and liability insurance expense

4 points  

Question 11

  1. Mandates are

     

    directives

     

    laws

     

    regulations

     

    standards

4 points  

Question 12

  1. Which type of HMO offers subscribers health care services by physicians who remain in their individual office setting?

     

    closed panel

     

    independent practice association

     

    network model

     

    staff model

4 points  

Question 13

  1. HIPAA requires payers to implement rules called electronic __________, which result in a uniform language for electronic data interchange.

     

        data interchanges

     

      health records

     

       medical records

     

        transaction standards

4 points  

Question 14

  1. The ambulatory payment classification prospective payment system is used to reimburse claims for what services?

     

    inpatient

     

    nursing facility

     

    outpatient

     

    rehabilitation

4 points  

Question 15

  1. Breach of confidentiality can result from

     

    discussing patient health care information with unauthorized sources

     

    discussing the patient’s case in the business office

     

    sending medical information to non-health care entities with the patient’s consent

     

    sending patient health care information to the patient’s insurance company

4 points  

Question 16

  1. When a patient elects to receive care from a non-PAR, the patient will accrue _____.

     

    higher copays

     

    higher out-of-pocket expenses

     

    lower premiums

     

    lower copays

4 points  

Question 17

  1. When a number of people are grouped for insurance purposes, this is known as a(n)

     

    adverse selection

     

    insurance pool

     

    member group

     

    risk pool

4 points  

Question 18

  1. Because the diagnosis and procedure codes reported affect the DRG selected (and resultant payment), some hospitals engaged in a practice called __________, which is the assignment of an ICD-10-CM diagnosis code that does not match patient record documentation, for the purpose of illegally increasing reimbursement.

     

        downcoding

     

      jamming

     

       unbundling

     

        upcoding

4 points  

Question 19

  1. The problem-oriented record (POR) is a systematic method of documentation that consists of

     

    a database.

     

    progress notes.

     

    an initial plan.

     

    all of the above.

4 points  

Question 20

  1. Which of the following is an example of fraud?

     

        billing noncovered services as covered services

     

        falsifying certificates of medical necessity plans of treatment

     

        reporting duplicative charges on an insurance claim

     

        submitting claims for services not medically necessary

4 points  

Question 21

  1. Care rendered to a patient that was not properly approved (e.g., preapproved) by the insurance company is known as

     

    medical necessity

     

    noncovered benefits

     

    unapproved services

     

    unauthorized services

4 points  

Question 22

  1. A risk contract is defined as an arrangement among health care providers

     

    stating that the HMO can provide services to Medicare beneficiaries only

     

    that allows higher payments to the HMO if they treat Medicare beneficiaries

     

    to make available capitated health care services to Medicare beneficiaries

     

    to offer fee-for-service health care services to Medicare beneficiaries

4 points  

Question 23

  1. Which of the following is an example of abuse?

     

        billing noncovered services/procedures as covered services/procedures

     

        falsifying health care certificates of medical necessity plans of treatment

     

        misrepresenting ICD-10-CM and CPT/HCPCS codes to justify payment

     

        submitting claims for services and procedures knowingly not provided

4 points  

Question 24

  1. Preventive services

     

    may result in the early detection of health problems.

     

    are required by most insurance companies.

     

    allow treatment options that are less dramatic and less expensive.

     

    both a and c.

4 points  

Question 25

  1. Drew Baker is referred to a health care provider by an employer for treatment of a fracture that occurred during a fall at work. The physician billed Medicare and did not indicate on the claim that the injury was work related. Medicare benefits were paid to the provider for services rendered. This resulted in Medicare contacting the provider, who is liable for the __________ because of the provider’s failure to disclose that the injury was work-related.

     

       adjudication

     

      mediation

     

        overpayment

     

        unbundling

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