Quiz

Final Exam

Question 1

Which two activities occur in the Pre-Patient Encounter component of the revenue cycle?

1. Registration and insurance verification

2. Treatment and clinical documentation review

3. Pre-authorization and concurrent utilization management

4. Chargemaster review and medical coding

Question 2

Which code indicates the location a service was performed, such as the Emergency Room, and is attached to charges in the charge description master?

1. Charge code

2. Revenue code

3. CPT code

4. HCPCs code

Question 3

Which statement is true regarding Medical Necessity?

1. A provider is not required to justify services provided to the patient.

2. Preauthorization is a guarantee of payment.

3. The diagnosis may be valid, but the treatment or services are not justified.

4. A provider may order any and all tests or procedures to determine a diagnosis.

Question 4

Which initiative was implemented to promote correct coding and control improper coding the leads to inappropriate payment?

1. HIPAA

2. Correct Claim

3. National Correct Coding

4. Coding Compliance

Question 5

For patients enrolled in both the Medicare and Medicaid programs, services covered by Medicare are paid before Medicaid makes payments because Medicaid is considered to be the _______.

1. Third-party payer

2. Supplemental payer

3. Payer of last resort

4. Secondary payer

Question 6

Which of the following is NOT typically a department participating in the revenue cycle?

1. Material Management

2. Patient Access

3. Administration

4. Health Information Management

Question 7

A patient, staff, or any individual that believe the HIPAA Privacy Rule has been violated can file a complaint with:

1. Office of Civil Rights (OCR)

2. President of the United States

3. Office of the Inspector General (OIG)

4. Department of Public Safety

Question 8

Which is NOT a true statement regarding electronic claims submission?

1. Reduction in overhead costs

2. Faster turnaround on Payments

3. Fewer rejection due to submission of clean claims

4. Complete elimination of paper claims

Question 9

Which revenue cycle activity is responsible for ensuring that documentation is accurate, timely, and supports the care provided?

1. Case management

2. Clinical documentation improvement

3. Discharge planning

4. Utilization management

Question 10

Medicaid, a federally funded program, provides medical care to all of the following EXCEPT?

1. Individuals with a disability status

2. Post-partum women, up to 90 days following delivery

3. People with limited financial resources

4. Low-income individuals

Question 11

Which of the following is NOT a true statement regarding coding system used in the revenue cycle?

1. HCPC codes are used for reporting professional services, procedures, and supplies.

2. ICD-10-CM codes are component of the charge description master.

3. ICD-10-PCS is used primarily for hospital inpatient coding.

4. CPT codes are used in the CDM and for Ambulatory Coding.

Question 12

A patient agrees to allow the third-party payer to pay the healthcare provides directly rather than issue payment to the patient. Which term describes this action?

1. Referral

2. Adjudication

3. Explanation of benefits

4. Assignment of benefits

Question 13

Which data element is NOT a required Uniform Hospital Discharge Data Set component?

1. Race and ethnicity

2. Present on Admission indicator

3. Principal diagnosis

4. Patient’s date of birth

Question 14

Which individual is responsible for responding to inquiries about HIPAA privacy rules?

1. Compliance Offices

2. Health Information Manager

3. Release of Information Specialist

4. Privacy Officer

Question 15

HIPAA laws provide patients with certain rights regarding the use and disclosure of their personal health information (PHI). Which of the following is an exception to PHI use and disclosure?

1. A neighbor’s request for PHI on a patient who has expired

2. An employer’s request for a patient’s PHI information

3. An attorney’s request for PHI information without an authorization

4. Request for PHI disclosure for purposes related to treatment, payment, and operations

Question 16

Which activity occurs in the Patient Encounter component of the revenue Cycle?

1. Third party audits

2. Scheduling

3. Charge capture

4. Claims submission

Question 17

Despite every effort to generate clean claims, denials and rejections occur. Which of the following reasons does not require a formal appeal?

1. Not medically necessary

2. Missing diagnosis code on a claim

3. Cosmetic service not covered

4. Need for additional information

Question 18

A/an______ is a communication between the CDI department or Coder and a provides regarding the completion or clarification of documentation that is necessary for coding and ensures an accurate accounting of intensity of services and severity of illness.

1. Physician query

2. Clinical progress note

3. Incomplete record notice

4. Explanation of benefits

Question 19

The “Discharged, not final billed’’ report (also known as the ‘’discharge, no final bill’’ or the ‘’unbilled’’ report) includes what type of accounts?

1. Accounts that have been discharged but have not been billed

2. Accounts pending due to incomplete record documentation

3. Accounts in the ‘’bill hold’’ waiting period

4. Only accounts that are not yet coded

Question 20

Present on Admission(POA) indicators are assigned to all hospital inpatient diagnoses. The POA indicator is used to identify diagnoses that were present at the time of admission. CMS will pay a higher rate if a diagnosis was present at the time of admission.

Which diagnosis may result in a lower payment from CMS?

1. Catheter-associated urinary tract infection(UTI) noted in the Emergency Room prior to admission

2. Uncontrolled spike in blood sugar during hospitalization

3. Decubitus ulcer discovered during the physical exam at the time of admission

4. Admission with pain and shortness of breath on inspiration following a recent hip replacement

Question 21

A determination is made that a patient scheduled for surgery as a hospital inpatient will need to have the surgery in the Ambulatory Surgery Unit. Which revenue cycle department made this decision?

1. Patient Finance

2. Case Management

3. Patient Access

4. Utilization Management

Question 22

A Patient is being prepared for discharge following a hip replacement surgery. Which revenue cycle department makes the arrangements to transfer the patient to an ambulatory rehab center post discharge?

1. Utilization Management

2. Care/Case Management

3. Quality Management

4. Administration

Question 23

Which reimbursement method predetermines the payment for a particular type of services BEFORE the services is provided to the patient?

1. Fee-for-service

2. Retrospective payment

3. Prospective payment system(PPS)

4. Worker’s compensation

Question 25

What should a Medicare patient be a given before services are provides if those services are not covered by Medicare?

1. Advance beneficiary notice

2. Remittance notice

3. Notice of health information practices

4. Notice of privacy practice

Question 26

When patients have coverage by more than one policy, the _____ensures that benefits paid by all policies do not exceed 100% of charges.

1. Coordination of benefits

2. Remittance advice

3. Explanation of benefits

4. Advance Beneficiary Notice

Question 27

The key field in the charge description master (CDM) is the _______, which is the unique identifier for each charge.

1. ICD-10 code

2. Revenue code

3. Insurance code

4. Charge code

Question 28

Which of the following is NOT a reason to rebill a claim?

1. The policy number is missing on the claim.

2. The wrong diagnosis or procedure code was submitted.

3. Billed services are not covered by the insurer

4. The total charges or number of units do not total properly.

Question 29

Which of the following is NOT true regarding Current Procedural Terminology (CPT)?

1. CPT codes are linked with ICD-10 PCS procedure codes to determine medical necessity.

2. CMS mandates the use of HCPCS (CPT) for reporting Medicare Part B services.

3. The American Medical Association (AMA) publishes an annual update to CPT.

4. CPT is a national standard under HIPAA.

Question 30

Under the HIPAA Privacy Rule, patients have the right to all of the following Except:

1. Refuse to provide proper identification prior to obtaining copies of their records

2. File a complain

3. Request an amendment to their PHI

4. Review their medical records

Question 31

Which is NOT a reason why an insurance carrier may deny a claim and require a formal appeal?

1. Worker’s compensation case

2. Carrier considers the procedure performed to be experimental

3. Diagnosis code missing a character

4. Preexisting condition not covered

Question 32

A claims scrubber is used to identify errors and ensure clean claims are submitted to third-payers. Which revenue cycle department would use the scrubber?

1. Claims Processing

2. Reconciliation and Collections

3. Patient Access

4. Health Information Management

Question 33

Which term describes the insurance carrier’s decision whether or not to pay a claim?

1. Reimbursement

2. Adjudication

3. Denial

4. Audit

Question 34

Which is NOT a required field in the charge description master (CDM)?

1. Revenue code

2. Charges

3. Procedure description

4. Date of services

Question 35

Which two financial strategies do hospitals use to improve their bottom line?

1. Decrease cost, increase patient volume

2. Increase inpatient visits, decrease outpatient visits

3. Eliminate waste, increase the case-mix index

4. Increase revenue, decrease cost

Question 36

Which statement is true about modifiers?

1. The presence of two different ICD-10-CM codes alone justifies adding a modifier.

2. The addition of modifiers to a denied services is not typically a reason for review.

3. The addition of a modifier suffices as support for additional services rendered.

4. Simply adding a modifier when a service is denied is not appropriate.

Question 37

Which of the following is NOT a revenue cycle job title?

1. Coding Specialist

2. Medical Biller

3. Medical Assistant

4. Privacy Officer

Question 38

According to the Department of Health and Human Services, the most frequent privacy complaint is because of:

1. Improper practices around the use and disclosure of PHI

2. Requiring patient authorization for release of information

3. Lack of communication by the provider to family members

4. Releasing only the minimum necessary PHI

Question 39

Which of the following BEST describes revenue cycle management?

1. Management of finance and billing functions

2. Claims management for healthcare services

3. Oversight of health information and coding activities

4. Coordination of a series of healthcare administrative and clinical functions related to the capture, management, and collection of revenue

Question 40

A claim is rejected due to missing diagnoses for the surgical services charges on the claim. Which revenue cycle department will need to review the account?

1. Patient Access/Admission

2. HIM/Coding

3. Administration

4. Patient Accounts

Question 41

Third-party payers impose time limits for submitting claims, inpatient claims for Medicaid patients must be filed within_____days from the date of discharge.

1. 30

2. 95

3. 100

4. 21

Question 42

Which is NOT true regarding documentation in the patient’s medical record?

1. Documentation is important for legal reason.

2. Providers are allowed to randomly document inpatient visits with a patient.

3. Documentation is required to support all charges.

4. Appropriate documentation needs to be available to support every service provided.

Question 43

Which of the following are required elements of an ‘’Accounting of Disclosure’’?

1. Charges for the disclosure, recipient of the disclosure, number of pages disclosed, date of disclosure, and the purpose of the disclosure

2. Recipient of the disclosure, name of individual who disclosed the information, date of disclosure, and the purpose of the disclosure

3. Date of request, date of disclosure, charges for the disclosure, payment method, and number of pages disclosed

4. Date of disclosure, recipient of the PHI, description of information disclosed, and the purpose of the disclosure

Question 44

Which of the following is NOT a requirement of valid authorization to release a patient’s PHI?

1. The description of the purpose of the use or disclosure

2. The authorization presented as a formal, typed document on official letterhead

3. A description of the information to be used or disclosed

4. The patient or patient representative signature and date of signature

Question 45

What term describes the amount of money a patient pays out of pocket prior to insurance payment for health care visit and services?

1. Deductible

2. Fee for service

3. Prospective payment

4. Copay

Question 46

Who has the authority to impose remedial action or administrative sanctions against individuals who consistently fail to comply with Medicare regulations or are deemed abusive to the Medicare program?

1. Attorney General

2. The Joint Commission

3. Office of the Inspector General (OIG)

4. Administrative Law Judge

Question 47

Bad debt accounts are unpaid accounts that the patient owes to the facility for treatment and services. Which of the following is a true statement regarding bad debt accounts?

1. The accounts is pending insurance payment.

2. The account is in collections.

3. The patient is paying monthly installments on the account.

4. The account is determined to be uncollectible.

Question 48

Which of the following is a common patient registration error that impacts the effectiveness of the revenue cycle?

1. Duplicate medical record numbers

2. Missing admission note

3. Incorrect admitting diagnosis

4. Record documentation errors

Question 49

The waiting period or bill hold period following discharge allows providers time to enter charges, make corrections, and enter codes.

1. 5 days for inpatients, 3 days for outpatients

2. 5 days for inpatients, 7 days for outpatients

3. 4 days for inpatients, 7 days for outpatients

4. 7 days for inpatients, 5 days for outpatients

Question 50

Which term describes a statement issued to the insured and the provides by a third-party payer to explain the services provides,

Charges, and amount paid?

1. Advance beneficiary notice

2. Explanation of benefits

3. Invoice

4. Notice of privacy practices

Question 51

Medicare Part A provides coverage for a skilled nursing facility (SNF). Medicare patients are eligible for up to _______ Days of SNF care during a benefit period.

1. 100

2. 21

3. 30

4. 90

Question 52

What is the ‘’Place of Service Code’’ used on the CMA-1500 claim (Form Locator 24B) for a Medicaid patient receiving services in a hospital emergency department?

1. 21

2. 11

3. 23

4. 20

Question 53

Professional _________ provide information that helps individuals stay current with their career and offers opportunities for networking.

1. Associations

2. Certifications

3. Organizations

4. Memberships

Question 54

The UB-04 Hospital Billing Claim has four main sections. Which of the following is NOT one of the sections?

1. Payer information

2. Provider information

3. Patient information

4. Billing information

Question 55

Which HIM function may be perceived by the Chief Financial Officer as the most valuable role in the revenue cycle?

1. Coding

2. Record completion

3. Release of information

4. Medical transcription