module 06
Final Exam
Question 1
Which two activities occur in the Pre-Patient Encounter component of the revenue cycle?
Registration and insurance verification
Treatment and clinical documentation review
Pre-authorization and concurrent utilization management
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?
Charge code
Revenue code
CPT code
HCPCs code
Question 3
Which statement is true regarding Medical Necessity?
A provider is not required to justify services provided to the patient.
Preauthorization is a guarantee of payment.
The diagnosis may be valid, but the treatment or services are not justified.
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?
HIPAA
Correct Claim
National Correct Coding
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 _______.
Third-party payer
Supplemental payer
Payer of last resort
Secondary payer
Question 6
Which of the following is NOT typically a department participating in the revenue cycle?
Material Management
Patient Access
Administration
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:
Office of Civil Rights (OCR)
President of the United States
Office of the Inspector General (OIG)
Department of Public Safety
Question 8
Which is NOT a true statement regarding electronic claims submission?
Reduction in overhead costs
Faster turnaround on Payments
Fewer rejection due to submission of clean claims
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?
Case management
Clinical documentation improvement
Discharge planning
Utilization management
Question 10
Medicaid, a federally funded program, provides medical care to all of the following EXCEPT?
Individuals with a disability status
Post-partum women, up to 90 days following delivery
People with limited financial resources
Low-income individuals
Question 11
Which of the following is NOT a true statement regarding coding system used in the revenue cycle?
HCPC codes are used for reporting professional services, procedures, and supplies.
ICD-10-CM codes are component of the charge description master.
ICD-10-PCS is used primarily for hospital inpatient coding.
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?
Referral
Adjudication
Explanation of benefits
Assignment of benefits
Question 13
Which data element is NOT a required Uniform Hospital Discharge Data Set component?
Race and ethnicity
Present on Admission indicator
Principal diagnosis
Patient’s date of birth
Question 14
Which individual is responsible for responding to inquiries about HIPAA privacy rules?
Compliance Offices
Health Information Manager
Release of Information Specialist
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?
A neighbor’s request for PHI on a patient who has expired
An employer’s request for a patient’s PHI information
An attorney’s request for PHI information without an authorization
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?
Third party audits
Scheduling
Charge capture
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?
Not medically necessary
Missing diagnosis code on a claim
Cosmetic service not covered
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.
Physician query
Clinical progress note
Incomplete record notice
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?
Accounts that have been discharged but have not been billed
Accounts pending due to incomplete record documentation
Accounts in the ‘’bill hold’’ waiting period
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?
Catheter-associated urinary tract infection(UTI) noted in the Emergency Room prior to admission
Uncontrolled spike in blood sugar during hospitalization
Decubitus ulcer discovered during the physical exam at the time of admission
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?
Patient Finance
Case Management
Patient Access
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?
Utilization Management
Care/Case Management
Quality Management
Administration
Question 23
Which reimbursement method predetermines the payment for a particular type of services BEFORE the services is provided to the patient?
Fee-for-service
Retrospective payment
Prospective payment system(PPS)
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?
Advance beneficiary notice
Remittance notice
Notice of health information practices
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.
Coordination of benefits
Remittance advice
Explanation of benefits
Advance Beneficiary Notice
Question 27
The key field in the charge description master (CDM) is the _______, which is the unique identifier for each charge.
ICD-10 code
Revenue code
Insurance code
Charge code
Question 28
Which of the following is NOT a reason to rebill a claim?
The policy number is missing on the claim.
The wrong diagnosis or procedure code was submitted.
Billed services are not covered by the insurer
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)?
CPT codes are linked with ICD-10 PCS procedure codes to determine medical necessity.
CMS mandates the use of HCPCS (CPT) for reporting Medicare Part B services.
The American Medical Association (AMA) publishes an annual update to CPT.
CPT is a national standard under HIPAA.
Question 30
Under the HIPAA Privacy Rule, patients have the right to all of the following Except:
Refuse to provide proper identification prior to obtaining copies of their records
File a complain
Request an amendment to their PHI
Review their medical records
Question 31
Which is NOT a reason why an insurance carrier may deny a claim and require a formal appeal?
Worker’s compensation case
Carrier considers the procedure performed to be experimental
Diagnosis code missing a character
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?
Claims Processing
Reconciliation and Collections
Patient Access
Health Information Management
Question 33
Which term describes the insurance carrier’s decision whether or not to pay a claim?
Reimbursement
Adjudication
Denial
Audit
Question 34
Which is NOT a required field in the charge description master (CDM)?
Revenue code
Charges
Procedure description
Date of services
Question 35
Which two financial strategies do hospitals use to improve their bottom line?
Decrease cost, increase patient volume
Increase inpatient visits, decrease outpatient visits
Eliminate waste, increase the case-mix index
Increase revenue, decrease cost
Question 36
Which statement is true about modifiers?
The presence of two different ICD-10-CM codes alone justifies adding a modifier.
The addition of modifiers to a denied services is not typically a reason for review.
The addition of a modifier suffices as support for additional services rendered.
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?
Coding Specialist
Medical Biller
Medical Assistant
Privacy Officer
Question 38
According to the Department of Health and Human Services, the most frequent privacy complaint is because of:
Improper practices around the use and disclosure of PHI
Requiring patient authorization for release of information
Lack of communication by the provider to family members
Releasing only the minimum necessary PHI
Question 39
Which of the following BEST describes revenue cycle management?
Management of finance and billing functions
Claims management for healthcare services
Oversight of health information and coding activities
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?
Patient Access/Admission
HIM/Coding
Administration
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.
30
95
100
21
Question 42
Which is NOT true regarding documentation in the patient’s medical record?
Documentation is important for legal reason.
Providers are allowed to randomly document inpatient visits with a patient.
Documentation is required to support all charges.
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’’?
Charges for the disclosure, recipient of the disclosure, number of pages disclosed, date of disclosure, and the purpose of the disclosure
Recipient of the disclosure, name of individual who disclosed the information, date of disclosure, and the purpose of the disclosure
Date of request, date of disclosure, charges for the disclosure, payment method, and number of pages disclosed
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?
The description of the purpose of the use or disclosure
The authorization presented as a formal, typed document on official letterhead
A description of the information to be used or disclosed
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?
Deductible
Fee for service
Prospective payment
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?
Attorney General
The Joint Commission
Office of the Inspector General (OIG)
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?
The accounts is pending insurance payment.
The account is in collections.
The patient is paying monthly installments on the account.
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?
Duplicate medical record numbers
Missing admission note
Incorrect admitting diagnosis
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.
5 days for inpatients, 3 days for outpatients
5 days for inpatients, 7 days for outpatients
4 days for inpatients, 7 days for outpatients
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?
Advance beneficiary notice
Explanation of benefits
Invoice
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.
100
21
30
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?
21
11
23
20
Question 53
Professional _________ provide information that helps individuals stay current with their career and offers opportunities for networking.
Associations
Certifications
Organizations
Memberships
Question 54
The UB-04 Hospital Billing Claim has four main sections. Which of the following is NOT one of the sections?
Payer information
Provider information
Patient information
Billing information
Question 55
Which HIM function may be perceived by the Chief Financial Officer as the most valuable role in the revenue cycle?
Coding
Record completion
Release of information
Medical transcription