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