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.

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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





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


    Stark II laws

4 points

Question 8

  1. The recognized difference between fraud and abuse is the





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





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





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?


    nursing facility



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.





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.





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