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.

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   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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