,QUESTION: Overall aggregate payments made to a hospice are subject to a computed
“cap amount” calculated by:
A. The Centers for Medicare & Medicaid Services (CMS)
B. The hospice provider
C. The Medicare Administrative Contractor (MAC)
D. The state Medicaid agency
ANSWER: C. The Medicare Administrative Contractor (MAC)
Rationale:
The MAC calculates the hospice aggregate cap at the end of the hospice cap period to ensure
Medicare payments do not exceed statutory limits.
QUESTION: Which of the following is required for participation in Medicaid?
A. Private health insurance
B. Employment status
C. Meeting income and asset requirements
D. Enrollment through a health exchange
ANSWER: C. Meeting income and asset requirements
Rationale:
Medicaid eligibility is based primarily on income and asset thresholds set by federal and state
guidelines.
QUESTION: In choosing a setting for patient financial discussions, organizations should
first and foremost:
A. Minimize staff time
B. Use standardized office locations
C. Respect the patient’s privacy
D. Ensure documentation efficiency
ANSWER: C. Respect the patient’s privacy
,Rationale:
Financial discussions often involve sensitive information and must be conducted in a private,
respectful environment.
QUESTION: A nightly room charge will be incorrect if the patient’s:
A. Diagnosis code is outdated
B. Insurance plan changes mid-stay
C. Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system
D. Physician order is missing
ANSWER: C. Transfer from ICU to the Medical/Surgical floor is not reflected in the registration
system
Rationale:
Room charges are based on the level of care; failure to update patient location leads to incorrect
billing.
QUESTION: The Affordable Care Act legislated the development of Health Insurance
Exchanges, where individuals and small businesses can:
A. Enroll only if uninsured
B. Purchase qualified health benefit plans regardless of health status
C. Obtain employer-sponsored insurance only
D. Apply for Medicaid directly
ANSWER: B. Purchase qualified health benefit plans regardless of health status
Rationale:
The ACA prohibits denial of coverage based on preexisting conditions and allows open access to
qualified plans.
QUESTION: A portion of the accounts receivable inventory which has NOT qualified for
billing includes:
A. Self-pay balances
B. Insurance denials
C. Charitable pledges
D. Pending claims
ANSWER: C. Charitable pledges
, Rationale:
Charitable pledges are not billable claims and therefore are excluded from accounts receivable
eligible for billing.
QUESTION: What is required for the UB-04/837-I, used by Rural Health Clinics to
generate payment from Medicare?
A. Diagnosis-related groups (DRGs)
B. CPT procedure codes only
C. Revenue codes
D. Physician National Provider Identifier (NPI)
ANSWER: C. Revenue codes
Rationale:
Revenue codes are required on the UB-04/837-I to identify the specific services provided and to
generate Medicare payment for institutional claims, including those from Rural Health Clinics.
QUESTION: This directive was developed to promote and ensure healthcare quality and
value and also to protect consumers and workers in the healthcare system. This directive is
called:
A. Affordable Care Act
B. EMTALA
C. Patient Bill of Rights
D. HIPAA
ANSWER: C. Patient Bill of Rights
Rationale:
The Patient Bill of Rights establishes protections related to quality of care, access, privacy, and
fairness for patients and healthcare workers.
QUESTION: The activity which results in the accurate recording of patient bed and level
of care assessment, patient transfer, and patient discharge status on a real-time basis is
known as:
A. Utilization review
B. Registration
C. Case management
D. Charge capture
ANSWER: C. Case management
“cap amount” calculated by:
A. The Centers for Medicare & Medicaid Services (CMS)
B. The hospice provider
C. The Medicare Administrative Contractor (MAC)
D. The state Medicaid agency
ANSWER: C. The Medicare Administrative Contractor (MAC)
Rationale:
The MAC calculates the hospice aggregate cap at the end of the hospice cap period to ensure
Medicare payments do not exceed statutory limits.
QUESTION: Which of the following is required for participation in Medicaid?
A. Private health insurance
B. Employment status
C. Meeting income and asset requirements
D. Enrollment through a health exchange
ANSWER: C. Meeting income and asset requirements
Rationale:
Medicaid eligibility is based primarily on income and asset thresholds set by federal and state
guidelines.
QUESTION: In choosing a setting for patient financial discussions, organizations should
first and foremost:
A. Minimize staff time
B. Use standardized office locations
C. Respect the patient’s privacy
D. Ensure documentation efficiency
ANSWER: C. Respect the patient’s privacy
,Rationale:
Financial discussions often involve sensitive information and must be conducted in a private,
respectful environment.
QUESTION: A nightly room charge will be incorrect if the patient’s:
A. Diagnosis code is outdated
B. Insurance plan changes mid-stay
C. Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system
D. Physician order is missing
ANSWER: C. Transfer from ICU to the Medical/Surgical floor is not reflected in the registration
system
Rationale:
Room charges are based on the level of care; failure to update patient location leads to incorrect
billing.
QUESTION: The Affordable Care Act legislated the development of Health Insurance
Exchanges, where individuals and small businesses can:
A. Enroll only if uninsured
B. Purchase qualified health benefit plans regardless of health status
C. Obtain employer-sponsored insurance only
D. Apply for Medicaid directly
ANSWER: B. Purchase qualified health benefit plans regardless of health status
Rationale:
The ACA prohibits denial of coverage based on preexisting conditions and allows open access to
qualified plans.
QUESTION: A portion of the accounts receivable inventory which has NOT qualified for
billing includes:
A. Self-pay balances
B. Insurance denials
C. Charitable pledges
D. Pending claims
ANSWER: C. Charitable pledges
, Rationale:
Charitable pledges are not billable claims and therefore are excluded from accounts receivable
eligible for billing.
QUESTION: What is required for the UB-04/837-I, used by Rural Health Clinics to
generate payment from Medicare?
A. Diagnosis-related groups (DRGs)
B. CPT procedure codes only
C. Revenue codes
D. Physician National Provider Identifier (NPI)
ANSWER: C. Revenue codes
Rationale:
Revenue codes are required on the UB-04/837-I to identify the specific services provided and to
generate Medicare payment for institutional claims, including those from Rural Health Clinics.
QUESTION: This directive was developed to promote and ensure healthcare quality and
value and also to protect consumers and workers in the healthcare system. This directive is
called:
A. Affordable Care Act
B. EMTALA
C. Patient Bill of Rights
D. HIPAA
ANSWER: C. Patient Bill of Rights
Rationale:
The Patient Bill of Rights establishes protections related to quality of care, access, privacy, and
fairness for patients and healthcare workers.
QUESTION: The activity which results in the accurate recording of patient bed and level
of care assessment, patient transfer, and patient discharge status on a real-time basis is
known as:
A. Utilization review
B. Registration
C. Case management
D. Charge capture
ANSWER: C. Case management
