Billing and Reimbursement Test 1
Questions and Answers
Accountable care organizations - ANSWER-help physicians, hospitals, and other health
care providers work together to improve care for people with Medicare.
The National Committee for Quality Assurance (NCQA) reviews managed care plans
and develops report cards to
__________. - ANSWER-allow health care consumers to make informed decisions
when selecting a plan
Which may specifically result in the early detection of health problems, allowing less
drastic and less expensive
treatment options? - ANSWER-preventive examination
The eHealth exchange is a health information exchange network for - ANSWER-
securely sharing clinical information over the Internet nationwide.
A medical foundation is a nonprofit organization that contracts with and __________ the
clinical and business assets
of physician practices. - ANSWER-acquires
Which uses data from electronic health records (EHR) and health information
technology systems to measure health care quality? - ANSWER-eCQMs
The primary purpose of the patient record is to provide for __________ of care, which
involves documenting patient
care services so that others who treat the patient have a source of information to assist
with additional care and
treatment. - ANSWER-continuity
Which consumer-directed health plan provides tax-exempt accounts offered by
employers to any number of employees; which individuals use to pay health care bills?
The employees contribute funds through a salary reduction agreement and withdraw
funds to pay medical bills. Funds are exempt from both income tax and Social Security
tax(and employers may also contribute). By law, employees forfeit unspent funds at the
end of the year. - ANSWER-flexible spending account
MACRA requires CMS to remove social security numbers (SSNs) from all Medicare
cards by April 2019 and implement a new randomly generated __________ to replace
the SSN-based health insurance claim number on new Medicare cards. - ANSWER-MBI
, Health care services provided to subscribers by physicians employed by the HMO are
associated with a
__________. Premiums and other revenue are paid to the HMO, and usually all
ambulatory services are provided
within HMO corporate buildings. - ANSWER-staff model HMO
Which type of health insurance coverage is subsidized by employers and other
organizations? - ANSWER-group health insurance
POR progress notes are documented for each problem assigned to the patient, using
the SOAP format. When the
patient states, "I have had a stuffy nose and sore throat for about one week," the
provider documents the statement in
the __________ portion of the progress note. - ANSWER-subjective
For Medicare Advantage risk adjustment models, at the individual (enrollee) level,
predicted medical costs can be lower or higher than actual medical costs. At the group
(of enrollees) level, __________. - ANSWER-below-average predicted costs balance
out above-average predicted costs
Total practice management software is used to generate the electronic medical record,
automating which of the
following medical practice functions? - ANSWER-appointment scheduling
The Merit-based Incentive Payment System (MIPS) combines parts of the Physician
Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment
Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one
single program that - ANSWER-allows providers to earn a performance-based payment
adjustment that considers quality, resource use, clinical practice improvement, and
meaningful use of certified EHR technology.
A lifetime maximum amount is the maximum benefits payable to a _________ -
ANSWER-health plan participant
The IMPACT Act - ANSWER-requires the reporting of standardized patient assessment
data on quality measures, resource use, and other measures.
The National Correct Coding Initiative (NCCI) was created to promote national correct
coding
methodologies and to eliminate __________ coding. - ANSWER-improper
Which is associated with health care that is provided in an HMO-owned center or
satellite clinic or by physicians who
belong to a specially formed medical group that serves the HMO? - ANSWER-closed-
panel HMO
Questions and Answers
Accountable care organizations - ANSWER-help physicians, hospitals, and other health
care providers work together to improve care for people with Medicare.
The National Committee for Quality Assurance (NCQA) reviews managed care plans
and develops report cards to
__________. - ANSWER-allow health care consumers to make informed decisions
when selecting a plan
Which may specifically result in the early detection of health problems, allowing less
drastic and less expensive
treatment options? - ANSWER-preventive examination
The eHealth exchange is a health information exchange network for - ANSWER-
securely sharing clinical information over the Internet nationwide.
A medical foundation is a nonprofit organization that contracts with and __________ the
clinical and business assets
of physician practices. - ANSWER-acquires
Which uses data from electronic health records (EHR) and health information
technology systems to measure health care quality? - ANSWER-eCQMs
The primary purpose of the patient record is to provide for __________ of care, which
involves documenting patient
care services so that others who treat the patient have a source of information to assist
with additional care and
treatment. - ANSWER-continuity
Which consumer-directed health plan provides tax-exempt accounts offered by
employers to any number of employees; which individuals use to pay health care bills?
The employees contribute funds through a salary reduction agreement and withdraw
funds to pay medical bills. Funds are exempt from both income tax and Social Security
tax(and employers may also contribute). By law, employees forfeit unspent funds at the
end of the year. - ANSWER-flexible spending account
MACRA requires CMS to remove social security numbers (SSNs) from all Medicare
cards by April 2019 and implement a new randomly generated __________ to replace
the SSN-based health insurance claim number on new Medicare cards. - ANSWER-MBI
, Health care services provided to subscribers by physicians employed by the HMO are
associated with a
__________. Premiums and other revenue are paid to the HMO, and usually all
ambulatory services are provided
within HMO corporate buildings. - ANSWER-staff model HMO
Which type of health insurance coverage is subsidized by employers and other
organizations? - ANSWER-group health insurance
POR progress notes are documented for each problem assigned to the patient, using
the SOAP format. When the
patient states, "I have had a stuffy nose and sore throat for about one week," the
provider documents the statement in
the __________ portion of the progress note. - ANSWER-subjective
For Medicare Advantage risk adjustment models, at the individual (enrollee) level,
predicted medical costs can be lower or higher than actual medical costs. At the group
(of enrollees) level, __________. - ANSWER-below-average predicted costs balance
out above-average predicted costs
Total practice management software is used to generate the electronic medical record,
automating which of the
following medical practice functions? - ANSWER-appointment scheduling
The Merit-based Incentive Payment System (MIPS) combines parts of the Physician
Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment
Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one
single program that - ANSWER-allows providers to earn a performance-based payment
adjustment that considers quality, resource use, clinical practice improvement, and
meaningful use of certified EHR technology.
A lifetime maximum amount is the maximum benefits payable to a _________ -
ANSWER-health plan participant
The IMPACT Act - ANSWER-requires the reporting of standardized patient assessment
data on quality measures, resource use, and other measures.
The National Correct Coding Initiative (NCCI) was created to promote national correct
coding
methodologies and to eliminate __________ coding. - ANSWER-improper
Which is associated with health care that is provided in an HMO-owned center or
satellite clinic or by physicians who
belong to a specially formed medical group that serves the HMO? - ANSWER-closed-
panel HMO
