AAHAM Full Exam Questions With Verified Answers

A hospital inpatient admit through discharge claim would be what Type of Bill (TOB) on the UB-04? - Answer 111 True/False Average Daily Census is the average number of inpatients maintained in the hospital each day for a specific period of time. - Answer True Which type of claim requires HCPCS/CPT codes? - Answer Outpatient Claims Which of the following is not true of a CAH? -They must maintain no more than 25 inpatient beds that may be used for swing bed services -They may operate a rehabilitation/psychiatric DPU, each with up to 10 beds -They can have an ALOS of 72 hours of less per patient for acute care (excluding swing bed and beds within DPUs) -They must furnish 24/7 emergency care services - Answer They can have an ALOS of 72 hours of less per patient for acute care (excluding swing bed and beds within DPUs) What is the name of the Medicare rule that all diagnostic and clinically related non-diagnostic outpatient services provided within a certain number of days of an inpatient admission must be combined to the inpatient claim when provided by an entity wholly owned or operated by the inpatient hospital? - Answer 3-Day Payment Window Rule The Fair Debt Collection Practices Act (FDCPA) prohibits: - Answer -Harassment or abuse in the collection process -Use of false or misleading information in the collection process -Contacting the consumer before 8:00 a.m. or after 9:00 p.m. HHS - Answer Department of Health and Human Services What are valid conditions preventing a consent form to be completed by the patient? - Answer -Intoxicated -Unconscious -Declared mentally incompetent by the courts Which of the following is not gathered during preregistration or preadmission? -History of chief complaint -Patient demographics -Financial information -Socioeconomic information - Answer History of chief complaint NCDs and LCDs - Answer NCDs are medical review policies issued by CMS to identify specific items, services, procedures or technologies that can be covered and paid for by Medicare. LCDs are policies developed by MACs that specify criteria for services and show under what clinical circumstances an item or service is considered to be reasonable, necessary and appropriate Which of the following is an operating division of HHS? (Select all that apply) -Food and Drug Administration (FDA) -Department of Veterans Affairs (VA) -Administration for Community Living (ACL) -Administration for Children and Families (ACF) -Administration for Health Living for Seniors (AHLS) - Answer -Food and Drug Administration (FDA) -Administration for Community Living (ACL) -Administration for Children and Families (ACF What is the consequence when timely-filing limits are not met when a claim is billed? - Answer The claim is written off, as billing the patient is not allowed Which of the following is not true of coordination of benefits? -Group health plans are always secondary to Medicare -Medicaid is always the payer of last resort except for Indian Health Service -TRICARE is also the payer of last resort except for Medicaid, TRICARE supplements, the Indian Health Service and other programs or plans as identified by the TRICARE Management Activity -Almost all payers are secondary to any liability or property casualty insurance - Answer -Group health plans are always secondary to Medicare An example of a Revenue Code would be: - Answer 0120 - Room and Board True/False The America Hospital Association (AHA) replaced the Patient's Bill of Rights with a plain-language brochure called the Patient Care Partnership. - Answer True True/False Per CMS, an ABN must be retained for three years from discharge or completion of care unless there is another state-specified requirement. - Answer False Self Insured insurance plans are different from commercial plans because: - Answer Premium payments are added into a fund to cover services and pays a third party administrator to administer benefits from the fund instead of purchasing group insurance Which of the following is not true of a discharged bankruptcy? -It released the guarantor/patient from financial responsibility of any and all account balances listed on the bankruptcy petition -The account balance is to be written off to the appropriate transaction code -It covers any patient accounts that occur within six months following the notification -It is usually entered within six months when a Chapter 7 bankruptcy is deemed to have no - Answer -It covers any patient accounts that occur within six months following the notification True/False For professional claims submitted by physicians or other suppliers, the "From" date will determine the date of service for filing claims timely. - Answer True True/False The Truth in Lending Act is also known as Regulation Z. - Answer True Which of the following is not a suggested tip for making collection efforts with internal resources? -Call frequently and have all questions and facts ready -Start with accounts with lower balances and work up to those with high balances -Fax needed documents and then call to ensure they were received -Maintain and review correspondence about denials, delays, disputes, and so on - Answer -Start with accounts with lower balances and work up to those with high balances True/False An MS-DRG payment is the total payment for a case, regardless of actual charges (unless an outlier is paid in certain cases). - Answer False