Revenue Cycle Management Final 100% Correct Review Test 2023 Update

Revenue Cycle Management Final 100% Correct Review Test 2023 Update enter an X in both the Medicare and Medicaid boxes of Block 1 - ANS-When completing a CMS-1500 claim for Medicare-Medicaid (Medi-Medi) crossover claims: a. enter an X in both the Medicare and Medicaid boxes of Block 1 b. enter MCD followed by the patient's Medicaid ID number in Block 10b c. enter MEDIGAP in Block 9a d. complete two claims, one each for Medicare and Medicaid E/M services - ANS-Major revisions to CPT made in 1991 resulted in which of the following? a. Category II and III codes b. E/M services c. guidelines d. modifiers preventive service - ANS-Which is designed to help individuals avoid health and injury problems? a. preventive service b. health insurance c. consumer-driven health plan d. medical care delivered to subscribers by individual physicians in the community - ANS-In a direct contract model HMO, contracted health care services are: a. provided to subscribers by physicians employed by the HMO b. provided to subscribers by two or more physician multispecialty group practices c. delivered to subscribers by physicians who remain in their independent office settings d. delivered to subscribers by individual physicians in the community staff model - ANS-Which is a type of HMO where health care services are provided to subscribers by physicians employed by the HMO? a. preferred provider organization (PPO) b. exclusive provider organization (EPO) c. group model d. staff model clearinghouses - ANS-The Electronic Healthcare Network Accreditation Commission (EHNAC) is an organization that accredits: a. participating providers b. clearinghouses c. electronic data interchange d. nonparticipating providers higher out-of-pocket expenses - ANS-Most preferred provider organizations (PPOs) are open-ended plans that allow patients to use non-PPO providers in exchange for: a. higher out-of-pocket expenses b. lower copayments c. higher premiums d. lower deductibles DRGs - ANS-Which system enacted by TEFRA issues a predetermined payment for inpatient services? a. ICD-9-CM b. CPT c. DRGs d. HCPCS level II capitation - ANS-Health care providers accept pre-established payments for providing care to health plan enrollees over a period of time under the reimbursement method of: a. fee-for-service b. Resource-Based Relative Value Scale (RBRVS) c. capitation d. point-of-service case management - ANS-Development of patient care plans for the coordination and provision of care for complicated cases is a part of: a. utilization review b. preadmission certification c. case management d. discharge planning physician incentive plan - ANS-Which requires managed care plans that contract with Medicare or Medicaid to disclose information about physician incentive plans to CMS or state Medicaid agencies before a new or renewed contract receives final approval? a. physician incentive plan b. federally qualified HMO c. Office of Managed Care d. Amendment to the HMO Act protects information collected by consumer reporting agencies such as credit bureaus, medical information companies, and tenant screening services - ANS-The Fair Credit Reporting Act: a. helps consumers resolve billing issues with card issuers and protects important credit rights b. requires credit and charge card issuers to provide certain disclosures in direct mail, telephone, and other applications and solicitations for open-end credit and charge accounts and under other circumstances c. protects information collected by consumer reporting agencies such as credit bureaus, medical information companies, and tenant screening services d. specifies what a collection source may and may not do when pursuing payment of past due accounts facilitates innovation and competition among Medicare HMOs - ANS-The Office of Managed Care is a CMS agency that: a. contracts with and acquires the clinical and business assets of physician practices b. facilitates innovation and competition among Medicare HMOs c. assesses the quality of managed care plans in the United States and releases the data to the public for its consideration when selecting a managed care plan d. ensures the accountability of managed care plans in terms of objective, measurable standards point-of-service plan (POS) - ANS-Which was implemented to create flexibility in managed care plans, which would allow patients to self-refer to out-of-network providers? a. point-of-service plan (POS) b. preferred provider organization (PPO) c. customized sub-capitation plan (CSCP) d. competitive medical plan (CMP) abstract of all recent claims filed on each patient - ANS-The common data file is a(n): a. chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day b. series of fixed-length records submitted to payers to bill for health care services c. computerized permanent record of all financial transactions between the patient and the practice d. abstract of all recent claims filed on each patient QISMC (quality improvement system for managed care) - ANS-Which was established by Medicare to ensure the accountability of managed care plans in terms of objective, measurable standards? a. QAPI (quality assessment and performance improvement program) b. NCQA (national committee for quality assurance) c. EQRO (external quality review organization) d. QISMC (quality improvement system for managed care) open-panel HMO - ANS-A model in which health care is provided by individuals who are not employees of the HMO or who do not belong to a specially formed medical group that serves the HMO is known as a(n): a. staff model HMO b. closed-panel HMO c. group model HMO d. open-panel HMO Continues...