Revenue Cycle Management: Questions With Proven
Solutions
In which issue of the Federal Register are updates to Medicare outpatient
reimbursement NOT published? Correct Ans - October
Medicare part _____ is a prescription drug benefit. Correct Ans - Part D
_____ assignment is when a provider does not bill a patient for the difference
between the service cost and Medicare allowed. Correct Ans - Accepting
Which of the following would be considered a discount that would be
permitted as a "safe harbor" from fraud and abuse regulations? Correct
Ans - HMO contracts with laboratory for laboratory services and receives a
discounted price.
Which is not a component that is taken into account with a Relative Value Unit
(RVU)? Correct Ans - work, malpractice and overhead (all are listed
components)
Which group does the Medicare program not cover? Correct Ans -
Prisoners
Healthcare is more heavily regulated than most other businesses in the United
States. Correct Ans - True
Which type of health insurance plan uses primary care clinician gatekeepers
to coordinate the care of plan participants? Correct Ans - HMO
Which type of healthcare reimbursement system pays a fixed amount per
patient? Correct Ans - Capitation
A legal document required in most states for expanding a hospital is
Correct Ans - Certificate of Need
A small, closely held corporation is owned by Correct Ans - private
investors
,The responsibility of medical services at most hospitals lies with Correct
Ans - The chief of staff or medical director
Home healthcare services___ Correct Ans - are eligible for Medicare and
Medicare reimbursement
Hospice care___ Correct Ans - is for patients and their families.
Nursing home costs for elderly Americans___ Correct Ans - are most
covered by Medicaid
The emergency department of a hospital is Correct Ans - an out-patient
facility
A not-for-profit hospital must Correct Ans - adopt a corporate structure
Ambulatory care refers to services provided by paramedics and emergency
medical technologists while transporting a patient to the hospital. Correct
Ans - False
Most proprietorship's form professional corporations in order to Correct
Ans - reduce financial liabilities
Which of the following financial management issues differentiates healthcare
from other businesses? Correct Ans - third party payers
Which of the following provides hospitalization insurance? Correct Ans -
Blue Cross
An individual works at a business that covers half the cost of a group
healthcare insurance plan with the other half paid by the employee. The
individual quits his job but wishes to retain group healthcare insurance as per
COBRA. How much will he pay for coverage? Correct Ans - Twice the
amount he paid while employed plus an administrative fee
Prescription drugs for the elderly are covered under Correct Ans - MMA
(2003)
, The following is true about a preferred provider organization plans and
explain their limited ability to control healthcare costs. Correct Ans - A
PPO plan is a form of managed care in which the insurer contracts with
healthcare providers that agree to a reduced cost fee schedule. and Covered
persons who use a PPO pay less through combination of lower premiums.
lower deductibles, and smaller co-payments. A PPO plan is a fee-for-service
and providers have no incentives for reducing services.
Premiums payments from Medicare recipients cover what portions of
Medicare's prescription drug benefits? Correct Ans - 10%
Healthcare providers who participate in a capitated payment type of health
maintenance organization Correct Ans - get paid a per member per
month rate
Medicare beneficiary premiums cover only one-fourth of Medicare Part B
costs. Correct Ans - True
A self employed person who earns $100K must pay a Medicare payroll tax of
$______. Correct Ans - $2900 (or 2.9%)
Individuals covered by a high deductible health plan within a preferred
provider organization use fewer outpatient services and shop around for
lower cost outpatient services because they Correct Ans - pay directly
for routine care.
What type of healthcare insurance coverage is most common in America?
Correct Ans - private insurance from employer
Usual, customary and Reasonable fees are Correct Ans - based on
surveys conducted by insurance companies
Americans without healthcare insurance (private or government) Correct
Ans - pay directly for routine medical care
TRICARE Insurance is a private company contracted by the federal
government to provide healthcare insurance to members for the members of
the armed forces. Correct Ans - False
Solutions
In which issue of the Federal Register are updates to Medicare outpatient
reimbursement NOT published? Correct Ans - October
Medicare part _____ is a prescription drug benefit. Correct Ans - Part D
_____ assignment is when a provider does not bill a patient for the difference
between the service cost and Medicare allowed. Correct Ans - Accepting
Which of the following would be considered a discount that would be
permitted as a "safe harbor" from fraud and abuse regulations? Correct
Ans - HMO contracts with laboratory for laboratory services and receives a
discounted price.
Which is not a component that is taken into account with a Relative Value Unit
(RVU)? Correct Ans - work, malpractice and overhead (all are listed
components)
Which group does the Medicare program not cover? Correct Ans -
Prisoners
Healthcare is more heavily regulated than most other businesses in the United
States. Correct Ans - True
Which type of health insurance plan uses primary care clinician gatekeepers
to coordinate the care of plan participants? Correct Ans - HMO
Which type of healthcare reimbursement system pays a fixed amount per
patient? Correct Ans - Capitation
A legal document required in most states for expanding a hospital is
Correct Ans - Certificate of Need
A small, closely held corporation is owned by Correct Ans - private
investors
,The responsibility of medical services at most hospitals lies with Correct
Ans - The chief of staff or medical director
Home healthcare services___ Correct Ans - are eligible for Medicare and
Medicare reimbursement
Hospice care___ Correct Ans - is for patients and their families.
Nursing home costs for elderly Americans___ Correct Ans - are most
covered by Medicaid
The emergency department of a hospital is Correct Ans - an out-patient
facility
A not-for-profit hospital must Correct Ans - adopt a corporate structure
Ambulatory care refers to services provided by paramedics and emergency
medical technologists while transporting a patient to the hospital. Correct
Ans - False
Most proprietorship's form professional corporations in order to Correct
Ans - reduce financial liabilities
Which of the following financial management issues differentiates healthcare
from other businesses? Correct Ans - third party payers
Which of the following provides hospitalization insurance? Correct Ans -
Blue Cross
An individual works at a business that covers half the cost of a group
healthcare insurance plan with the other half paid by the employee. The
individual quits his job but wishes to retain group healthcare insurance as per
COBRA. How much will he pay for coverage? Correct Ans - Twice the
amount he paid while employed plus an administrative fee
Prescription drugs for the elderly are covered under Correct Ans - MMA
(2003)
, The following is true about a preferred provider organization plans and
explain their limited ability to control healthcare costs. Correct Ans - A
PPO plan is a form of managed care in which the insurer contracts with
healthcare providers that agree to a reduced cost fee schedule. and Covered
persons who use a PPO pay less through combination of lower premiums.
lower deductibles, and smaller co-payments. A PPO plan is a fee-for-service
and providers have no incentives for reducing services.
Premiums payments from Medicare recipients cover what portions of
Medicare's prescription drug benefits? Correct Ans - 10%
Healthcare providers who participate in a capitated payment type of health
maintenance organization Correct Ans - get paid a per member per
month rate
Medicare beneficiary premiums cover only one-fourth of Medicare Part B
costs. Correct Ans - True
A self employed person who earns $100K must pay a Medicare payroll tax of
$______. Correct Ans - $2900 (or 2.9%)
Individuals covered by a high deductible health plan within a preferred
provider organization use fewer outpatient services and shop around for
lower cost outpatient services because they Correct Ans - pay directly
for routine care.
What type of healthcare insurance coverage is most common in America?
Correct Ans - private insurance from employer
Usual, customary and Reasonable fees are Correct Ans - based on
surveys conducted by insurance companies
Americans without healthcare insurance (private or government) Correct
Ans - pay directly for routine medical care
TRICARE Insurance is a private company contracted by the federal
government to provide healthcare insurance to members for the members of
the armed forces. Correct Ans - False
