Mindtap Cengage UPDATED ACTUAL
Exam Questions and CORRECT Answers
Which entity processes health information from another entity into a standard format?
a. Local Medical Review Board
b. Third-Party Payer
c. Clearinghouse
d. Third-Party Administrator - CORRECT ANSWER - c. Clearinghouse
Which procedure coding system was developed by the American Medical Association (AMA)?
a. CPT
b. DSM
c. HCPCS
d. ICD - CORRECT ANSWER - a. CPT
Which type of insurance replaces 40 to 60 percent of an individual's gross income if an illness
prevents the individual from earning an income?
a. Workers' Compensation
b. Employer-Based Group Health Insurance
c. Indemnity Plan
d. Disability Insurance - CORRECT ANSWER - d. Disability Insurance
Interdisciplinary guidelines developed by hospitals to manage the delivery of care in a time of
constrained resources are called ________.
a. diagnosis-related groups (DRGs)
b. critical pathways
c. case mix
d. severity of illness systems - CORRECT ANSWER - b. critical pathways
, The UB-04 claim is also known as which of the following?
a. CMS-1500
b. UB-55
c. CMS-1450
d. Encounter Form - CORRECT ANSWER - c. CMS-1450
The computer-to-computer transfer of data between providers and payers in an approved format
is called ________.
a. electronic data interchange
b. billing
c. claims submission
d. administrative simplification - CORRECT ANSWER - a. electronic data interchange
Which federal agency employs a four-part strategy to deter fraud and abuse?
a. False Claims Act
b. Centers for Medicare and Medicaid Services
c. HIPAA
d. Payment Error Prevention Program - CORRECT ANSWER - b. Centers for Medicare and
Medicaid Services
Which initiative was introduced to reduce Medicare spending by detecting inappropriate coding
on claims?
a. PEPP
b. Physicians at Teaching Hospitals Initiative (PATH)
c. Correct Coding Initiative (CCI)
d. Compliance Guidelines - CORRECT ANSWER - c. Correct Coding Initiative (CCI)
Who processes claims for reimbursement covered by a health care plan?
a. Clearinghouse
Exam Questions and CORRECT Answers
Which entity processes health information from another entity into a standard format?
a. Local Medical Review Board
b. Third-Party Payer
c. Clearinghouse
d. Third-Party Administrator - CORRECT ANSWER - c. Clearinghouse
Which procedure coding system was developed by the American Medical Association (AMA)?
a. CPT
b. DSM
c. HCPCS
d. ICD - CORRECT ANSWER - a. CPT
Which type of insurance replaces 40 to 60 percent of an individual's gross income if an illness
prevents the individual from earning an income?
a. Workers' Compensation
b. Employer-Based Group Health Insurance
c. Indemnity Plan
d. Disability Insurance - CORRECT ANSWER - d. Disability Insurance
Interdisciplinary guidelines developed by hospitals to manage the delivery of care in a time of
constrained resources are called ________.
a. diagnosis-related groups (DRGs)
b. critical pathways
c. case mix
d. severity of illness systems - CORRECT ANSWER - b. critical pathways
, The UB-04 claim is also known as which of the following?
a. CMS-1500
b. UB-55
c. CMS-1450
d. Encounter Form - CORRECT ANSWER - c. CMS-1450
The computer-to-computer transfer of data between providers and payers in an approved format
is called ________.
a. electronic data interchange
b. billing
c. claims submission
d. administrative simplification - CORRECT ANSWER - a. electronic data interchange
Which federal agency employs a four-part strategy to deter fraud and abuse?
a. False Claims Act
b. Centers for Medicare and Medicaid Services
c. HIPAA
d. Payment Error Prevention Program - CORRECT ANSWER - b. Centers for Medicare and
Medicaid Services
Which initiative was introduced to reduce Medicare spending by detecting inappropriate coding
on claims?
a. PEPP
b. Physicians at Teaching Hospitals Initiative (PATH)
c. Correct Coding Initiative (CCI)
d. Compliance Guidelines - CORRECT ANSWER - c. Correct Coding Initiative (CCI)
Who processes claims for reimbursement covered by a health care plan?
a. Clearinghouse
