REVENUE CYCLE MANAGEMENT
MIDTERM QUESTIONS WITH ANSWERS
All of the following are true of state Medicaid programs except:
a. federal funds allocated to each state are based on the average income per person for that state
b. the program must cover infants born to Medicaid-eligible pregnant women
c. states may offer a managed care option
d. services offered to beneficiaries are the same in each state ✔ans d. services offered to beneficiaries
are the same in each state
In states where there is not a mandated fund for workers' compensation which of the following is an
option for employers?
a. use the federal program operated by the Office of Workers' Compensation Programs
b. purchase workers' compensation insurance from a private carrier
c. provide workers' compensation at a cost to the employee
d. do not offer workers' compensation to their employees ✔ans b. purchase workers' compensation
insurance from a private carrier
Which of the following is a service that is excluded from Medicare Part A and Part B, but may be
provided under Part C?
a. inpatient hospitalization
b. physical therapy
c. eye exams including contacts and eyeglasses
d. physician services ✔ans c. eye exams including contacts and eyeglasses
Which of the following statements about retrospective reimbursement is false?
a. reimbursement is based on the actual resources expended to deliver the services
b. total reimbursement amount is determined after the services are provided
c. the fewer services performed the greater the potential for increased total reimbursement
,d. types include fee schedule and per diem ✔ans c. the fewer services performed the greater the
potential for increased total reimbursement
Dr. Jones is a podiatrist who performs over 100 bunionectomies a year. Several of Dr. Jones' patients are
insured by Super Payer. Super Payer reimburses Dr. Jones one amount for the preoperative visit, the
surgery, and routine post-operative follow-up visits. Which reimbursement methodology does Super
Payer uses to reimburse Dr. Jones?
a. fee schedule
b. global payment method
c. case-rate methodology
d. bundled payment methodology ✔ans b. global payment method
Dr. Ward is an endocrinologist who is part of the City Endocrinologist Specialists practice. Super Payer
reimburses City Endocrinologist Specialists $450 per month for each of the 250 beneficiaries assigned to
their care. Which type of reimbursement methodology is Super Payer using to reimburse City
Endocrinologist Specialists?
a. case-rate
b. percent of billed charges
c. capitation
d. global payment method ✔ans c. capitation
Dr. McGee is a primary care physician. Several of Dr. McGee's patients are insured by Super Payer. Super
Payer reimburses Dr. McGee for each service she provides during a clinic visit. Which reimbursement
methodology does Super Payer use to reimburse Dr. McGee?
a. fee schedule
b. global payment method
c. case-rate methodology
d. bundled payment methodology ✔ans a. fee schedule
Dayna is analyst at Community Hospital. She is examining inpatient cases for the payer Super Payer. She
notices that all pneumonia cases have the reimbursement amount of $4,000 and that all CHF cases have
a reimbursement rate of $4,200. The reimbursement is consistent for the entire year. Which
, reimbursement methodology is Super Payer using to reimbursement Community Hospital for inpatient
admissions?
a. fee schedule
b. per diem
c. global payment method
d. case-rate methodology ✔ans d. case-rate methodology
CMS uses this reimbursement methodology when they contract with Medicare Advantage Payers to
care for Medicare beneficiaries under Medicare Part C.
a. capitation
b. per diem
c. percent of billed charges
d. bundled payment method ✔ans a. capitation
The CMS-HCC model uses ____ and _____ to predict the patient's healthcare costs.
a. patient demographic characteristics; health status
b. patient demographics data; past surgeries
c. patient age; health status
d. patient functional status; health status ✔ans a. patient demographic characteristics; health status
In the CMS ACO model, what is attribution?
a. a beneficiary is given a list of applicable ACOs and may choose which one to use
b. a beneficiary is assigned to multiple ACOs
c. a beneficiary is assigned to a particular ACO
d. a beneficiary rejects an ACO for healthcare services ✔ans c. a beneficiary is assigned to a particular
ACO
Giant ACO has agreed to a shared savings rate if 65 percent and a shared loss rate of 40 percent with
CMS. Giant ACO participates in a ____ risk agreement
a. one-sided
MIDTERM QUESTIONS WITH ANSWERS
All of the following are true of state Medicaid programs except:
a. federal funds allocated to each state are based on the average income per person for that state
b. the program must cover infants born to Medicaid-eligible pregnant women
c. states may offer a managed care option
d. services offered to beneficiaries are the same in each state ✔ans d. services offered to beneficiaries
are the same in each state
In states where there is not a mandated fund for workers' compensation which of the following is an
option for employers?
a. use the federal program operated by the Office of Workers' Compensation Programs
b. purchase workers' compensation insurance from a private carrier
c. provide workers' compensation at a cost to the employee
d. do not offer workers' compensation to their employees ✔ans b. purchase workers' compensation
insurance from a private carrier
Which of the following is a service that is excluded from Medicare Part A and Part B, but may be
provided under Part C?
a. inpatient hospitalization
b. physical therapy
c. eye exams including contacts and eyeglasses
d. physician services ✔ans c. eye exams including contacts and eyeglasses
Which of the following statements about retrospective reimbursement is false?
a. reimbursement is based on the actual resources expended to deliver the services
b. total reimbursement amount is determined after the services are provided
c. the fewer services performed the greater the potential for increased total reimbursement
,d. types include fee schedule and per diem ✔ans c. the fewer services performed the greater the
potential for increased total reimbursement
Dr. Jones is a podiatrist who performs over 100 bunionectomies a year. Several of Dr. Jones' patients are
insured by Super Payer. Super Payer reimburses Dr. Jones one amount for the preoperative visit, the
surgery, and routine post-operative follow-up visits. Which reimbursement methodology does Super
Payer uses to reimburse Dr. Jones?
a. fee schedule
b. global payment method
c. case-rate methodology
d. bundled payment methodology ✔ans b. global payment method
Dr. Ward is an endocrinologist who is part of the City Endocrinologist Specialists practice. Super Payer
reimburses City Endocrinologist Specialists $450 per month for each of the 250 beneficiaries assigned to
their care. Which type of reimbursement methodology is Super Payer using to reimburse City
Endocrinologist Specialists?
a. case-rate
b. percent of billed charges
c. capitation
d. global payment method ✔ans c. capitation
Dr. McGee is a primary care physician. Several of Dr. McGee's patients are insured by Super Payer. Super
Payer reimburses Dr. McGee for each service she provides during a clinic visit. Which reimbursement
methodology does Super Payer use to reimburse Dr. McGee?
a. fee schedule
b. global payment method
c. case-rate methodology
d. bundled payment methodology ✔ans a. fee schedule
Dayna is analyst at Community Hospital. She is examining inpatient cases for the payer Super Payer. She
notices that all pneumonia cases have the reimbursement amount of $4,000 and that all CHF cases have
a reimbursement rate of $4,200. The reimbursement is consistent for the entire year. Which
, reimbursement methodology is Super Payer using to reimbursement Community Hospital for inpatient
admissions?
a. fee schedule
b. per diem
c. global payment method
d. case-rate methodology ✔ans d. case-rate methodology
CMS uses this reimbursement methodology when they contract with Medicare Advantage Payers to
care for Medicare beneficiaries under Medicare Part C.
a. capitation
b. per diem
c. percent of billed charges
d. bundled payment method ✔ans a. capitation
The CMS-HCC model uses ____ and _____ to predict the patient's healthcare costs.
a. patient demographic characteristics; health status
b. patient demographics data; past surgeries
c. patient age; health status
d. patient functional status; health status ✔ans a. patient demographic characteristics; health status
In the CMS ACO model, what is attribution?
a. a beneficiary is given a list of applicable ACOs and may choose which one to use
b. a beneficiary is assigned to multiple ACOs
c. a beneficiary is assigned to a particular ACO
d. a beneficiary rejects an ACO for healthcare services ✔ans c. a beneficiary is assigned to a particular
ACO
Giant ACO has agreed to a shared savings rate if 65 percent and a shared loss rate of 40 percent with
CMS. Giant ACO participates in a ____ risk agreement
a. one-sided
