The amount of money set aside to cover an expense is called? B. An Accrual
In a physician practice, Pre-service Revenue Cycle consists of: D. All the answers are correct
Intentional misrepresentations that can result in criminal prosecution, civil liability and Ad-
Abuse
ministrative sanctions are known as?
A benefit period is a method Medicare uses to measure inpatient utilization for each Medicare Deductible $1364.00
patient, There is no limit on the number of benefits period. What are the 2019 Deductible, Co-Insurance $341.00
Co-Insurance and Life Time Reserve amounts? Life Time Recovery Days $682.00
In following up on an unpaid claim, simply asking for a status of the claim: Will always result in honest responses
are organizations that are hired by employers to process claims, administer benefits Per
TPA's
the employer's policies and pay claims as they determine them to be reasonable.
Which of the following are true statements? D. All of the answers are correct
EMTALA stands for: Emergency Medical Treatment and Active Labor Act
The automatic assignment of a person to a health insurance plan, typically under Medicaid
C. Auto-enrollment
plans is known as
In a physician practice revenue cycle structure, point of service consists of: Coding and Charge Capture
Patient access has a direct impact on several areas of the healthcare provider organization
D. All of the answers are correct
Including the following:
Doctor services, outpatient care, and some home health care are services covered by . B. Medicare Part B
All of the following codes EXCEPT are frequently used when billing a claim to Medicare
D. All of the Above
on the UB-04.
The CMS 838 is: B. The Medicare quarterly credit balance report
Tricare for Life is: B. Sometimes the primary payer
If a CT scan is ordered for neck pain for a Medicare beneficiary, but Medicare may not cover
A. An ABN
the CT Scan with the diagnosis noted, what form should be signed by the patient?
Missing patient information can lead to incorrectly selecting the correct insurance plan code. A. True
Disclosures made regarding a patient's protected health information without their Authoriza-
A. A violation of the privacy rule (HIPPA)
tion are considered
Physician Oflce statt should provide hospital schedulers with the following: D. All of the answers are correct
Which statement below is NOT true? A. Medicare Part B does not cover self-administered drugs.
The type of bill used to void or cancel a claim is __________________________________________ D. xx8
DRG stands for: Diagnosis Related Group
An ABN (Advanced Beneficiary Notice) should be issued to the patient at the time of: Pre-Service Review
The medical coding and charging for services may be performed manually in a Physician
A. Superbill
practice via a:
Each medical record must contain information that will: D. All of the answers are correct
Failure to submit Medicare credit balance report on a timely basis will result in suspension of
future payments from the Medicare program. When payments are suspended, when will the B. After the delinquent submission is accepted by intermediary
Provider payments be re-instated?
Diagnosis codes serve the purpose of establishing medical necessity, reflecting the acuity of
Providing data for statistical analysis
the illness, and:
1/8
, An organization that accesses a discounted rate for services from a physician, hospital, or
other healthcare provider without direct authorization from the provider (insurance company) A. A silent PPO
is Known as
At least days prior to filing a lien, a letter of intent to file a lien must be sent to the
B. 15
patient and all known possible responsible parties.
A spouse is responsible for debts of their mates if they don't sign the financial guarantee. B. FALSE
To yield optimum positive results the following recommendations should be considered for
A. Ongoing compliance and quality assurance
front end processes:
The practice of acquiring, analyzing, and protecting digital and traditional medical information
HIM - Health Information Management
is known as:
The 2019 Medicare Part B Deductible is: A. 185
Patients with this coverage must have a DMA69 form completed and signed prior to steril-
A. Medicaid
ization procedures.
The timely filing limit for Medicare claims is: A. 1 year
A complete medical record contains: C. All documentation related to the patient's care.
A simply formal name for mechanisms that help people find their way is: B. Wayfinding
The amount of money set aside to cover expenses is called . B. An accrual
D. All of the above
Early HMO's basic models included:
(statt, group, network, direct contract, IRA)
Payments for claims may be delayed if the claim is audited. What are the two types of audits? C. Hospital/ Defense Audits and Insurance Company Audits
The State Health Benefit Plan provides health insurance coverage to: D. State employees, teachers and retirees in Georgia
The complete medical record components are defined by Medicare and Medicaid, the
C. The Joint Commission
Department of Human Resources in the State, and:
The Center for Medicare and Medicaid Services (CMS) developed the National Correct Coding
D. All of the answers are correct
Initiative (CCI) in 1996 to:
TCPA stands for: Telephone Consumer Protection Act
What percentage of denials are traced back to the front end? C. 0.75
is a federal law enacted to address Administrative Simplification and Insurance
C. HIPAA
Reform.
Additional information requests and medical record requests are examples of
B. Soft
denials.
The patient has days from the date of the accident to report the claim to their employer.
With some exceptions, the Statute of Limitations for filing a claim is one year from the date of D. 30 days
injury.
This program covers children under the age of eighteen (18), pregnant women, and aged,
blind and/ or disabled persons who otherwise would not be Medicaid eligible because their Medically Needy Spend-Down
monthly income exceeds the AFDC eligibility standards.
Patient responsibility on accounts may be known as spend down. B. Medicaid
ICD-10-PCS is the International Classification of Diseases and: A. Procedural Coding System
is responsible for auditing, investigating and imposing sanctions when necessary
A. The Oflce of Inspector General
against health care providers.
2/8
In a physician practice, Pre-service Revenue Cycle consists of: D. All the answers are correct
Intentional misrepresentations that can result in criminal prosecution, civil liability and Ad-
Abuse
ministrative sanctions are known as?
A benefit period is a method Medicare uses to measure inpatient utilization for each Medicare Deductible $1364.00
patient, There is no limit on the number of benefits period. What are the 2019 Deductible, Co-Insurance $341.00
Co-Insurance and Life Time Reserve amounts? Life Time Recovery Days $682.00
In following up on an unpaid claim, simply asking for a status of the claim: Will always result in honest responses
are organizations that are hired by employers to process claims, administer benefits Per
TPA's
the employer's policies and pay claims as they determine them to be reasonable.
Which of the following are true statements? D. All of the answers are correct
EMTALA stands for: Emergency Medical Treatment and Active Labor Act
The automatic assignment of a person to a health insurance plan, typically under Medicaid
C. Auto-enrollment
plans is known as
In a physician practice revenue cycle structure, point of service consists of: Coding and Charge Capture
Patient access has a direct impact on several areas of the healthcare provider organization
D. All of the answers are correct
Including the following:
Doctor services, outpatient care, and some home health care are services covered by . B. Medicare Part B
All of the following codes EXCEPT are frequently used when billing a claim to Medicare
D. All of the Above
on the UB-04.
The CMS 838 is: B. The Medicare quarterly credit balance report
Tricare for Life is: B. Sometimes the primary payer
If a CT scan is ordered for neck pain for a Medicare beneficiary, but Medicare may not cover
A. An ABN
the CT Scan with the diagnosis noted, what form should be signed by the patient?
Missing patient information can lead to incorrectly selecting the correct insurance plan code. A. True
Disclosures made regarding a patient's protected health information without their Authoriza-
A. A violation of the privacy rule (HIPPA)
tion are considered
Physician Oflce statt should provide hospital schedulers with the following: D. All of the answers are correct
Which statement below is NOT true? A. Medicare Part B does not cover self-administered drugs.
The type of bill used to void or cancel a claim is __________________________________________ D. xx8
DRG stands for: Diagnosis Related Group
An ABN (Advanced Beneficiary Notice) should be issued to the patient at the time of: Pre-Service Review
The medical coding and charging for services may be performed manually in a Physician
A. Superbill
practice via a:
Each medical record must contain information that will: D. All of the answers are correct
Failure to submit Medicare credit balance report on a timely basis will result in suspension of
future payments from the Medicare program. When payments are suspended, when will the B. After the delinquent submission is accepted by intermediary
Provider payments be re-instated?
Diagnosis codes serve the purpose of establishing medical necessity, reflecting the acuity of
Providing data for statistical analysis
the illness, and:
1/8
, An organization that accesses a discounted rate for services from a physician, hospital, or
other healthcare provider without direct authorization from the provider (insurance company) A. A silent PPO
is Known as
At least days prior to filing a lien, a letter of intent to file a lien must be sent to the
B. 15
patient and all known possible responsible parties.
A spouse is responsible for debts of their mates if they don't sign the financial guarantee. B. FALSE
To yield optimum positive results the following recommendations should be considered for
A. Ongoing compliance and quality assurance
front end processes:
The practice of acquiring, analyzing, and protecting digital and traditional medical information
HIM - Health Information Management
is known as:
The 2019 Medicare Part B Deductible is: A. 185
Patients with this coverage must have a DMA69 form completed and signed prior to steril-
A. Medicaid
ization procedures.
The timely filing limit for Medicare claims is: A. 1 year
A complete medical record contains: C. All documentation related to the patient's care.
A simply formal name for mechanisms that help people find their way is: B. Wayfinding
The amount of money set aside to cover expenses is called . B. An accrual
D. All of the above
Early HMO's basic models included:
(statt, group, network, direct contract, IRA)
Payments for claims may be delayed if the claim is audited. What are the two types of audits? C. Hospital/ Defense Audits and Insurance Company Audits
The State Health Benefit Plan provides health insurance coverage to: D. State employees, teachers and retirees in Georgia
The complete medical record components are defined by Medicare and Medicaid, the
C. The Joint Commission
Department of Human Resources in the State, and:
The Center for Medicare and Medicaid Services (CMS) developed the National Correct Coding
D. All of the answers are correct
Initiative (CCI) in 1996 to:
TCPA stands for: Telephone Consumer Protection Act
What percentage of denials are traced back to the front end? C. 0.75
is a federal law enacted to address Administrative Simplification and Insurance
C. HIPAA
Reform.
Additional information requests and medical record requests are examples of
B. Soft
denials.
The patient has days from the date of the accident to report the claim to their employer.
With some exceptions, the Statute of Limitations for filing a claim is one year from the date of D. 30 days
injury.
This program covers children under the age of eighteen (18), pregnant women, and aged,
blind and/ or disabled persons who otherwise would not be Medicaid eligible because their Medically Needy Spend-Down
monthly income exceeds the AFDC eligibility standards.
Patient responsibility on accounts may be known as spend down. B. Medicaid
ICD-10-PCS is the International Classification of Diseases and: A. Procedural Coding System
is responsible for auditing, investigating and imposing sanctions when necessary
A. The Oflce of Inspector General
against health care providers.
2/8
