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HCM 425 Midterm Exam Practice Questions and Answers

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This document contains combined practice questions with correct answers designed to prepare students for the HCM 425 midterm exam. It covers essential health care management topics including medical coding systems (ICD-10-CM, ICD-10-PCS, CPT, and HCPCS), health insurance programs, claims processing, reimbursement systems, and Medicare and Medicaid regulations. The material also reviews electronic health records, utilization management, billing procedures, managed care concepts, and compliance requirements used in modern health care administration.

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HCM 425
Vak
HCM 425

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Hcm 425 Midterm Exam Combined
Practice Questions With Correct
Answers




The Skilled Nursing Facility Prospective Payment System (SNFPPS)
Generates Payments For Each Skilled Nursing Facility Admission --
Answer--Per Diem



In 2000, Which Type Of Health Plan Was Introduced As A Way To
Encourage Individuals To Locate The Best Health Care At The Lowest Price
Possible, With The Goal Of Holding Down Health Care Costs? -- Answer--
Consumer-Driven



The Systematic Method Of Documentation That Consist Of Four
Components (Database, Problem List, Initial Plan, And Progress Notes) Is
Called The: --Answer--Problem Oriented Record



The Primary Purpose Of The Record Is To Provide For ,
Which Involves Documenting Patient Care Services So That Others Who
Treat The Patient Have A Source Of Information To Assist With
Additional Care And Treatment --Answer--Continuity Of Care



Employees And Dependents Who Join A Managed Care Plan Are Called --
Answer--Enrollees

,If A Physician Provides Services That Cost Less Than The Managed Care
Capitation Amount, The Physician Will --Answer--Make A Profit



The Primary Care Provider Is Responsible For --Answer--Supervising And
Coordinating Health Care Services For Enorllees



Which Is The Method Of Controlling Health Care Cost And Quality Of
Care By Reviewing The Appropriateness And Necessity Of Care Provided
To Patients --Answer--Utilization Management



Assigning Passwords To Users Who Are Authorized To Access Patient Is A
Form Of: --Answer--Security



Which Party Signs A Contract With A Health Insurance Company Thus,
Owns The Health Insurance Policy? --Answer--Policy Holder




Which Has As Its Goal Access To Health Care Coverage For Every
Individual, Regardless Of The System Implemented To Achieve That Goal?
--Answer--Universal Health Insurance



The Terms Electronic Health Record (Ehr) And Electronic Medical Record
(EMR) Are Often Used Interchangeably, But The Is
A More Global Concept That Includes The Collection Of Patient
Information Documented By A Number Of Providers At Different Facilities
Regarding One Patient --Answer--Electronic Health Record

,Total Practice Management Software (TPMS) Is Used To Generate The
Emr, Automating Which Of The Following Medical Practice Functions -
-Answer--Patient Registration



If A Veteran Is Rated As 100% Permanently And Totally Disabled As A
Result Of Service-Connected Condition, Which Program Will Provide
Benefits To The Veteran's Dependents? --Answer--Champva



A New Fee Schedule For Medicare Services Was Implemented As Part Of
Obra In 1989 And 1990, Replacing The Regional "Usual And Reasonable"
Payment Basis With A Fixed Fee Schedule Called: -- Answer--Rbrvs




Quality Standards For All Laboratory Testing To Ensure The Accuracy,
Reliability, And Timeliness Of Patient Test Results Regardless Of Where
The Tests Are Performed Were Established Specifically By

Legislation --Answer--Clia



Cms Developed The National Correct Coding Initiative (Ncci) To: --
Answer--Eliminate Improper Coding And Promote National Correct Coding
Methodologies



Which Act Protects Whistleblowers-Individuals Who Make Specified
Disclosures Relating To Funds Covered By The Act> --Answer--Arra



The First Step A Physician Practice Can Take To Identify Areas In The

, Practice That Are Vulnerable To Fraud And Abuse Is To: --Answer--
Perform Periodic Audits To Internally Monitor Billing Processes



An Example Of An Overpayment Is: --Answer--Duplicate Processing Of
Claim




The International Classification Of Diseases, Published By Who Is Used
To Classify Data From Death Certificates --Answer--
Mortality



Icd-10-Cm Was Developed In The Us And Is Used To Classify


Data
From Inpatient And Outpatient Records, Including Provider-Based Office
Records --Answer--Morbidity



Icd-9-Cm Is A(N) Classification System Because Of Icd-10-Cm
And Icd-10-Pcs Implementation --Answer--Legacy



Physician Office Codes Are Submitted For Reimbursement Purposes
--Answer--Icd-10-Cm, Cpt, And Hcpcs Level Ii



General Equivalency Mappings Are Of Codes That Can Be Used To
Roughly Identify Icd-10-Cm Codes For Their Icd-9-Cm Equivalent Codes
(And Vice Versa) --Answer--Crosswalks

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