Revenue Cycle Management Final with the
solutions (2023)
When completing a CMS-1500 claim for Medicare-Medicaid (Medi-Medi) crossover
claims:
a. enter an X in both the Medicare and Medicaid boxes of Block 1
b. enter MCD followed by the patient's Medicaid ID number in Block 10b
c. enter MEDIGAP in Block 9a
d. complete two claims, one each for Medicare and Medicaid -ANSW- enter an X in
both the Medicare and Medicaid boxes of Block 1
Major revisions to CPT made in 1991 resulted in which of the following?
a. Category II and III codes
b. E/M services
c. guidelines
d. modifiers -ANSW- E/M services
Which is designed to help individuals avoid health and injury problems?
a. preventive service
b. health insurance
c. consumer-driven health plan
d. medical care -ANSW- preventive service
In a direct contract model HMO, contracted health care services are:
a. provided to subscribers by physicians employed by the HMO
b. provided to subscribers by two or more physician multispecialty group practices
c. delivered to subscribers by physicians who remain in their independent office
settings
d. delivered to subscribers by individual physicians in the community -ANSW-
delivered to subscribers by individual physicians in the community
Which is a type of HMO where health care services are provided to subscribers by
physicians employed by the HMO?
a. preferred provider organization (PPO)
b. exclusive provider organization (EPO)
c. group model
d. staff model -ANSW- staff model
The Electronic Healthcare Network Accreditation Commission (EHNAC) is an
organization that accredits:
a. participating providers
,b. clearinghouses
c. electronic data interchange
d. nonparticipating providers -ANSW- clearinghouses
Most preferred provider organizations (PPOs) are open-ended plans that allow patients
to use non-PPO providers in exchange for:
a. higher out-of-pocket expenses
b. lower copayments
c. higher premiums
d. lower deductibles -ANSW- higher out-of-pocket expenses
Which system enacted by TEFRA issues a predetermined payment for inpatient
services?
a. ICD-9-CM
b. CPT
c. DRGs
d. HCPCS level II -ANSW- DRGs
Health care providers accept pre-established payments for providing care to health plan
enrollees over a period of time under the reimbursement method of:
a. fee-for-service
b. Resource-Based Relative Value Scale (RBRVS)
c. capitation
d. point-of-service -ANSW- capitation
Development of patient care plans for the coordination and provision of care for
complicated cases is a part of:
a. utilization review
b. preadmission certification
c. case management
d. discharge planning -ANSW- case management
Which requires managed care plans that contract with Medicare or Medicaid to disclose
information about physician incentive plans to CMS or state Medicaid agencies before a
new or renewed contract receives final approval?
a. physician incentive plan
b. federally qualified HMO
c. Office of Managed Care
d. Amendment to the HMO Act -ANSW- physician incentive plan
The Fair Credit Reporting Act:
a. helps consumers resolve billing issues with card issuers and protects important
credit rights
b. requires credit and charge card issuers to provide certain disclosures in direct mail,
telephone, and other applications and solicitations for open-end credit and charge
accounts and under other circumstances
, c. protects information collected by consumer reporting agencies such as credit
bureaus, medical information companies, and tenant screening services
d. specifies what a collection source may and may not do when pursuing payment of
past due accounts -ANSW- protects information collected by consumer reporting
agencies such as credit bureaus, medical information companies, and tenant screening
services
The Office of Managed Care is a CMS agency that:
a. contracts with and acquires the clinical and business assets of physician practices
b. facilitates innovation and competition among Medicare HMOs
c. assesses the quality of managed care plans in the United States and releases the
data to the public for its consideration when selecting a managed care plan
d. ensures the accountability of managed care plans in terms of objective, measurable
standards -ANSW- facilitates innovation and competition among Medicare HMOs
Which was implemented to create flexibility in managed care plans, which would allow
patients to self-refer to out-of-network providers?
a. point-of-service plan (POS)
b. preferred provider organization (PPO)
c. customized sub-capitation plan (CSCP)
d. competitive medical plan (CMP) -ANSW- point-of-service plan (POS)
The common data file is a(n):
a. chronological summary of all transactions posted to individual patient
ledgers/accounts on a specific day
b. series of fixed-length records submitted to payers to bill for health care services
c. computerized permanent record of all financial transactions between the patient and
the practice
d. abstract of all recent claims filed on each patient -ANSW- abstract of all recent
claims filed on each patient
Which was established by Medicare to ensure the accountability of managed care plans
in terms of objective, measurable standards?
a. QAPI (quality assessment and performance improvement program)
b. NCQA (national committee for quality assurance)
c. EQRO (external quality review organization)
d. QISMC (quality improvement system for managed care) -ANSW- QISMC (quality
improvement system for managed care)
A model in which health care is provided by individuals who are not employees of the
HMO or who do not belong to a specially formed medical group that serves the HMO is
known as a(n):
a. staff model HMO
b. closed-panel HMO
c. group model HMO
d. open-panel HMO -ANSW- open-panel HMO
, Which was implemented as a result of the BBA of 1997 to cover all costs related to
services furnished to Medicare Part A beneficiaries in skilled nursing facilities?
a. OPPS
b. SNF PPS
c. IPF PPS
d. IRF PPS -ANSW- SNF PPS
A(n) _________ submits written confirmation authorizing treatment to the provider.
a. case manager
b. subscriber
c. gatekeeper
d. enrollee -ANSW- case manager
The patient account record (or patient ledger) is a(n):
a. computerized permanent record of all financial transactions between the patient and
the practice
b. financial record source document used by providers and other personnel to record
treated diagnoses and services rendered to the patient during the current encounter
c. abstract of all recent claims filed on each patient
d. chronological summary of all transactions posted to individual patient
ledgers/accounts on a specific day -ANSW- computerized permanent record of all
financial transactions between the patient and the practice
Coverage for catastrophic or prolonged illnesses and injuries is known as:
a. universal health insurance
b. major medical insurance
c. single-payer plan
d. coinsurance -ANSW- major medical insurance
A medical condition that was diagnosed, treated, or both within a specified period of
time immediately preceding the enrollee's effective date of coverage is called a(n):
a. pre-existing condition
b. covered entity
c. unauthorized service
d. noncovered benefit -ANSW- pre-existing condition
Which legislation amended the PPACA to implement health care reform initiatives, such
as increasing tax credits to buy health care insurance, eliminating special deals
provided to senators, closing the Medicare "donut hole," and modifying higher education
assistance provisions, such as implementing student loan reform?
a. BIPA
b. HITECH Act
c. HCERA
d. HIPAA -ANSW- HCERA
solutions (2023)
When completing a CMS-1500 claim for Medicare-Medicaid (Medi-Medi) crossover
claims:
a. enter an X in both the Medicare and Medicaid boxes of Block 1
b. enter MCD followed by the patient's Medicaid ID number in Block 10b
c. enter MEDIGAP in Block 9a
d. complete two claims, one each for Medicare and Medicaid -ANSW- enter an X in
both the Medicare and Medicaid boxes of Block 1
Major revisions to CPT made in 1991 resulted in which of the following?
a. Category II and III codes
b. E/M services
c. guidelines
d. modifiers -ANSW- E/M services
Which is designed to help individuals avoid health and injury problems?
a. preventive service
b. health insurance
c. consumer-driven health plan
d. medical care -ANSW- preventive service
In a direct contract model HMO, contracted health care services are:
a. provided to subscribers by physicians employed by the HMO
b. provided to subscribers by two or more physician multispecialty group practices
c. delivered to subscribers by physicians who remain in their independent office
settings
d. delivered to subscribers by individual physicians in the community -ANSW-
delivered to subscribers by individual physicians in the community
Which is a type of HMO where health care services are provided to subscribers by
physicians employed by the HMO?
a. preferred provider organization (PPO)
b. exclusive provider organization (EPO)
c. group model
d. staff model -ANSW- staff model
The Electronic Healthcare Network Accreditation Commission (EHNAC) is an
organization that accredits:
a. participating providers
,b. clearinghouses
c. electronic data interchange
d. nonparticipating providers -ANSW- clearinghouses
Most preferred provider organizations (PPOs) are open-ended plans that allow patients
to use non-PPO providers in exchange for:
a. higher out-of-pocket expenses
b. lower copayments
c. higher premiums
d. lower deductibles -ANSW- higher out-of-pocket expenses
Which system enacted by TEFRA issues a predetermined payment for inpatient
services?
a. ICD-9-CM
b. CPT
c. DRGs
d. HCPCS level II -ANSW- DRGs
Health care providers accept pre-established payments for providing care to health plan
enrollees over a period of time under the reimbursement method of:
a. fee-for-service
b. Resource-Based Relative Value Scale (RBRVS)
c. capitation
d. point-of-service -ANSW- capitation
Development of patient care plans for the coordination and provision of care for
complicated cases is a part of:
a. utilization review
b. preadmission certification
c. case management
d. discharge planning -ANSW- case management
Which requires managed care plans that contract with Medicare or Medicaid to disclose
information about physician incentive plans to CMS or state Medicaid agencies before a
new or renewed contract receives final approval?
a. physician incentive plan
b. federally qualified HMO
c. Office of Managed Care
d. Amendment to the HMO Act -ANSW- physician incentive plan
The Fair Credit Reporting Act:
a. helps consumers resolve billing issues with card issuers and protects important
credit rights
b. requires credit and charge card issuers to provide certain disclosures in direct mail,
telephone, and other applications and solicitations for open-end credit and charge
accounts and under other circumstances
, c. protects information collected by consumer reporting agencies such as credit
bureaus, medical information companies, and tenant screening services
d. specifies what a collection source may and may not do when pursuing payment of
past due accounts -ANSW- protects information collected by consumer reporting
agencies such as credit bureaus, medical information companies, and tenant screening
services
The Office of Managed Care is a CMS agency that:
a. contracts with and acquires the clinical and business assets of physician practices
b. facilitates innovation and competition among Medicare HMOs
c. assesses the quality of managed care plans in the United States and releases the
data to the public for its consideration when selecting a managed care plan
d. ensures the accountability of managed care plans in terms of objective, measurable
standards -ANSW- facilitates innovation and competition among Medicare HMOs
Which was implemented to create flexibility in managed care plans, which would allow
patients to self-refer to out-of-network providers?
a. point-of-service plan (POS)
b. preferred provider organization (PPO)
c. customized sub-capitation plan (CSCP)
d. competitive medical plan (CMP) -ANSW- point-of-service plan (POS)
The common data file is a(n):
a. chronological summary of all transactions posted to individual patient
ledgers/accounts on a specific day
b. series of fixed-length records submitted to payers to bill for health care services
c. computerized permanent record of all financial transactions between the patient and
the practice
d. abstract of all recent claims filed on each patient -ANSW- abstract of all recent
claims filed on each patient
Which was established by Medicare to ensure the accountability of managed care plans
in terms of objective, measurable standards?
a. QAPI (quality assessment and performance improvement program)
b. NCQA (national committee for quality assurance)
c. EQRO (external quality review organization)
d. QISMC (quality improvement system for managed care) -ANSW- QISMC (quality
improvement system for managed care)
A model in which health care is provided by individuals who are not employees of the
HMO or who do not belong to a specially formed medical group that serves the HMO is
known as a(n):
a. staff model HMO
b. closed-panel HMO
c. group model HMO
d. open-panel HMO -ANSW- open-panel HMO
, Which was implemented as a result of the BBA of 1997 to cover all costs related to
services furnished to Medicare Part A beneficiaries in skilled nursing facilities?
a. OPPS
b. SNF PPS
c. IPF PPS
d. IRF PPS -ANSW- SNF PPS
A(n) _________ submits written confirmation authorizing treatment to the provider.
a. case manager
b. subscriber
c. gatekeeper
d. enrollee -ANSW- case manager
The patient account record (or patient ledger) is a(n):
a. computerized permanent record of all financial transactions between the patient and
the practice
b. financial record source document used by providers and other personnel to record
treated diagnoses and services rendered to the patient during the current encounter
c. abstract of all recent claims filed on each patient
d. chronological summary of all transactions posted to individual patient
ledgers/accounts on a specific day -ANSW- computerized permanent record of all
financial transactions between the patient and the practice
Coverage for catastrophic or prolonged illnesses and injuries is known as:
a. universal health insurance
b. major medical insurance
c. single-payer plan
d. coinsurance -ANSW- major medical insurance
A medical condition that was diagnosed, treated, or both within a specified period of
time immediately preceding the enrollee's effective date of coverage is called a(n):
a. pre-existing condition
b. covered entity
c. unauthorized service
d. noncovered benefit -ANSW- pre-existing condition
Which legislation amended the PPACA to implement health care reform initiatives, such
as increasing tax credits to buy health care insurance, eliminating special deals
provided to senators, closing the Medicare "donut hole," and modifying higher education
assistance provisions, such as implementing student loan reform?
a. BIPA
b. HITECH Act
c. HCERA
d. HIPAA -ANSW- HCERA
