NURS 8024 PHARMACOLOGY EXAM 2 STUDY GUIDE 2024
(LATEST UPDATE) REVIEW-WRITER-AVATAR
1. What are collection agency fees based on?: A percentage of dollars collected
2. Self-funded benefit plans may choose to coordinate benefits using the gender
rule or what other rule?: Birthday
3. In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers?: Case rates
4. What customer service improvements might improve the patient accounts
department?: Holding staff accountable for customer service during performance reviews
5. What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do?:
Inform a Medicare beneficiary that Medicare may not pay for the order or service
6. What type of account adjustment results from the patient's unwillingness to pay for
a self-pay balance?: Bad debt adjustment
7. What is the initial hospice benefit?: Two 90-day periods and an unlimited
number of subsequent periods
8. When does a hospital add ambulance charges to the Medicare inpatient claim?: If
the patient requires ambulance transportation to a skilled nursing facility
9. How should a provider resolve a late-charge credit posted after an account is billed?:
Post a late-charge adjustment to the account
10. an increase in the dollars aged greater than 90 days from date of service indicate
what about accounts: They are not being processed in a timely manner
11. What is an advantage of a preregistration program?: It reduces processing times at
the time of service
12. What are the two statutory exclusions from hospice coverage?: Medically
unnecessary services and custodial care
13. What core financial activities are resolved within patient access?: Scheduling,
insurance verification, discharge processing, and payment of point-of-service receipts
14. What statement applies to the scheduled outpatient?: The services do not involve an
overnight stay
15. How is a mis-posted contractual allowance resolved?: Comparing the contract
reimbursement rates with the contract on the admittance advice to identify the correct
amount
16. What type of patient status is used to evaluate the patient's need for inpatient
care?: Observation
17. Coverage rules for Medicare beneficiaries receiving skilled nursing care require that
the beneficiary has received what?: Medically necessary inpatient hospital services for at
least 3 consecutive days before the skilled nursing care admission
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, 18. When is the word "SAME" entered on the CMS 1500 billing form in Field 0$?: When
the patient is the insured
19. What are non-emergency patients who come for service without prior
notification to the provider called?: Unscheduled patients
20. If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse?: Neither enrolled not entitled to benefits
21. Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what?: Disclosure rules for consumer credit sales and consumer
loans
22. What is a principal diagnosis?: Primary reason for the patient's admission
23. Collecting patient liability dollars after service leads to what?: Lower ac- counts
receivable levels
24. What is the daily out-of-pocket amount for each lifetime reserve day used?-
: 50% of the current deductible amount
25. What service provided to a Medicare beneficiary in a rural health clinic (RHC) is
not billable as an RHC services?: Inpatient care
26. What code indicates the disposition of the patient at the conclusion of service?:
Patient discharge status code
27. What are hospitals required to do for Medicare credit balance accounts?-
: They result in lost reimbursement and additional cost to collect
28. When an undue delay of payment results from a dispute between the patient
and the third party payer, who is responsible for payment?: Patient
29. Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include:: A valid CPT or HCPCS code
30. With advances in internet security and encryption, revenue-cycle process- es are
expanding to allow patients to do what?: Access their information and perform functions
on-line
31. What date is required on all CMS 1500 claim forms?: onset date of current illness
32. What does scheduling allow provider staff to do: Review appropriateness of the
service request
33. What code is used to report the provider's most common semiprivate room rate?:
Condition code
34. Regulations and requirements for coding accountable care organizations, which
allows providers to begin creating these organizations, were finalized in:: 2012
2/
9
(LATEST UPDATE) REVIEW-WRITER-AVATAR
1. What are collection agency fees based on?: A percentage of dollars collected
2. Self-funded benefit plans may choose to coordinate benefits using the gender
rule or what other rule?: Birthday
3. In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers?: Case rates
4. What customer service improvements might improve the patient accounts
department?: Holding staff accountable for customer service during performance reviews
5. What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do?:
Inform a Medicare beneficiary that Medicare may not pay for the order or service
6. What type of account adjustment results from the patient's unwillingness to pay for
a self-pay balance?: Bad debt adjustment
7. What is the initial hospice benefit?: Two 90-day periods and an unlimited
number of subsequent periods
8. When does a hospital add ambulance charges to the Medicare inpatient claim?: If
the patient requires ambulance transportation to a skilled nursing facility
9. How should a provider resolve a late-charge credit posted after an account is billed?:
Post a late-charge adjustment to the account
10. an increase in the dollars aged greater than 90 days from date of service indicate
what about accounts: They are not being processed in a timely manner
11. What is an advantage of a preregistration program?: It reduces processing times at
the time of service
12. What are the two statutory exclusions from hospice coverage?: Medically
unnecessary services and custodial care
13. What core financial activities are resolved within patient access?: Scheduling,
insurance verification, discharge processing, and payment of point-of-service receipts
14. What statement applies to the scheduled outpatient?: The services do not involve an
overnight stay
15. How is a mis-posted contractual allowance resolved?: Comparing the contract
reimbursement rates with the contract on the admittance advice to identify the correct
amount
16. What type of patient status is used to evaluate the patient's need for inpatient
care?: Observation
17. Coverage rules for Medicare beneficiaries receiving skilled nursing care require that
the beneficiary has received what?: Medically necessary inpatient hospital services for at
least 3 consecutive days before the skilled nursing care admission
1/
9
, 18. When is the word "SAME" entered on the CMS 1500 billing form in Field 0$?: When
the patient is the insured
19. What are non-emergency patients who come for service without prior
notification to the provider called?: Unscheduled patients
20. If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse?: Neither enrolled not entitled to benefits
21. Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what?: Disclosure rules for consumer credit sales and consumer
loans
22. What is a principal diagnosis?: Primary reason for the patient's admission
23. Collecting patient liability dollars after service leads to what?: Lower ac- counts
receivable levels
24. What is the daily out-of-pocket amount for each lifetime reserve day used?-
: 50% of the current deductible amount
25. What service provided to a Medicare beneficiary in a rural health clinic (RHC) is
not billable as an RHC services?: Inpatient care
26. What code indicates the disposition of the patient at the conclusion of service?:
Patient discharge status code
27. What are hospitals required to do for Medicare credit balance accounts?-
: They result in lost reimbursement and additional cost to collect
28. When an undue delay of payment results from a dispute between the patient
and the third party payer, who is responsible for payment?: Patient
29. Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include:: A valid CPT or HCPCS code
30. With advances in internet security and encryption, revenue-cycle process- es are
expanding to allow patients to do what?: Access their information and perform functions
on-line
31. What date is required on all CMS 1500 claim forms?: onset date of current illness
32. What does scheduling allow provider staff to do: Review appropriateness of the
service request
33. What code is used to report the provider's most common semiprivate room rate?:
Condition code
34. Regulations and requirements for coding accountable care organizations, which
allows providers to begin creating these organizations, were finalized in:: 2012
2/
9
