SARAH MICHELLE LIVE REVIEW STUDY
GUIDE Complete Questions with 100%
Correct Answers A+ Rated Solution Guide
Latest update 2025
What is the Transitional Care Model? --- correct answer ---
Transitioning their care.
Goal of this model is to prevent readmissions and exacerbations.
What is the difference between ICD-10 codes and CPT code? --- correct
answer ---ICD-10 code identifies the diagnosis- it tells the insurance
what disease process or condition that we are billing for. The CPT
code is for any procedures that were done during the visit. Ex:
diagnostics, labs, XR, surgical procedures, etc.
What 3 things are required in a note about a patient with either ICD-
10 and/or CPT codes? --- correct answer ---A history, physical exam,
and a plan
What is the Swiss Cheese Model? --- correct answer ---Risk analysis
and management
This is when an error happens and we go back after the fact and see
where did this issue continually "fall through the cracks" or "fall
through the holes." So it inadvertently reached the patient.
,Focuses on root cause analysis so that we can prevent this from
happening to patients again in the future.
What is incident to billing? How does it impact out reimbursement as
NP's? --- correct answer ---This is going to be when a physician first
sees the patient for a medical issue and then we see the same patient
for the same diagnosis later on. We're allowed to bill at 100% for this.
When typically NP's can only bill up to 85%. If any new problems
develop in the visit and we're no longer seeing the patient for the
same issue that was previously seen by the physician for, we can not
use incident to billing.
What determines your legal right to practice as a NP and also
determines our scope of practice? --- correct answer ---The State
Nursing Practice Act
Who is going to enforce that State Nursing Practice Act? --- correct
answer ---The State Board of Nursing
Are we able to have collaborative agreements with people other then
physicians? --- correct answer ---Yes, dentists and DO's, NOT
chiropractors
What is a resource we can use to improve access to care for patients? -
-- correct answer ---Telehealth
,What components do we need to ensure we ask patients about in
regards to their social history? --- correct answer ---Relationship
status, sexual status, who they live with, highest level of education,
employment, smoking, drug, and alcohol status. New stressors or
concerns, social supports, exercise, do they have access to running
water and air conditioning.
Who funds Medicare? --- correct answer ---Federal government
What types of patients do we expect to see using this benefit? ---
correct answer ---Elderly and disabled
We CARE for the elderly and disabled and we AID the poor
What is Medicare Part A? --- correct answer ---All of your inpatient
stuff, including hospice.
What is Medicare Part B? --- correct answer ---All of your outpatient
needs, including diagnostic tests, second opinions, medical equipment.
What is Medicare Part C? --- correct answer ---All of your advantage
plans, supplemental insurances like dental and vision.
What is Medicare Part D? --- correct answer ---Majority of your drug
coverage, or prescription drugs.
, What are the 2 acts involved with Medicare Reimbursement? Which
one came first? --- correct answer ---BRA came first: Budget
Reconciliation Act
Balanced Budget Act
What is the difference between the Budget Reconciliation Act and
Balanced Budget Act? --- correct answer ---The BRA allows us to get
reimbursed up to 85% when seeing a patient.
The Balanced Budget Act required NP's to have an NPI number
whenever you charge for your care
What did the HITECH Act mandate? --- correct answer ---Mandated
that we all move to EMR in order to get paid.
Who funds Medicaid? --- correct answer ---Federal and state
government
What types of patients would we expect to see using Medicaid? ---
correct answer ---Those who can not afford health care insurance
because they live below the poverty level.
AID the poor
How low does your income level have to be to be eligible for
Medicaid? --- correct answer ---Currently $2000 per month in your
household is the max amount in order to even be eligible for Medicaid.
GUIDE Complete Questions with 100%
Correct Answers A+ Rated Solution Guide
Latest update 2025
What is the Transitional Care Model? --- correct answer ---
Transitioning their care.
Goal of this model is to prevent readmissions and exacerbations.
What is the difference between ICD-10 codes and CPT code? --- correct
answer ---ICD-10 code identifies the diagnosis- it tells the insurance
what disease process or condition that we are billing for. The CPT
code is for any procedures that were done during the visit. Ex:
diagnostics, labs, XR, surgical procedures, etc.
What 3 things are required in a note about a patient with either ICD-
10 and/or CPT codes? --- correct answer ---A history, physical exam,
and a plan
What is the Swiss Cheese Model? --- correct answer ---Risk analysis
and management
This is when an error happens and we go back after the fact and see
where did this issue continually "fall through the cracks" or "fall
through the holes." So it inadvertently reached the patient.
,Focuses on root cause analysis so that we can prevent this from
happening to patients again in the future.
What is incident to billing? How does it impact out reimbursement as
NP's? --- correct answer ---This is going to be when a physician first
sees the patient for a medical issue and then we see the same patient
for the same diagnosis later on. We're allowed to bill at 100% for this.
When typically NP's can only bill up to 85%. If any new problems
develop in the visit and we're no longer seeing the patient for the
same issue that was previously seen by the physician for, we can not
use incident to billing.
What determines your legal right to practice as a NP and also
determines our scope of practice? --- correct answer ---The State
Nursing Practice Act
Who is going to enforce that State Nursing Practice Act? --- correct
answer ---The State Board of Nursing
Are we able to have collaborative agreements with people other then
physicians? --- correct answer ---Yes, dentists and DO's, NOT
chiropractors
What is a resource we can use to improve access to care for patients? -
-- correct answer ---Telehealth
,What components do we need to ensure we ask patients about in
regards to their social history? --- correct answer ---Relationship
status, sexual status, who they live with, highest level of education,
employment, smoking, drug, and alcohol status. New stressors or
concerns, social supports, exercise, do they have access to running
water and air conditioning.
Who funds Medicare? --- correct answer ---Federal government
What types of patients do we expect to see using this benefit? ---
correct answer ---Elderly and disabled
We CARE for the elderly and disabled and we AID the poor
What is Medicare Part A? --- correct answer ---All of your inpatient
stuff, including hospice.
What is Medicare Part B? --- correct answer ---All of your outpatient
needs, including diagnostic tests, second opinions, medical equipment.
What is Medicare Part C? --- correct answer ---All of your advantage
plans, supplemental insurances like dental and vision.
What is Medicare Part D? --- correct answer ---Majority of your drug
coverage, or prescription drugs.
, What are the 2 acts involved with Medicare Reimbursement? Which
one came first? --- correct answer ---BRA came first: Budget
Reconciliation Act
Balanced Budget Act
What is the difference between the Budget Reconciliation Act and
Balanced Budget Act? --- correct answer ---The BRA allows us to get
reimbursed up to 85% when seeing a patient.
The Balanced Budget Act required NP's to have an NPI number
whenever you charge for your care
What did the HITECH Act mandate? --- correct answer ---Mandated
that we all move to EMR in order to get paid.
Who funds Medicaid? --- correct answer ---Federal and state
government
What types of patients would we expect to see using Medicaid? ---
correct answer ---Those who can not afford health care insurance
because they live below the poverty level.
AID the poor
How low does your income level have to be to be eligible for
Medicaid? --- correct answer ---Currently $2000 per month in your
household is the max amount in order to even be eligible for Medicaid.
