,TESTBANK for Revenue Cycle for Healthcare, 1st
Edition Linda J. Parks
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel
sheet if it exists.
4- We have all what you need, we make
update at every time. There are many new
editions waiting you.
5- If you think you purchased the wrong file
You can contact us at every time, we can
replace it with true one.
Our email:
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
1. What is the first step of the life cycle of a payment claim?
a. The patient checks in at the front desk.
b. Denials and appeals have been closed.
c. Coinsurance payments are met.
d. Treatment plans have been identified.
ANSWER: a
FEEDBACK: a. Correct. The revenue cycle is the life cycle of a payment claim that begins
when the patient checks in at the front desk and ends after all payments or
denials and appeals have been made.
b. Incorrect. The revenue cycle ends when all payments or denials and appeals
have been made.
c. Incorrect. Coinsurance is the percentage the patient pays for covered services
after the deductible has been met and the copay has been paid.
d. Incorrect. Bills must accurately describe the treatment or service so that the
claim can be paid appropriately.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Introduction
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.1 - Identify the steps in the revenue cycle.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 1:17 AM
DATE MODIFIED: 6/2/2023 1:20 AM
2. Why is it important that the process of managing billing cycles be performed accurately and on a timely basis?
a. to maintain cash flows
b. to ensure deductibles have been met
c. to enable the organization to become a covered entity
d. to prevent Medicare abuse
ANSWER: a
FEEDBACK: a. Correct. Throughout the process of managing billing cycles, cash flow must be
maintained to enable health care facilities to deliver quality care to their patients
and stay in business.
b. Incorrect. The insurance provider, not the provider of the service, will ensure
that deductibles have been met.
c. Incorrect. Health care organizations that are required to comply with HIPAA
regulations are known as covered entities (CE), and that definition includes all
organizations that electronically transmit any information that is protected under
HIPAA.
d. Incorrect. Medicare defines abuse as “practices that directly or indirectly result
in unnecessary costs to Medicare.”
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Introduction
QUESTION TYPE: Multiple Choice
Copyright Cengage Learning. Powered by Cognero. Page 1
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.1 - Identify the steps in the revenue cycle.
OTHER: Bloom's: Analyze
DATE CREATED: 6/2/2023 2:01 AM
DATE MODIFIED: 6/2/2023 2:03 AM
3. How does HIPAA apply to the revenue cycle?
a. It protects patient information.
b. It tracks copays and deductibles for patients.
c. It indicates what a patient will owe for services.
d. It determines eligibility for Medicare and Medicaid.
ANSWER: a
FEEDBACK: a. Correct. HIPAA applies to the revenue cycle because it protects the
transmission of patient information as well as the privacy of the patient’s
information as it is shared in the business of reimbursing for services rendered.
b. Incorrect. Patients and their insurance companies must be billed for services in
accordance with the terms of their health insurance coverage, deductibles,
copays, and coinsurances.
c. Incorrect. Coinsurance is the percentage the patient pays for covered services
after the deductible has been met and the copay has been paid.
d. Incorrect. Medicare and Medicaid are covered and monitored under
amendments to the Social Security Act.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.2 - Describe the role of HIPAA in the revenue cycle.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:03 AM
DATE MODIFIED: 6/2/2023 2:06 AM
4. What is the role of health care clearinghouses in the revenue cycle?
a. to convert nonstandard transactions into standard ones
b. to transmit all information protected under HIPAA
c. to monitor the impact of privacy rules
d. to provide information to lessen imminent danger
ANSWER: a
FEEDBACK: a. Correct. Health care clearinghouses are companies that convert nonstandard
transactions into standard transactions and transmit the data to health plans
and the reverse process.
b. Incorrect. Health care organizations that are required to comply with HIPAA
regulations are known as covered entities (CE), and that definition includes all
organizations that electronically transmit any information that is protected under
HIPAA.
Copyright Cengage Learning. Powered by Cognero. Page 2
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
c. Incorrect. The Privacy Rule covers the use and disclosure of PHI that is
transmitted or maintained by electronic media, such as over the Internet to “the
cloud” or stored on computer modems or remote servers.
d. Incorrect. Information needed to prevent or lessen imminent danger may be
disclosed to law enforcement if the information is needed to identify or
apprehend an escapee or violent criminal.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.2 - Describe the role of HIPAA in the revenue cycle.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:06 AM
DATE MODIFIED: 6/2/2023 2:09 AM
5. In the revenue cycle system, which group is responsible for billing and receiving payment for health care services in the
normal course of business?
a. health care providers
b. health care plans
c. health care clearinghouses
d. health care covered entities
ANSWER: a
FEEDBACK: a. Correct. Health care providers are the people or organizations that furnish, bill,
and are paid for health care in the normal course of business.
b. Incorrect. Health plans are individual or group health insurance plans that pay
for medical care.
c. Incorrect. Health care clearinghouses are companies that convert nonstandard
transactions into standard transactions and transmit the data to health plans
and the reverse process.
d. Incorrect. Health care organizations that are required to comply with HIPAA
regulations are known as covered entities (CE), and that definition includes all
organizations that electronically transmit any information that is protected under
HIPAA.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.2 - Describe the role of HIPAA in the revenue cycle.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:09 AM
DATE MODIFIED: 6/2/2023 2:11 AM
6. What is used to protect how personal health information is transmitted or maintained by electronic media?
Copyright Cengage Learning. Powered by Cognero. Page 3
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
a. the Privacy Rule
b. clearinghouses
c. revenue cycle management
d. the Security Rule
ANSWER: a
FEEDBACK: a. Correct. The Privacy Rule covers the use and disclosure of PHI that is
transmitted or maintained by electronic media, such as over the Internet to “the
cloud” or stored on computer modems or remote servers.
b. Incorrect. Health care clearinghouses are companies that convert nonstandard
transactions into standard transactions and transmit the data to health plans
and the reverse process.
c. Incorrect. Revenue cycle management consists of all administrative and clinical
functions that contribute to the capture, management, and collection of patient
service revenue.
d. Incorrect. The HIPAA Security Rule protects a subset of information covered by
the Privacy Rule.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.3 - Recommend procedures to ensure compliance with HIPAA regulations.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:11 AM
DATE MODIFIED: 6/2/2023 2:13 AM
7. Which rights does the Privacy Rule give to individuals over their PHI?
a. the right to direct the transition of an electronic copy to a third party
b. the right to high-quality health care
c. the right to protection of image in the public health system
d. the right to physical well-being
ANSWER: a
FEEDBACK: a. Correct. The Privacy Rule gives individuals rights over their PHI, including the
right to examine and obtain copies of their records, to direct a covered entity to
transmit an electronic copy to a third party, and the right to request corrections.
b. Incorrect. One goal of the Privacy Rule is to allow the flow of health information
needed to provide and promote high-quality health care.
c. Incorrect. One goal of the Privacy Rule is to allow the flow of health information
needed to protect the public's health and well-being.
d. Incorrect. One goal of the Privacy Rule is to allow the flow of health information
needed to provide and promote high-quality health care that protects the
public's well-being.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
Copyright Cengage Learning. Powered by Cognero. Page 4
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.3 - Describe the standard precaution guidelines for disease prevention.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:13 AM
DATE MODIFIED: 6/2/2023 2:16 AM
8. Which qualifier under HIPAA limits the amount of PHI shared to only that needed to accomplish the intended purpose
of the use of disclosure?
a. minimum necessary
b. security management
c. integrity controls
d. transmission security
ANSWER: a
FEEDBACK: a. Correct. Minimum necessary is a qualifier that appears in HIPPA. It means that
disclosures to other health care providers for treatment purposes must be only
the minimum amount of PHI needed to accomplish the intended purpose of the
use or disclosure.
b. Incorrect. Security management is an administrative safeguard used to identify
and analyze potential risks to ePHI.
c. Incorrect. Integrity controls are types of technical safeguards that relate to
policies and procedures to ensure the ePHI is not improperly altered or
destroyed.
d. Incorrect. Transmission security is a technical safeguard that guards against
unauthorized access to ePHI that is being transmitted over an electronic
network.
POINTS: 1
DIFFICULTY: Medium
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.3 - Recommend procedures to ensure compliance with HIPAA regulations.
OTHER: Bloom's: Analyze
DATE CREATED: 6/2/2023 2:16 AM
DATE MODIFIED: 6/2/2023 2:18 AM
9. What is a large portion of HIPAA regulation used in the attempt to prevent fraud and abuse based on?
a. the Medicare Integrity Program
b. the False Claims Act
c. the Medicare and Medicaid Patient and Program Protection Act of 1987
d. Operation Restore Trust
ANSWER: a
FEEDBACK: a. Correct. Although HIPAA is widely known for its privacy and security
protections, a large portion of the act focuses on preventing fraud and abuse
through the Medicare Integrity Program. This program reviews provider claims,
cost reports, and payment determinations for fraud and abuse.
Copyright Cengage Learning. Powered by Cognero. Page 5
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
b. Incorrect. The False Claims Act began during the Civil War. This act prohibited
federal contractors from knowingly filing a fraudulent claim using false
statements or otherwise conspiring to defraud the U.S. government.
c. Incorrect. The False Claims Act formed the foundation for more recent laws,
like the Medicare and Medicaid Patient and Program Protection Act of 1987.
d. Incorrect. In 1995, Operation Restore Trust targeted fraud and abuse among
health care providers.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.4 - Define fraud and abuse.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:19 AM
DATE MODIFIED: 6/2/2023 2:21 AM
10. Which of the following would qualify as abuse under Medicare?
a. billing for unnecessary services
b. billing for services more complex than that provided
c. billing for appointments that the patient did not keep
d. billing for unnecessary items of service
ANSWER: a
FEEDBACK: a. Correct. Medicare defines abuse as “practices that directly or indirectly result in
unnecessary costs to Medicare.” These include practices that are not medically
necessary services or that do not meet professionally recognized standards of
care.
b. Incorrect. Fraud includes knowingly billing for services at a level of complexity
higher than the services actually provided or documented in the medical record.
c. Incorrect. Fraud includes billing Medicare for appointments patients did not
keep.
d. Incorrect. Fraud includes knowingly ordering medically unnecessary items of
service for a patient.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: What Is Fraud and Abuse?
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.4 - Define fraud and abuse.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:22 AM
DATE MODIFIED: 6/2/2023 2:23 AM
11. What of the following is the pre-established fixed payment per patient per unit to time that is paid to help care
providers?
Copyright Cengage Learning. Powered by Cognero. Page 6
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
a. capitation
b. fee schedule
c. clean claim
d. Charge Description Master
ANSWER: a
FEEDBACK: a. Correct. Capitation is a pre-established fixed payment per patient per unit of
time paid in advance to the physician for the delivery of health care services for
patients/beneficiaries in a health care plan. The provider agrees to accept, in
full, the payment established in the contract.
b. Incorrect. A fee schedule is a predetermined list of fees that the payer allows
for the payment of all health care services.
c. Incorrect. All providers strive to submit a clean claim—one that is correctly
completed without errors or omissions.
d. Incorrect. The Charge Description Master is a database that contains all the
information necessary for the system to place the information on the claim
form.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Revenue Cycle Basics in Three Parts
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.1 - Identify the steps in the revenue cycle.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:25 AM
DATE MODIFIED: 6/2/2023 2:27 AM
12. From a revenue cycle perspective, when is it best to get the most accurate information and minimize errors in the
patient's encounter?
a. during front-end tasks
b. when applying the Charge Description Master
c. when claims are undergoing adjudication
d. during the patient visit to the health care provider
ANSWER: a
FEEDBACK: a. Correct. From a revenue cycle perspective, getting the most accurate
information up front starts with patient scheduling and registration. Successful
health care revenue cycle management strategies focus on front-end tasks.
b. Incorrect. Accurate code assignment by the HIM coding staff and having an
updated Charge Description Master, which is a database that contains all the
information necessary for the system to place the information on the claim
form, leads to the submission of more clean claims.
c. Incorrect. Claims adjudication is used to verify that the patient on the claim is
covered by their company’s policy, the services are necessary, and the patient
will benefit from them. They also verify the policy’s deductibles, copays, and
coinsurance.
d. Incorrect. In the middle of the revenue cycle, the patient is seen by the health
care provider. The visit is documented, including all physical examinations or
treatments that are provided.
Copyright Cengage Learning. Powered by Cognero. Page 7
, Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Revenue Cycle Basics in Three Parts
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.5 - Define a clean claim.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:27 AM
DATE MODIFIED: 6/2/2023 2:31 AM
13. Which of the following will happen when a claim goes under the adjudication process?
a. The claim is compared to the health plan benefits.
b. Codes from the Charge Description Master are applied to the claim.
c. Claims are electronically transferred to a clearinghouse.
d. Precertification and authorization is provided.
ANSWER: a
FEEDBACK: a. Correct. The payer compares the claim to the payer edits and the patient’s
health plan benefits to verify that all required information is available to process
the claim, that the claim is not a duplicate submission, and that the procedures
performed or services provided are covered benefits.
b. Incorrect. A clean claim is one that is correctly completed without errors or
omissions. This means accurate code assignment by the HIM coding staff and
having an updated Charge Description Master.
c. Incorrect. Before the claim is adjudicated, all the required data is posted to the
claims and the claims are in a computer file, which are then transmitted
electronically to a clearinghouse.
d. Incorrect. Pre-certification or authorization assesses medical necessity and is
done before patient check-in.
POINTS: 1
DIFFICULTY: Medium
REFERENCES: Cycle Basics in Three Parts
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.6 - Identify the importance of a clean claim to the revenue cycle.
OTHER: Bloom's: Analyze
DATE CREATED: 6/2/2023 2:31 AM
DATE MODIFIED: 6/2/2023 2:33 AM
14. When is a determination of the patient's annual deductible, copay, and coinsurance made?
a. during claims adjudication
b. during the sending of the remittance advice
c. during the establishment of the fee schedule
d. during claims capitation
ANSWER: a
Copyright Cengage Learning. Powered by Cognero. Page 8
Edition Linda J. Parks
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel
sheet if it exists.
4- We have all what you need, we make
update at every time. There are many new
editions waiting you.
5- If you think you purchased the wrong file
You can contact us at every time, we can
replace it with true one.
Our email:
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
1. What is the first step of the life cycle of a payment claim?
a. The patient checks in at the front desk.
b. Denials and appeals have been closed.
c. Coinsurance payments are met.
d. Treatment plans have been identified.
ANSWER: a
FEEDBACK: a. Correct. The revenue cycle is the life cycle of a payment claim that begins
when the patient checks in at the front desk and ends after all payments or
denials and appeals have been made.
b. Incorrect. The revenue cycle ends when all payments or denials and appeals
have been made.
c. Incorrect. Coinsurance is the percentage the patient pays for covered services
after the deductible has been met and the copay has been paid.
d. Incorrect. Bills must accurately describe the treatment or service so that the
claim can be paid appropriately.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Introduction
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.1 - Identify the steps in the revenue cycle.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 1:17 AM
DATE MODIFIED: 6/2/2023 1:20 AM
2. Why is it important that the process of managing billing cycles be performed accurately and on a timely basis?
a. to maintain cash flows
b. to ensure deductibles have been met
c. to enable the organization to become a covered entity
d. to prevent Medicare abuse
ANSWER: a
FEEDBACK: a. Correct. Throughout the process of managing billing cycles, cash flow must be
maintained to enable health care facilities to deliver quality care to their patients
and stay in business.
b. Incorrect. The insurance provider, not the provider of the service, will ensure
that deductibles have been met.
c. Incorrect. Health care organizations that are required to comply with HIPAA
regulations are known as covered entities (CE), and that definition includes all
organizations that electronically transmit any information that is protected under
HIPAA.
d. Incorrect. Medicare defines abuse as “practices that directly or indirectly result
in unnecessary costs to Medicare.”
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Introduction
QUESTION TYPE: Multiple Choice
Copyright Cengage Learning. Powered by Cognero. Page 1
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.1 - Identify the steps in the revenue cycle.
OTHER: Bloom's: Analyze
DATE CREATED: 6/2/2023 2:01 AM
DATE MODIFIED: 6/2/2023 2:03 AM
3. How does HIPAA apply to the revenue cycle?
a. It protects patient information.
b. It tracks copays and deductibles for patients.
c. It indicates what a patient will owe for services.
d. It determines eligibility for Medicare and Medicaid.
ANSWER: a
FEEDBACK: a. Correct. HIPAA applies to the revenue cycle because it protects the
transmission of patient information as well as the privacy of the patient’s
information as it is shared in the business of reimbursing for services rendered.
b. Incorrect. Patients and their insurance companies must be billed for services in
accordance with the terms of their health insurance coverage, deductibles,
copays, and coinsurances.
c. Incorrect. Coinsurance is the percentage the patient pays for covered services
after the deductible has been met and the copay has been paid.
d. Incorrect. Medicare and Medicaid are covered and monitored under
amendments to the Social Security Act.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.2 - Describe the role of HIPAA in the revenue cycle.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:03 AM
DATE MODIFIED: 6/2/2023 2:06 AM
4. What is the role of health care clearinghouses in the revenue cycle?
a. to convert nonstandard transactions into standard ones
b. to transmit all information protected under HIPAA
c. to monitor the impact of privacy rules
d. to provide information to lessen imminent danger
ANSWER: a
FEEDBACK: a. Correct. Health care clearinghouses are companies that convert nonstandard
transactions into standard transactions and transmit the data to health plans
and the reverse process.
b. Incorrect. Health care organizations that are required to comply with HIPAA
regulations are known as covered entities (CE), and that definition includes all
organizations that electronically transmit any information that is protected under
HIPAA.
Copyright Cengage Learning. Powered by Cognero. Page 2
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
c. Incorrect. The Privacy Rule covers the use and disclosure of PHI that is
transmitted or maintained by electronic media, such as over the Internet to “the
cloud” or stored on computer modems or remote servers.
d. Incorrect. Information needed to prevent or lessen imminent danger may be
disclosed to law enforcement if the information is needed to identify or
apprehend an escapee or violent criminal.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.2 - Describe the role of HIPAA in the revenue cycle.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:06 AM
DATE MODIFIED: 6/2/2023 2:09 AM
5. In the revenue cycle system, which group is responsible for billing and receiving payment for health care services in the
normal course of business?
a. health care providers
b. health care plans
c. health care clearinghouses
d. health care covered entities
ANSWER: a
FEEDBACK: a. Correct. Health care providers are the people or organizations that furnish, bill,
and are paid for health care in the normal course of business.
b. Incorrect. Health plans are individual or group health insurance plans that pay
for medical care.
c. Incorrect. Health care clearinghouses are companies that convert nonstandard
transactions into standard transactions and transmit the data to health plans
and the reverse process.
d. Incorrect. Health care organizations that are required to comply with HIPAA
regulations are known as covered entities (CE), and that definition includes all
organizations that electronically transmit any information that is protected under
HIPAA.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.2 - Describe the role of HIPAA in the revenue cycle.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:09 AM
DATE MODIFIED: 6/2/2023 2:11 AM
6. What is used to protect how personal health information is transmitted or maintained by electronic media?
Copyright Cengage Learning. Powered by Cognero. Page 3
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
a. the Privacy Rule
b. clearinghouses
c. revenue cycle management
d. the Security Rule
ANSWER: a
FEEDBACK: a. Correct. The Privacy Rule covers the use and disclosure of PHI that is
transmitted or maintained by electronic media, such as over the Internet to “the
cloud” or stored on computer modems or remote servers.
b. Incorrect. Health care clearinghouses are companies that convert nonstandard
transactions into standard transactions and transmit the data to health plans
and the reverse process.
c. Incorrect. Revenue cycle management consists of all administrative and clinical
functions that contribute to the capture, management, and collection of patient
service revenue.
d. Incorrect. The HIPAA Security Rule protects a subset of information covered by
the Privacy Rule.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.3 - Recommend procedures to ensure compliance with HIPAA regulations.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:11 AM
DATE MODIFIED: 6/2/2023 2:13 AM
7. Which rights does the Privacy Rule give to individuals over their PHI?
a. the right to direct the transition of an electronic copy to a third party
b. the right to high-quality health care
c. the right to protection of image in the public health system
d. the right to physical well-being
ANSWER: a
FEEDBACK: a. Correct. The Privacy Rule gives individuals rights over their PHI, including the
right to examine and obtain copies of their records, to direct a covered entity to
transmit an electronic copy to a third party, and the right to request corrections.
b. Incorrect. One goal of the Privacy Rule is to allow the flow of health information
needed to provide and promote high-quality health care.
c. Incorrect. One goal of the Privacy Rule is to allow the flow of health information
needed to protect the public's health and well-being.
d. Incorrect. One goal of the Privacy Rule is to allow the flow of health information
needed to provide and promote high-quality health care that protects the
public's well-being.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
Copyright Cengage Learning. Powered by Cognero. Page 4
,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.3 - Describe the standard precaution guidelines for disease prevention.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:13 AM
DATE MODIFIED: 6/2/2023 2:16 AM
8. Which qualifier under HIPAA limits the amount of PHI shared to only that needed to accomplish the intended purpose
of the use of disclosure?
a. minimum necessary
b. security management
c. integrity controls
d. transmission security
ANSWER: a
FEEDBACK: a. Correct. Minimum necessary is a qualifier that appears in HIPPA. It means that
disclosures to other health care providers for treatment purposes must be only
the minimum amount of PHI needed to accomplish the intended purpose of the
use or disclosure.
b. Incorrect. Security management is an administrative safeguard used to identify
and analyze potential risks to ePHI.
c. Incorrect. Integrity controls are types of technical safeguards that relate to
policies and procedures to ensure the ePHI is not improperly altered or
destroyed.
d. Incorrect. Transmission security is a technical safeguard that guards against
unauthorized access to ePHI that is being transmitted over an electronic
network.
POINTS: 1
DIFFICULTY: Medium
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.3 - Recommend procedures to ensure compliance with HIPAA regulations.
OTHER: Bloom's: Analyze
DATE CREATED: 6/2/2023 2:16 AM
DATE MODIFIED: 6/2/2023 2:18 AM
9. What is a large portion of HIPAA regulation used in the attempt to prevent fraud and abuse based on?
a. the Medicare Integrity Program
b. the False Claims Act
c. the Medicare and Medicaid Patient and Program Protection Act of 1987
d. Operation Restore Trust
ANSWER: a
FEEDBACK: a. Correct. Although HIPAA is widely known for its privacy and security
protections, a large portion of the act focuses on preventing fraud and abuse
through the Medicare Integrity Program. This program reviews provider claims,
cost reports, and payment determinations for fraud and abuse.
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,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
b. Incorrect. The False Claims Act began during the Civil War. This act prohibited
federal contractors from knowingly filing a fraudulent claim using false
statements or otherwise conspiring to defraud the U.S. government.
c. Incorrect. The False Claims Act formed the foundation for more recent laws,
like the Medicare and Medicaid Patient and Program Protection Act of 1987.
d. Incorrect. In 1995, Operation Restore Trust targeted fraud and abuse among
health care providers.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.4 - Define fraud and abuse.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:19 AM
DATE MODIFIED: 6/2/2023 2:21 AM
10. Which of the following would qualify as abuse under Medicare?
a. billing for unnecessary services
b. billing for services more complex than that provided
c. billing for appointments that the patient did not keep
d. billing for unnecessary items of service
ANSWER: a
FEEDBACK: a. Correct. Medicare defines abuse as “practices that directly or indirectly result in
unnecessary costs to Medicare.” These include practices that are not medically
necessary services or that do not meet professionally recognized standards of
care.
b. Incorrect. Fraud includes knowingly billing for services at a level of complexity
higher than the services actually provided or documented in the medical record.
c. Incorrect. Fraud includes billing Medicare for appointments patients did not
keep.
d. Incorrect. Fraud includes knowingly ordering medically unnecessary items of
service for a patient.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: What Is Fraud and Abuse?
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.4 - Define fraud and abuse.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:22 AM
DATE MODIFIED: 6/2/2023 2:23 AM
11. What of the following is the pre-established fixed payment per patient per unit to time that is paid to help care
providers?
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,Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
a. capitation
b. fee schedule
c. clean claim
d. Charge Description Master
ANSWER: a
FEEDBACK: a. Correct. Capitation is a pre-established fixed payment per patient per unit of
time paid in advance to the physician for the delivery of health care services for
patients/beneficiaries in a health care plan. The provider agrees to accept, in
full, the payment established in the contract.
b. Incorrect. A fee schedule is a predetermined list of fees that the payer allows
for the payment of all health care services.
c. Incorrect. All providers strive to submit a clean claim—one that is correctly
completed without errors or omissions.
d. Incorrect. The Charge Description Master is a database that contains all the
information necessary for the system to place the information on the claim
form.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Revenue Cycle Basics in Three Parts
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.1 - Identify the steps in the revenue cycle.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:25 AM
DATE MODIFIED: 6/2/2023 2:27 AM
12. From a revenue cycle perspective, when is it best to get the most accurate information and minimize errors in the
patient's encounter?
a. during front-end tasks
b. when applying the Charge Description Master
c. when claims are undergoing adjudication
d. during the patient visit to the health care provider
ANSWER: a
FEEDBACK: a. Correct. From a revenue cycle perspective, getting the most accurate
information up front starts with patient scheduling and registration. Successful
health care revenue cycle management strategies focus on front-end tasks.
b. Incorrect. Accurate code assignment by the HIM coding staff and having an
updated Charge Description Master, which is a database that contains all the
information necessary for the system to place the information on the claim
form, leads to the submission of more clean claims.
c. Incorrect. Claims adjudication is used to verify that the patient on the claim is
covered by their company’s policy, the services are necessary, and the patient
will benefit from them. They also verify the policy’s deductibles, copays, and
coinsurance.
d. Incorrect. In the middle of the revenue cycle, the patient is seen by the health
care provider. The visit is documented, including all physical examinations or
treatments that are provided.
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, Name: Class: Date:
Chapter 01 Overview of Revenue Cycle Management
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Revenue Cycle Basics in Three Parts
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.5 - Define a clean claim.
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:27 AM
DATE MODIFIED: 6/2/2023 2:31 AM
13. Which of the following will happen when a claim goes under the adjudication process?
a. The claim is compared to the health plan benefits.
b. Codes from the Charge Description Master are applied to the claim.
c. Claims are electronically transferred to a clearinghouse.
d. Precertification and authorization is provided.
ANSWER: a
FEEDBACK: a. Correct. The payer compares the claim to the payer edits and the patient’s
health plan benefits to verify that all required information is available to process
the claim, that the claim is not a duplicate submission, and that the procedures
performed or services provided are covered benefits.
b. Incorrect. A clean claim is one that is correctly completed without errors or
omissions. This means accurate code assignment by the HIM coding staff and
having an updated Charge Description Master.
c. Incorrect. Before the claim is adjudicated, all the required data is posted to the
claims and the claims are in a computer file, which are then transmitted
electronically to a clearinghouse.
d. Incorrect. Pre-certification or authorization assesses medical necessity and is
done before patient check-in.
POINTS: 1
DIFFICULTY: Medium
REFERENCES: Cycle Basics in Three Parts
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: LO: 1.6 - Identify the importance of a clean claim to the revenue cycle.
OTHER: Bloom's: Analyze
DATE CREATED: 6/2/2023 2:31 AM
DATE MODIFIED: 6/2/2023 2:33 AM
14. When is a determination of the patient's annual deductible, copay, and coinsurance made?
a. during claims adjudication
b. during the sending of the remittance advice
c. during the establishment of the fee schedule
d. during claims capitation
ANSWER: a
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