Question 1

  1. When a provider receives a fixed amount to provide only the care that an individual needs from the provider, this is known as a _____________ payment.









4 points  

Question 2

  1. The healthcare industry is heavily regulated by ____ and ____ legislation.


    city; local


    state; city


    county; state


    federal; state

4 points  

Question 3

  1. When a patient signs a release of medical information at a physician’s office, that release is generally considered to be valid


    for six months


    for a single visit to the physician


    for one year from the date entered on the form


    until the patient changes insurance companies

4 points  

Question 4

  1. When the provider is required  to receive as payment in full whatever amount the insurance reimburses for services, the provider is agreeing to


    accept assignment


    assignment of benefits


    authorize services


    coordination of benefits

4 points  

Question 5

  1. Which document is used to guarantee the patient’s financial and medical record?


    encounter form


    patient insurance form


    patient ledger


    patient registration form

4 points  

Question 6

  1. The person responsible for paying the charges for services rendered by the provider is the









4 points  

Question 7

  1. Which federal legislation was enacted in1995 to restrict the referral of patients to organizations in which providers have a financial interest?


    Federal Anti-Kickback Law


    Hill-Burton Act




    Stark II laws

4 points  

Question 8

  1. The recognized difference between fraud and abuse is the









4 points  

Question 9

  1. The specified amount of annual out-of-pocket expenses for covered health care services that the insured must pay annually for health care is called the









4 points  

Question 10

  1. Which three components constitute the RBRVS payment system?


    fee schedule, practice expense, and malpractice expense


    physician work, practice expense, and geographical location


    physician work, practice expense, and malpractice insurance espense


    practice expense, malpractice insurance expense, and liability insurance expense

4 points  

Question 11

  1. Mandates are









4 points  

Question 12

  1. Which type of HMO offers subscribers health care services by physicians who remain in their individual office setting?


    closed panel


    independent practice association


    network model


    staff model

4 points  

Question 13

  1. HIPAA requires payers to implement rules called electronic __________, which result in a uniform language for electronic data interchange.


        data interchanges


      health records


       medical records


        transaction standards

4 points  

Question 14

  1. The ambulatory payment classification prospective payment system is used to reimburse claims for what services?




    nursing facility





4 points  

Question 15

  1. Breach of confidentiality can result from


    discussing patient health care information with unauthorized sources


    discussing the patient’s case in the business office


    sending medical information to non-health care entities with the patient’s consent


    sending patient health care information to the patient’s insurance company

4 points  

Question 16

  1. When a patient elects to receive care from a non-PAR, the patient will accrue _____.


    higher copays


    higher out-of-pocket expenses


    lower premiums


    lower copays

4 points  

Question 17

  1. When a number of people are grouped for insurance purposes, this is known as a(n)


    adverse selection


    insurance pool


    member group


    risk pool

4 points  

Question 18

  1. Because the diagnosis and procedure codes reported affect the DRG selected (and resultant payment), some hospitals engaged in a practice called __________, which is the assignment of an ICD-10-CM diagnosis code that does not match patient record documentation, for the purpose of illegally increasing reimbursement.









4 points  

Question 19

  1. The problem-oriented record (POR) is a systematic method of documentation that consists of


    a database.


    progress notes.


    an initial plan.


    all of the above.

4 points  

Question 20

  1. Which of the following is an example of fraud?


        billing noncovered services as covered services


        falsifying certificates of medical necessity plans of treatment


        reporting duplicative charges on an insurance claim


        submitting claims for services not medically necessary

4 points  

Question 21

  1. Care rendered to a patient that was not properly approved (e.g., preapproved) by the insurance company is known as


    medical necessity


    noncovered benefits


    unapproved services


    unauthorized services

4 points  

Question 22

  1. A risk contract is defined as an arrangement among health care providers


    stating that the HMO can provide services to Medicare beneficiaries only


    that allows higher payments to the HMO if they treat Medicare beneficiaries


    to make available capitated health care services to Medicare beneficiaries


    to offer fee-for-service health care services to Medicare beneficiaries

4 points  

Question 23

  1. Which of the following is an example of abuse?


        billing noncovered services/procedures as covered services/procedures


        falsifying health care certificates of medical necessity plans of treatment


        misrepresenting ICD-10-CM and CPT/HCPCS codes to justify payment


        submitting claims for services and procedures knowingly not provided

4 points  

Question 24

  1. Preventive services


    may result in the early detection of health problems.


    are required by most insurance companies.


    allow treatment options that are less dramatic and less expensive.


    both a and c.

4 points  

Question 25

  1. Drew Baker is referred to a health care provider by an employer for treatment of a fracture that occurred during a fall at work. The physician billed Medicare and did not indicate on the claim that the injury was work related. Medicare benefits were paid to the provider for services rendered. This resulted in Medicare contacting the provider, who is liable for the __________ because of the provider’s failure to disclose that the injury was work-related.