Which document is used to guarantee the patient’s financial and medical record? encounter form patient insurance form patient ledger patient registration form

Question 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. capitation fixed premium sub-capitation
4 points

Question 2

The healthcare industry is heavily regulated by ____ and ____ legislation. city; local state; city county; state federal; state
4 points

Question 3

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

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

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

The person responsible for paying the charges for services rendered by the provider is the beneficiary guarantor guardian subscriber
4 points

Question 7

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 HIPAA Stark II laws
4 points

Question 8

The recognized difference between fraud and abuse is the cost intent payer timing
4 points

Question 9

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 coinsurance copayment deductible premium
4 points

Question 10

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

Mandates are directives laws regulations standards
4 points

Question 12

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

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

The ambulatory payment classification prospective payment system is used to reimburse claims for what services? inpatient nursing facility outpatient rehabilitation
4 points

Question 15

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

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

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

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. downcoding jamming unbundling upcoding
4 points

Question 19

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

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

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

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

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

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

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. adjudication mediation overpayment unbundling