When a number of people are grouped for insurance purposes, this is known as a(n) adverse selection insurance pool member group risk pool

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quiz

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. capitation fixed premium sub-capitation

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 beneficiary guarantor guardian subscriber

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 HIPAA Stark II laws

4 points  

Question 8

  1. The recognized difference between fraud and abuse is the cost intent payer timing

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 coinsurance copayment deductible premium

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 directives laws regulations standards

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? inpatient nursing facility outpatient rehabilitation

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.     downcoding   jamming    unbundling     upcoding

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.    adjudication   mediation     overpayment     unbundling