Rev Cycle Final
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| In the United States, what is healthcare insurance? | show 🗑
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| The physician's office sent a request for payment to Able Insurance Company. The term used in the healthcare industry for this request of payment is a/n_____ | show 🗑
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| All of the following are discounted fee-for-service healthcare payment methods except: | show 🗑
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| show | Worker's compensation insurance
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| In which type of reimbursement methodology, do healthcare insurance companies reimburse providers after the costs have been incurred? | show 🗑
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| The Physician says theIC is paying for the exacerbation of CHF that the patient had The exacerbation, treatment and resoultion covered 5 weeks. The payment covered all services that the patient had. What method of reimbursment was the practice receiving? | show 🗑
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| The health plan reimburses Dr. Tan $15 per patient per month. In January, Dr. Tan saw 300 patients so he received $4,500 from the health plan. What method is the health plan using to reimburse Dr. Tan? | show 🗑
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| show | Reimbursement
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| show | Employment
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| show | Retrospective
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| show | Per member per month
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| In which type of healthcare payment method does the healthcare plan pay for each service that a provider renders? | show 🗑
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| In the health care industry, what is another word for "charge"? | show 🗑
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| show | The guarantor will pay the entire bill
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| What is the term for a predetermined list of charges? | show 🗑
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| show | Renegotiate the contract
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| show | allowable fee
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| show | Resource based relative value scale
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| show | Capitated rate
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| Medicare's payment system for home health services consolidates all types of services, such as speech, physical, and occupational therapy, into a single lump sum payment. What type of healthcare payment method does this lump sum represent? | show 🗑
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| show | Per diem
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| From the patient's healthcare insurance plan, the rehab facility received a fixed, pre established payment for the patient rehabilitation after a total knee replacement. What type of healthcare payment method was the patient's insurance plan using? | show 🗑
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| All of the following are refined case based payment methods except: | show 🗑
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| show | ICD-9-CM
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| Which of the following coding systems was created for reporting procedures and services performed by physicians in clinical practice? | show 🗑
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| Under MS-DRGs, all of the following factors influence a facility's case mix index, EXCEPT for: | show 🗑
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| show | Determine the correct MS-DRG for the encounter
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| The practice of undercoding can affect a hospital's MS-DRG case mix index in which of the following ways? | show 🗑
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| Which of the following is the correct format for HCPCS level II codes? | show 🗑
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| show | Operation Restore Trust
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| show | Payment Error Prevention Program
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| show | All of the above
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| show | A and B are both correct
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| All of the following entities are voluntary healthcare insurance except? | show 🗑
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| Which of the following entities is also known as a "group plan" | show 🗑
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| show | JANE B. WHITE
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| From figure 1, determine whether the plan covers Gill F. White, Jane's spouse. | show 🗑
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| What third party payer does figure 1 represent? | show 🗑
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| According to figure 1, what type of coverage does the third party payer provide Jane B. White? | show 🗑
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| From figure 1, determine the insured | show 🗑
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| show | Greater benefits for lower premiums
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| show | For profit in the private sector
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| In regards to healthcare insurance, the percentage that the guarantor pays is called the: | show 🗑
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| The insurance analyst at the large group practice is responsible for issues related to coordination of benefits. What does he or she do? | show 🗑
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| Which of the following services has the highest likelihood of being a covered service? | show 🗑
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| The guarantor paid $2000 as coinsurance on medical bills. Per the insurance policy, the plan would now pay 100% of remaining bills with no coinsurance being assessed as the guarantor. What type of provision does this clause in the policy represent? | show 🗑
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| What is the term for the contract between the healthcare insurance company and the individual or group for whom the company is assuming the risk? | show 🗑
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| show | benefit
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| The child's prescription drug is not on the healthcare plan's formulary. The pharmacist states that the drug's cost is 113.45. Per figure 2, how much should the guarantor expect to pay for the prescription? | show 🗑
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| What does figure 4 represent? | show 🗑
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| show | No, as evidenced by the guarantor's payment of $250
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| Per figure 4, after the payment of the third party payer, how much will the guarantor have to pay? | show 🗑
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| show | $3.60
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| _____ ______ Nursing home care | show 🗑
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| ________ salary security for lengthy illness | show 🗑
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| show | Accidental death and dismemberment
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| show | Medigap
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| show | Part D
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| show | TRICARE
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| show | Temporary Assistance for Needy Families Program (TANF)
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| show | Provides only inpatient healthcare services
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| The civilian health and medical program of the department of veterans affairs (CHAMPVA) is available for: | show 🗑
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| Which of the following is/are true of SCHIP? | show 🗑
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| show | 4
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| Medicare part C is a ________ option known as Medicare Advantage | show 🗑
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| All of the following are true of state Medicaid programs EXCEPT: | show 🗑
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| Which TRICARE program offers services to active duty family families (ADFMs) with no enrollment, deductible, or copayment fees for covered services? | show 🗑
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| In which type of HMO are the physicians employees? | show 🗑
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| Today's managed care traces its origins to all of the following arrangements except: | show 🗑
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| show | To encourage the delivery of affordable quality healthcare
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| show | Freedom of choice and autonomous decision making
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| Access to mental or behavioral health or medical specialists is through referral. What is the term for the individual who makes the referral? | show 🗑
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| show | Focus on single specialist for acute disease
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| What is the term for an explicit statement that directs clinical decision making? | show 🗑
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| All of the following are tools managed care organizations use to promote quality care in their healthcare plans except: | show 🗑
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| show | Reasons for referrals to specialists
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| show | Utilization review
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| show | Standard of care for health condition
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| All of the following sets represent criteria for medical necessity and utilization review except: | show 🗑
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| All of the following services are typically reviewed for medical necessity and utilization except: | show 🗑
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| show | Rate of capitation or reimbursement
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| show | Precertification
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| The patient belonged to a managed care plan. The patient had an elective surgery had not been obtained. What should the patient expect? | show 🗑
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| show | Treatment protocols that have low risk
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| For what type of care should the physician practice manager expect to work with a case manager? | show 🗑
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| What is the term for contracts that separate out certain types of healthcare services to decrease MCO's risk? | show 🗑
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| All of the following are elements of prescription management except: | show 🗑
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| All of the following attributes characterize episode of care reimbursement except: | show 🗑
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| show | bonus
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| A patient, who was a medicaid recipient asked about the types of fiancial incentives that the MCO used. What should the MCO's administrator do? | show 🗑
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| The patient belongs to a managed care plan. The patient wants to make an appointment with an out of network specialist. The plan has approved the appointment as "out of plan". What should the patient expect: | show 🗑
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| show | Staff model
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| What is meant by the phrase "point of service" in "point of service insurance plan"? | show 🗑
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| show | Medicare advantage
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| Integrated delivery systems use varying degrees of integration. Which degree of integration is least binding? | show 🗑
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| In the group practice, the physicians have maintained their separate practices and offices. The individual practices share administrative systems to form a group practice. Which form of integrated delivery system does this arrangement represent? | show 🗑
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| show | Patient's awareness of and responsibility for healthcare costs
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| show | Incentive for cost control because hospitals retain profits or suffer losses based on differences between payment rate and actual costs
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| What is the average of the sum of the relative weights of all patients treated during a specified time period? | show 🗑
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| The MS-DRG payment includes reimbursement for all the following inpatient services except: | show 🗑
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| Select the highest level of the IPPS hierarchy: | show 🗑
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| What is the general term for software that assigns inpatient diagnosis related groups? | show 🗑
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| show | Disproportionate share hospital
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| What condition does CMS require be met for a facility to receive the indirect medical education adjustment? | show 🗑
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| New medical technologies are often very expensive. What is the CMS's position on the use of technologies to treat Medicare beneficiaries? | show 🗑
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| What is the name of the entity that pays Medicare Part A claims? | show 🗑
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| show | Consumption of resources
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| In the IPPS, what is the term for each hospital's unique standardized amount based on its costs per Medicare discharge? | show 🗑
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| What is the basis of the labor related share? | show 🗑
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| A Medicare patient was discharged from one acute IPPS and admitted to another acute IPPS hospital on the same day. How will the two acute IPPS hospitals be reimbursed? | show 🗑
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| For purposes of Medicare reimbursement, which of the following situations represents a discharge from the the first acute IPPS hospital? | show 🗑
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| Which is the correct formula for wage index adjustment? | show 🗑
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| Which reimbursement scheme is used in the Inpatient Psychiatric Facility Prospective Payment System? | show 🗑
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| show | Length of stay outlier
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| Under the IPF PPS which states are included in the cost of living adjustment (COLA)? | show 🗑
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| show | Full service emergency department
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| show | MS-DRG calculated for the encounter
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| Which congressional act called for the creation of a PPS for the psychiatric inpatient setting? | show 🗑
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| show | Conversion factor
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| What is the term for an index based on relative differences in the cost of a market basket of goods across areas? | show 🗑
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| All of the following elements are used to calculate a Medicare payment under the RBRVS EXCEPT: | show 🗑
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| show | RBRVS payment system reflects the skill and resources required for each procedure
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| Which researcher is associated with the RBRVS payment system? | show 🗑
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| show | Harvard
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| show | Ambulance
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| Which element of the RVU accounts for the cost of the medical practice, such as office rent, wages of nonphysician personnel and supplies and equiptment? | show 🗑
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| All of the following items are packaged under the Medicare Hospital Outpatient Prospective Payment System (HOPPS) except for | show 🗑
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| Under the HOPPS, outpatient services that are similar both clinically and in use of resources are assigned to separate groups called ______? | show 🗑
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| show | APCs are based on the CPT or HCPCS code(s) reported
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| In the APC system, an outlier payment is paid when which of the following occurs? | show 🗑
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| show | T- surgical service
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| show | unlimited
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| The prospective payment system used by hospitals for the majority of services provided to Medicare hospital outpatients is called _______ and became effective on ______. | show 🗑
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| This PPS has been adopted for use by many third party payers (that is, Medicaid) for reimbursement of outpatient visits. It is NOT the methodology used by Medicare | show 🗑
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| show | hold harmless
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| show | percent of billed charges
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| show | Omnibus consolidated and Emergency Supplemental Appropriations Act of 1999
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| show | Ambulance
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| show | Provider
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| Which act of congress added a new section to the SSA calling for the creation of a PPS for ambulance services? | show 🗑
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| The Ambulance Fee Schedule was implemented on _______. | show 🗑
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| Under the Ambulance Fee Schedule the_______ is used to determine the level of service for ground transport. | show 🗑
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| show | Urban area service adjustment
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| When a patient is pronounced dead prior to an ambulance being called, which of the following payment provisions is followed under the Ambulance Fee Schedule? | show 🗑
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| show | The ASC list of covered procedures
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| show | (payment rate*labor portion *WI) + (payment rate*nonlabor portion) (payment rate * WI)
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| Under the ASC List multiple procedures performed during the same surgical session are reimbursed at which of the following rate? | show 🗑
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| show | between 2006 and 2008
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| The medicare moderization act of 2003 mandated the creation of a new PPS for ASC services because ________ | show 🗑
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| Medicare-certified ASCs must accept assignment, meaning | show 🗑
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| Under the SNF, PPS which of the following healthcare services is excluded from the consolidated payment? | show 🗑
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| show | Resource utilization groups
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| show | Minimum data set
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| The therapist in the skilled nursing facility is treating multiple patients who are each performing different therapies. How does tthe CMS classify this mode of delivery? | show 🗑
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| show | Market basket
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| In which of the PAC payment systems, is the unit of payment the 60 day episode of care? | show 🗑
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| show | Special care
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| Generally, what is the average length of stay of long term care hospitals? | show 🗑
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| show | acute myocardial infarction
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| show | exactly the same
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| In terms of grouping and reimbursement, how are the MS-LTC-DRGs and acute care MS-DRGs similar? | show 🗑
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| show | constant that converts the MS-LTC-DRG weight into a payment
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| show | To promote equity for beneficiaries, facilities, and taxpayers
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| To meet the definition of an IRF, facilities must have an inpatient population with at least a specified percentage of patients with certain conditions. Which of the following conditions is counted in the defintion? | show 🗑
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| show | major diagnostic category
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| All of the following types of diagnoses are used in the IRF PPS except: | show 🗑
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| In the IRF, PPS what is the tool for data collection that drives payment? | show 🗑
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| What data set provides the underpinning of the HHPPS? | show 🗑
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| show | Durable medical equipment
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| show | Medical malpractice
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| How many HHRGs are there? | show 🗑
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| For what variations in resource consumption does the HHPPS account? | show 🗑
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| show | Labor portion
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| In which of the PAC payment systems, is the adjusted rate multipied by the patient's number of Medicare days to determine the reimbursement amount? | show 🗑
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| show | Functional status
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| What targets should be the focus of pay per performance or value based purchasing systems? | show 🗑
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| show | Compensation withheld for lack of improvement
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| Which of the following entities sponsor value based purchasing or pay for performance systems? | show 🗑
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| How do organizations control costs indirectly? | show 🗑
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| Why are incremental implementations of pay for performance systems perferable to full scale implementations? | show 🗑
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| show | Authoritarian
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| Which of the following incentives is non-fiancial? | show 🗑
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| In order for p4p abd VBP systems to function properly, the system must be able to identify the clinican who provided the care and is responsible for the care's quality. In P4P and VBP, this process is known as | show 🗑
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| show | Hospital outpatient departments and ambulatory surgical centers
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| show | Staphylococcus infections
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