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NAME
34 Written questions
1. coverage percentage
INCORRECT
No answer given
THE ANSWER
the percentage at which a payer will reimburse the provider; also called the reimbursement rate. typically are applied after
contractual discounts are applied
2. initial enrollment questionnaire
INCORRECT
No answer given
THE ANSWER
a questionnaire mailed about 3 months before patients become entitled to Medicare. It asks about any other health care
coverage that may be primary to Medicare
3. a loan program where there is a complete, extensive check on the customers credit worthiness and, once the invoices are
sold to the factoring company, the provider is not liable for any non payments
INCORRECT
No answer given
THE ANSWER
factoring of receivables without recourse
4. a document required to be given by hospital to all Medicare and Medicare Advantage beneficiaries who are Hospital
inpatients within two days of admission and again within two days of discharge
INCORRECT
No answer given
THE ANSWER
important message from Medicare
5. The standard claim form used to submit physician and Professional Service claims in the rare instance that a provider
qualify for a waiver from HIPAA mandated electronic claims submission
INCORRECT
No answer given
THE ANSWER
CMS-1500
6. Medicare administrative contractor, Mac
INCORRECT
No answer given
THE ANSWER
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a private firm that processes Medicare claims. Formerly known as fiscal intermediaries or carriers
7. average daily census, ADC
INCORRECT
No answer given
THE ANSWER
the total number of patient days in a given time Divided by the number of days in that period
8. informed consent
INCORRECT
No answer given
THE ANSWER
consent given when a patient has been made aware of the risks and benefits of the services he is about to receive.
required unless an exception is present oh, such as the patient's incapacity to understand the explanation of the
procedures or in an emergency situation
9. Home Health
INCORRECT
No answer given
THE ANSWER
limited part-time or intermittent skilled nursing care and home health aide Services, Physical Therapy, occupational
therapy, speech language therapy, medical social services, medical supplies, and other services
10. Dual eligible
INCORRECT
No answer given
THE ANSWER
an individual who is entitled to Medicare Part A and/or Part B, and also eligible for some form of Medicaid benefit.
11. the percentage of total costs to the total dollar amount received.
INCORRECT
No answer given
THE ANSWER
cost to collect
12. average length of stay, ALOS
INCORRECT
No answer given
THE ANSWER
a metric calculated by dividing the total number of patient Days by the number of discharges
13. a type of denial when one line of the UB claim is rejected. It will usually hit the RTP file and the billing team is allowed to
correct and resubmit the claim, but not to appeal the line rejection
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INCORRECT
No answer given
THE ANSWER
line item rejection
14. a type of skip where the information is wrong due to error on the part of the provider
INCORRECT
No answer given
THE ANSWER
False
15. AR Days
INCORRECT
No answer given
THE ANSWER
a measure of how long, on average, it takes to collect revenue from the date of discharge. Gross AR days have not had
any allowances deducted, while net AR days have had some or many deductions
16. individuals to help consumers and small businesses complete the application process and enroll in health coverage
through the Marketplace
INCORRECT
No answer given
THE ANSWER
Agents
17. implied consent in fact
INCORRECT
No answer given
THE ANSWER
consumed by silence. The patient implied consent to the treatment by not objecting
18. Fair Credit billing Act
INCORRECT
No answer given
THE ANSWER
A law that sets requirements for resolving billing disputes
19. 1-day payment window rule
INCORRECT
No answer given
THE ANSWER
a Medicare requirement similar to the day payment window rule that applies to inpatient poychiatric hosp tals, inpatient
rehabilitation facilities, long term care facilities, and chil dren's and cancer hospital.
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20. judgement
INCORRECT
No answer given
THE ANSWER
a legally verified claim against a debtor validated by the court. A legal right to collect a debt that can be used to obtain a
lien
21. Birthday rule
INCORRECT
No answer given
THE ANSWER
determines coordination of benefits for a child covered by both parents. It dictates that the parent with the first birthday
in the calendar year will provide the primary coverage. If both parents happen to have the same birthday, the plan that
has covered a parent longer pays first
22. another name for Medicare Part C. It replaces traditional fee-for-Service Medicare and often offers better benefits such
as Vision, Dental, or more preventative Services
INCORRECT
No answer given
THE ANSWER
Medicare Advantage
23. incidents or practices of providers Physicians or suppliers of services that although not usually considered fraudulent are
inconsistent with accepted sound medical business or fiscal practices directly or indirectly resulting in unnecessary costs
to the insurer and improper reimbursement for services that fail to meet professionally recognized standards of care or
that are medically unnecessary
INCORRECT
No answer given
THE ANSWER
Abuse
24. CMS
INCORRECT
No answer given
THE ANSWER
Centers for Medicare and Medicaid Services, one of the HHS Operating Divisions
25. one of numerous laws that have determined when Medicare is primary
INCORRECT
No answer given
THE ANSWER
Consolidated Omnibus Budget Reconciliation Act (COBRA)
26. Joint Commission, TJC
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INCORRECT
No answer given
THE ANSWER
a private agency that seeks to protect and improve the quality and safety of care. CMS allows this agency to accredit
hospitals. It inspects facilities and provides education on issues affecting patient care and safety
27. a statement provided by a creditor to a debtor which says something like, this is an attempt to collect a debt and any
information obtained will be used for that purpose
INCORRECT
No answer given
THE ANSWER
Mini Miranda
28. claim rejection
INCORRECT
No answer given
THE ANSWER
the top of denial win the entire claim is rejected. The billing team is allowed to correct and resubmit the claim, but not to
appeal the claim rejection
29. an option for consumers to ask questions about health coverage options and obtain assistance with the Marketplace
application process.
INCORRECT
No answer given
THE ANSWER
Call centers
30. a health insurance program also known as Title XIX. A state-federal partnership intended to ensure that the vulnerable
have access to Medical Care
INCORRECT
No answer given
THE ANSWER
Medicaid
31. local coverage determination, LCD
INCORRECT
No answer given
THE ANSWER
a decision by a carrier whether to cover a particular service on an intermediary wide or Carrier basis
32. Gatekeeper
INCORRECT
No answer given
THE ANSWER
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the primary care physician, or PCP
33. coordinated, palliative care provided to terminally ill patients, sometimes in the patient's home and other times inspection
facility
INCORRECT
No answer given
THE ANSWER
hospice
34. one of the OIGs seven elements of a compliance plan
INCORRECT
No answer given
THE ANSWER
compliance officer
34 Matching questions
1. any equipment that can withstand repeated use, is used for A. Medicare 30-day readmissions
medical purposes, is of generally no use in the absence of
illness or injury, and is intended for use in the home
INCORRECT
No answer given
THE ANSWER
B. Advanced alternative payment models, APMs
C. Inpatient
D. AHRQ
AC. Durable Medical Equipment (DME)
E. Medicare beneficiary identifier or MBI
2. a type of skip in which someone gives false information on
purpose with the intent of skipping out on the debt
INCORRECT
No answer given
THE ANSWER
F. mandatory exclusion
G. minimum data set or MDS
H. Medical Savings Account (MSA)
AG. intentional
I. living will
3. a document that specifies What treatments a patient does
J. International classification of diseases
and does not wish to receive. It means that difficult decisions
about future care are made while the person is alert, patients
can choose the circumstances under which they will die.
patient desires regarding organ donation are made known
INCORRECT
No answer given
K. ANSI
L. Initiation
M. Dismissal (of bankruptcy)
N. Asset control
THE ANSWER
I. living will
4. the top of health care plan used by Medicare Advantage
plans. It includes hmos ppos PFFS plans SMPs and MSAs
O. EOB
P. assignment of benefits
Q. Automated
INCORRECT
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No answer given
THE ANSWER
AH. Coordinated Care plan, CCP
R. Employee Retirement income Security Act ERISA
S. DNR order
T. claim suspension
5. the agency housing the division of financial practices within
its Bureau of Consumer Protection, which is responsible for
taking action against companies that violate debt collection
laws
INCORRECT
U. ACL
V. Medicaid Integrity contractor, MIC
W. Geographic practice cost index
No answer given
THE ANSWER
AB. Federal Trade Commission
6. an entity that reviews and audits Medicaid claims to
identify overpayment. It can look back 5 years and there is no
limit on how many records it may request
INCORRECT
X. 3-day payment window rule
Y. Medicare Appeals Council
Z. Chapter 11 Bankruptcy
AA. False Claims Act
AB. Federal Trade Commission
No answer given
THE ANSWER
V. Medicaid Integrity contractor, MIC
7. explanation of benefits
INCORRECT
No answer given
THE ANSWER
AC. Durable Medical Equipment (DME)
AD. CHNA
AE. FMLA
AF. MSP questionnaire
AG. intentional
O. EOB
AH. Coordinated Care plan, CCP
8. an outcome of a bankruptcy petition where the debtor fails
to meet the terms, such as not by disclosing all assets or not
appearing as required. The petition is thrown out.
INCORRECT
No answer given
THE ANSWER
M. Dismissal (of bankruptcy)
9. Agency for Healthcare Research and Quality; one of the
HHS Operating Divisions
INCORRECT
No answer given
THE ANSWER
D. AHRQ
10. a level of Health Care where, on doctor's orders, the
patient is admitted to a bed with the expectation that the
patient will require hospital care that will span at least two
midnights. Often called acute care
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INCORRECT
No answer given
THE ANSWER
C. Inpatient
11. allows a person who has worked at least 1250 hours in the
last 12 months for a qualified employer to take up to 12 work
weeks of unpaid leave because of his own serious health
condition or that of a family member, or the birth or adoption
of a child
INCORRECT
No answer given
THE ANSWER
AE. FMLA
12. one of two ways conditions can choose to participate in
the quality payment program, clinicians may earn a Medicare
incentive payment for sufficiently participating in an
innovative payment model
INCORRECT
No answer given
THE ANSWER
B. Advanced alternative payment models, APMs
13. the fourth level of both the Medicare and RAC appeals
process
INCORRECT
No answer given
THE ANSWER
Y. Medicare Appeals Council
14. a Medicare requirement that all diagnostic and clinically
related non-diagnostic outpatient services provided with in
three days of an inpatient admission must combined the inpatient claim when they are provided by an entity wholly owned
or oper ated by the inpatient hospital (or by another entity
under arrangements with the admitting hospital).
INCORRECT
No answer given
THE ANSWER
X. 3-day payment window rule
15. patient's written authorization giving the insurance
company the right to pay the physician directly for billed
charges
INCORRECT
No answer given
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THE ANSWER
P. assignment of benefits
16. a type of RAC review where the RAC merely identifies a
potential issue and uses its database to find improper
payments. The provider is then given notification of denied
claims
INCORRECT
No answer given
THE ANSWER
Q. Automated
17. the type of bankruptcy frequently referred to as a
reorganization. It gives a distressed business a reprieve from
creditor claim while it continues to function and works out a
repayment plan
INCORRECT
No answer given
THE ANSWER
Z. Chapter 11 Bankruptcy
18. the type of Medicare Advantage plan with two parts, a
high deductible insurance plan with a medical savings
account that beneficiaries can use to pay for their healthcare
costs
INCORRECT
No answer given
THE ANSWER
H. Medical Savings Account (MSA)
19. Community Health Needs Assessment
INCORRECT
No answer given
THE ANSWER
AD. CHNA
20. a type of denial when the claim is suspended within the
Medicare system for medical review or another reason. The
claim is not hit the RTP file
INCORRECT
No answer given
THE ANSWER
T. claim suspension
21. a number replacing the personally identifiable information
on the Medicare card
INCORRECT
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No answer given
THE ANSWER
E. Medicare beneficiary identifier or MBI
22. a questionnaire designed to help determine if a Medicare
is primary or secondary. It asks about employment, accidents,
and several other relevant subject
INCORRECT
No answer given
THE ANSWER
AF. MSP questionnaire
23. part of the federally required process for clinical
assessment of all residence in Medicare or Medicaid certified
nursing homes. The set then determines the RUG and hence
the payment
INCORRECT
No answer given
THE ANSWER
G. minimum data set or MDS
24. procedures to protect assets from theft
INCORRECT
No answer given
THE ANSWER
N. Asset control
25. the federal law that governs self-insured plans
INCORRECT
No answer given
THE ANSWER
R. Employee Retirement income Security Act ERISA
26. Administration for Community Living; one of the HHS
Operating Divisions.
INCORRECT
No answer given
THE ANSWER
U. ACL
27. a type of office of Inspector General exclusion from
participating in any federal Healthcare program. It applies to
Providers and suppliers convicted of Medicare fraud. Patient
neglect, patient abuse, felonies, healthcare-related fraud,
healthcare-related best, financial misconduct, prescription
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fraud, or unlawfully manufacturing, Distributing, or dispensing
of controlled substances
INCORRECT
No answer given
THE ANSWER
F. mandatory exclusion
28. Do not resuscitate order: gives you permission not to
attempt resuscitation.
INCORRECT
No answer given
THE ANSWER
S. DNR order
29. the beginning of the treatment for a new encounter or a
new plan of care. One of triggering events for a ABN
INCORRECT
No answer given
THE ANSWER
L. Initiation
30. American National Standards Institute
INCORRECT
No answer given
THE ANSWER
K. ANSI
31. hospital readmissions that are tracked and monitored as
part of the registration and admission process. Hospitals with
exes readmissions are liable for payment reductions in
accordance with the hospital readmission Reduction Program
INCORRECT
No answer given
THE ANSWER
A. Medicare 30-day readmissions
32. an adjustment to the values assigned to each RVU to
account for differences in wages and other costs among
different Geographic areas of the country
INCORRECT
No answer given
THE ANSWER
W. Geographic practice cost index
33. legislation that prohibits offering free or discounted
Services to a physician associated with, or who referred
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patient two, another Healthcare facility
INCORRECT
No answer given
THE ANSWER
AA. False Claims Act
34. a mandated transaction code set used for diagnosis and
inpatient procedures
INCORRECT
No answer given
THE ANSWER
J. International classification of diseases
31 Multiple choice questions
1. also known as charge description master or CDM, an electronic file of all charges that might be posted to a patient
account. Each item has an entry with the description and price of the item, it's CPT codes, what general ledger account it
impacts, and, in the case of supplies and medications, inventory control information, such as supplier and cost
itemized statement
Automated
Chargemaster
living will
2. lifetime Reserve LTR
part of the federally required process for clinical assessment of all residence in Medicare or Medicaid certified nursing homes.
The set then determines the RUG and hence the payment
60 days of inpatient Hospital services that a beneficiary can opt to use after having used the 90 days of inpatient Hospital
services in a benefit period. It comes with a high coinsurance and can be used only once in the beneficiary lifetime
a form of acute care for patients who are expected to stay more than 25 days. this also sometimes referred to custodial care that
is offered in nursing homes
a complete listing or detailed account of every service posted to a patient account with date of service, description of service,
service code, charge amount, estimated Insurance amount, patient pay amount, and totals
3. I recorded claim against real or personal property, generally arising out of a debt. If the property is sold by the debtor, the
Creditor must be paid out of the proceeds of that sale
Agents
judgement
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lien
AHRQ
4. both the process of and the charge for examining a patient and formulating a treatment plan
Advance Beneficiary Notice ABN
evaluation and management
Mini Miranda
local coverage determination, LCD
5. fraud
the intentional or illegal deception or misrepresentation that an individual knows or suspect to be false and knows that the
deception could result in some type of benefit themselves, some of the person, or organization
the type of bankruptcy where the debtor does not have any means to repay debts, assets, if any, are divided among the creditors
according to precedent. Legal fees, then secured debts, then unsecured debt such as medical bills
the agency housing the division of financial practices within its Bureau of Consumer Protection, which is responsible for taking
action against companies that violate debt collection laws
The standard claim form used to submit physician and Professional Service claims in the rare instance that a provider qualify for a
waiver from HIPAA mandated electronic claims submission
6. a mandated transaction code set for outpatient procedures
Coordinated Care plan, CCP
ACL
Healthcare common procedure coding system
Clinical Laboratory Improvement Amendment
7. a program designed to reduce errors due to clerical entries and incorrect coding based on an atomic considerations, CPT
code descriptors, CPT coding instructions, established CMS policies, nature of a service or procedure, nature of
equipment, and unlikely clinical treatment
initial enrollment questionnaire
average length of stay, ALOS
medically unlikely edit or mue
Medicare beneficiary identifier or MBI
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8. conflict of interest
the top of health care plan used by Medicare Advantage plans. It includes hmos ppos PFFS plans SMPs and MSAs
a situation where one or more parties to an arrangement have an opportunity to exploit their position for personal or business
advantage
A law that sets requirements for resolving billing disputes
Administration for Community Living; one of the HHS Operating Divisions.
9. CHIP
a person who has healthcare insurance for Medicare
a health insurance program also known as Title XIX. A state-federal partnership intended to ensure that the vulnerable have
access to Medical Care
Children's Health Insurance Program
the primary care physician, or PCP
10. DNFB
discharged not final billed
Children's Health Insurance Program
Administration for Children and Families one of HHS operating divisions
American National Standards Institute
11. a type of facility that provides services to patients that need intensive rehabilitation services to improve the individual's
overall physical condition
average length of stay, ALOS
durable power of attorney for health care
long term care
inpatient Rehabilitation facility
12. consent that is inferred from certain actions or by inaction
harassment
Asset control
Call centers
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Implied consent
13. complex
a type of RAC review where the RAC merely identifies a potential issue and uses its database to find improper payments. The
provider is then given notification of denied claims
a type of discharge in which a patient's financial considerations have been met so he or she is allowed to leave the hospital
without going through the usual formalities; the patient is billed at a later date.
a type of RAC review where the RAC request medical records and makes its determination from them
coordinated, palliative care provided to terminally ill patients, sometimes in the patient's home and other times inspection
facility
14. conditional payment
a type of skip in which someone gives false information on purpose with the intent of skipping out on the debt
a reorganization form of bankruptcy for individuals that allows the debtors to keep their property and use their income to pay a
portion of their debts over three to five years
the type of bankruptcy where the debtor does not have any means to repay debts, assets, if any, are divided among the
creditors according to precedent. Legal fees, then secured debts, then unsecured debt such as medical bills
payment made when another pair is responsible, but the claim is not expected to be paid promptly, usually within 120 days from
receipt of the claim. It prevents the beneficiary from having to pay out-of-pocket. Medicare then has the right to recover any
payments that should have been made by another payer
15. Medicare outpatient observation notice or MOON
one of five types of Medicare Advantage plans. Generally the most restrictive of the CCP models because they control
utilization and restricts the network of providers from which the beneficiary can receive services
a standardized notice developed to inform beneficiaries when they are in a patient receiving observation services. Established
by the notice Act
consent that occurs in a situation where the patient is unconscious and is taken to the emergency room. The law allows treating
patient
allows a person who has worked at least 1250 hours in the last 12 months for a qualified employer to take up to 12 work weeks of
unpaid leave because of his own serious health condition or that of a family member, or the birth or adoption of a child
16. document that designates a health care proxy, who is authorized make health care decisions for a client who is unable
durable power of attorney for health care
important message from Medicare
Medicare administrative contractor, Mac
Advanced alternative payment models, APMs
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17. Comprehensive legislation that is designed to protect individuals with disabilities against discrimination.
Healthcare common procedure coding system
Employee Retirement income Security Act ERISA
Anti-Kickback Statute
Americans with Disabilities Act, ADA
18. implied consent by law
Prohibits offering, paying, soliciting or receiving anything of value to induce or reward referrals or generate federal healthcare
program business.
A form of bankruptcy that lets family farmers and fishing businesses create a plan for debt repayment that allows them to keep
their operations running
consent that occurs in a situation where the patient is unconscious and is taken to the emergency room. The law allows treating
patient
Do not resuscitate order: gives you permission not to attempt resuscitation.
19. also known as utilization review or UR, an area that works with patient access in a collaborative approach that includes
assessing providing coordinating and monitoring
fee schedule
Mini Miranda
Medicare Advantage
case management
20. Chapter 13 Bankruptcy
also known as utilization review or UR, an area that works with patient access in a collaborative approach that includes
assessing providing coordinating and monitoring
the agency housing the division of financial practices within its Bureau of Consumer Protection, which is responsible for taking
action against companies that violate debt collection laws
a private agency that seeks to protect and improve the quality and safety of care. CMS allows this agency to accredit hospitals.
It inspects facilities and provides education on issues affecting patient care and safety
a reorganization form of bankruptcy for individuals that allows the debtors to keep their property and use their income to pay a
portion of their debts over three to five years
21. a liability noticed similar to an ABN. Hospitals give non coverage notice for fee for service inpatient Hospital beneficiaries
who are due to receive specific diagnostic or therapeutic procedures that are separate from treatment cover to the
inpatient stay
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Hospital-Issued Notice of Noncoverage (HINN)
local coverage determination, LCD
important message from Medicare
certified application counselor
22. the fifth and final level of both the Medicare and the RAC appeals process
implied consent in fact
Medicaid Integrity contractor, MIC
Medicare administrative contractor, Mac
Federal District Court
23. American Hospital Association
CHIP
AHA
EOB
DNFB
24. a payment methodology for some out patient services. The schedule lists CPT and hcpcs codes and what Medicare
allowed for each, before deductible and coinsurance is applied
Home Health
coverage percentage
ambulatory payment classification, APC
fee schedule
25. Agency for Toxic Substances and Disease Registry; one of the HHS Operating Divisions.
False
CMS
ATSDR
complex
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26. a method of payment in which a provider is paid a set dollar amount for each patient for a specific time period, and that
payment covers all care the group of patients receive for that period, no matter the actual charges
claim rejection
Chapter 7 Bankruptcy
Capitation
Inpatient
27. Chapter 7 Bankruptcy
the type of bankruptcy where the debtor does not have any means to repay debts, assets, if any, are divided among the
creditors according to precedent. Legal fees, then secured debts, then unsecured debt such as medical bills
the use of certified EHR technology to achieve health and efficiency goals. It can qualify a provider for federal or state funds
60 days of inpatient Hospital services that a beneficiary can opt to use after having used the 90 days of inpatient Hospital
services in a benefit period. It comes with a high coinsurance and can be used only once in the beneficiary lifetime
a method of payment in which a provider is paid a set dollar amount for each patient for a specific time period, and that
payment covers all care the group of patients receive for that period, no matter the actual charges
28. Fair Credit Reporting Act
A federal law that established procedures that consumer-reporting agencies must follow in order to ensure that records are
confidential, accurate, relevant and properly used.
the type of Medicare Advantage plan with two parts, a high deductible insurance plan with a medical savings account that
beneficiaries can use to pay for their healthcare costs
Comprehensive legislation that is designed to protect individuals with disabilities against discrimination.
Administration for Community Living; one of the HHS Operating Divisions.
29. certified application counselor
a loan program where there is an agreement with the provider and the factoring company that's the provider except the
default. If the patient defaults on the loan, the provider must pay back the financial institution
individuals who fulfill some of the same roles as Navigators and non Navigators. They are not responsible for outreach and
education but they do provide free information to customers about insurance programs. They assist them in applying for
coverage, and they help to facilitate the enrollment in health coverage
an adjustment to the values assigned to each RVU to account for differences in wages and other costs among different
Geographic areas of the country
a document required to be given by hospital to all Medicare and Medicare Advantage beneficiaries who are Hospital inpatients
within two days of admission and again within two days of discharge
30. courtesy discharge
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a form of acute care for patients who are expected to stay more than 25 days. this also sometimes referred to custodial care
that is offered in nursing homes
a complete listing or detailed account of every service posted to a patient account with date of service, description of service,
service code, charge amount, estimated Insurance amount, patient pay amount, and totals
a level of Health Care where, on doctor's orders, the patient is admitted to a bed with the expectation that the patient will
require hospital care that will span at least two midnights. Often called acute care
a type of discharge in which a patient's financial considerations have been met so he or she is allowed to leave the hospital
without going through the usual formalities; the patient is billed at a later date.
31. 837P
Agency for Healthcare Research and Quality; one of the HHS Operating Divisions
the percentage of allowable charges, which the patient must pay after paying his deductible
a type of skip where the information is wrong due to error on the part of the provider
the HIPAA standard transaction that replaces the CMS-1500 and is required of almost all physicians.
34 True/False questions
1. the third level of both the Medicare and RAC appeals process → balanced budget act, BBA
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → administrative law judge, ALJ
2. Coinsurance → the percentage of allowable charges, which the patient must pay after paying his deductible
True
False
INCORRECT
No answer given
THE ANSWER
True
It should be → the percentage of allowable charges, which the patient must pay after paying his deductible
3. the use of certified EHR technology to achieve health and efficiency goals. It can qualify a provider for federal or state
funds → meaningful use or mu
True
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False
INCORRECT
No answer given
THE ANSWER
True
It should be → meaningful use or mu
4. balanced budget act, BBA → Do not resuscitate order: gives you permission not to attempt resuscitation.
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → one of numerous laws that have determined when Medicare is primary
5. locum tenens → a temporary substitute, especially for a doctor or member of the clergy
True
False
INCORRECT
No answer given
THE ANSWER
True
It should be → a temporary substitute, especially for a doctor or member of the clergy
6. 838 report → coordinated, palliative care provided to terminally ill patients, sometimes in the patient's home and other
times inspection facility
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → a mandatory quarterly credit balance report used to monitor identification and recovery of credit balances
owed to Medicare.
7. ACF → American National Standards Institute
True
False
INCORRECT
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No answer given
THE ANSWER
False
It should be → Administration for Children and Families one of HHS operating divisions
8. one of five types of Medicare Advantage plans. Generally the most restrictive of the CCP models because they control
utilization and restricts the network of providers from which the beneficiary can receive services → Health maintenance
organization
True
False
INCORRECT
No answer given
THE ANSWER
True
It should be → Health maintenance organization
9. individuals who help consumers and small businesses complete the application process and enroll in health care
coverage through the marketplace. They are able to make recommendations about coverage and may only sell plans from
specific health insurance companies → Abuse
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → agents
10. Clinical Laboratory Improvement Amendment → the third level of both the Medicare and RAC appeals process
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → legislation that provides for the registration, certification, and inspection of all laboratory sites to ensure
quality Laboratory Testing
11. hey health insurance program also known as title XVI. It's covered individuals who are elderly, age 65 or older, or have
permanent disabilities, ESRB, for Lou Gehrig's disease → Medicare
True
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False
INCORRECT
No answer given
THE ANSWER
True
It should be → Medicare
12. a person who has healthcare insurance for Medicare → Gatekeeper
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → beneficiary
13. Prohibits offering, paying, soliciting or receiving anything of value to induce or reward referrals or generate federal
healthcare program business. → False Claims Act
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → Anti-Kickback Statute
14. a CMS file that contains Medicare patient eligibility and utilization data → local coverage determination, LCD
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → Common Working File (CWF)
15. DMERC → the oldest method of payment, in which providers are paid for each medical service rendered to a patient
True
False
INCORRECT
No answer given
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THE ANSWER
False
It should be → Durable Medical Equipment Regional Center, one of four carriers, different from hospital and physician
MACs, where DME is billed
16. A law that protects consumers from abusive practices by creditors and collection agencies → Fair Debt Collection
Practices Act
True
False
INCORRECT
No answer given
THE ANSWER
True
It should be → Fair Debt Collection Practices Act
17. a federal agency responsible for regulating food and drug products sold to the public. One of the HHS Operating
Divisions → average length of stay, ALOS
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → Food and Drug Administration (FDA)
18. a form of acute care for patients who are expected to stay more than 25 days. this also sometimes referred to custodial
care that is offered in nursing homes → accrual method
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → long term care
19. Durable medical equipment, prosthetics, orthotics, and supplies → DMEPOS
True
False
INCORRECT
No answer given
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THE ANSWER
True
It should be → DMEPOS
20. a system of descriptive terms and five-digit, alphanumeric codes that are used to primarily identify medical services and
procedures furnished by physicians and other Healthcare professionals → initial enrollment questionnaire
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → current procedural terminology CPT
21. electronic remittance advice → EOB
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → ERA
22. HIPAA (Health Insurance Portability and Accountability Act) → a decision by a carrier whether to cover a particular
service on an intermediary wide or Carrier basis
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → its primary objective was protecting Insurance subscribers from loss of coverage due to job changes. It
also establishes the privacy and security rules
23. Advance Beneficiary Notice ABN → both the process of and the charge for examining a patient and formulating a
treatment plan
True
False
INCORRECT
No answer given
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THE ANSWER
False
It should be → Document that acknowledges patient responsibility for payment if Medicare denies the claim.
24. Charity Care → care given to a patient who doesn't have the means to pay and meets established charity care guidelines
True
False
INCORRECT
No answer given
THE ANSWER
True
It should be → care given to a patient who doesn't have the means to pay and meets established charity care guidelines
25. a payment methodology used for Medicare's OPPS which places services into groups based on similar clinical
characteristics and similar cost. Each a PC has a weighted value that bundles payment for Associated services → fee
schedule
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → ambulatory payment classification, APC
26. accrual method → a method of accounting that generally recognizes income in the period earned and recognizes
deductions in the period that liabilities are incurred.
True
False
INCORRECT
No answer given
THE ANSWER
True
It should be → a method of accounting that generally recognizes income in the period earned and recognizes
deductions in the period that liabilities are incurred.
27. Chapter 12 Bankruptcy → A form of bankruptcy that lets family farmers and fishing businesses create a plan for debt
repayment that allows them to keep their operations running
True
False
INCORRECT
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No answer given
THE ANSWER
True
It should be → A form of bankruptcy that lets family farmers and fishing businesses create a plan for debt repayment that
allows them to keep their operations running
28. 8371 → the HIPAA standard transaction that replaces the CMS-1500 and is required of almost all physicians.
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → the dataset that is utilized to electronically submit hospital claims to the payer.
29. itemized statement → a level of Health Care where, on doctor's orders, the patient is admitted to a bed with the
expectation that the patient will require hospital care that will span at least two midnights. Often called acute care
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → a complete listing or detailed account of every service posted to a patient account with date of service,
description of service, service code, charge amount, estimated Insurance amount, patient pay amount, and totals
30. harassment → conduct that makes the workplace disturbing or threatening. It can be sexual or otherwise and can take
many forms
True
False
INCORRECT
No answer given
THE ANSWER
True
It should be → conduct that makes the workplace disturbing or threatening. It can be sexual or otherwise and can take
many forms
31. factoring of receivables with recourse → a loan program where there is an agreement with the provider and the factoring
company that's the provider except the default. If the patient defaults on the loan, the provider must pay back the
financial institution
True
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False
INCORRECT
No answer given
THE ANSWER
True
It should be → a loan program where there is an agreement with the provider and the factoring company that's the
provider except the default. If the patient defaults on the loan, the provider must pay back the financial institution
32. the oldest method of payment, in which providers are paid for each medical service rendered to a patient → claim
rejection
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → fee-for-service
33. midnight census → the oldest method of payment, in which providers are paid for each medical service rendered to a
patient
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → the Census count for the previous midnight, minus any discharges, plus any admissions, plus or minus any
status changes
34. Advance beneficiary notice → conduct that makes the workplace disturbing or threatening. It can be sexual or otherwise
and can take many forms
True
False
INCORRECT
No answer given
THE ANSWER
False
It should be → Document that acknowledges patient responsibility for payment if Medicare denies the claim.
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