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Which of the following is an operating division of HHS (select all that apply)

Food and Drug Administration (FDA)

Department of veteran affairs (VA)

Administration for Community (ACL)

Adminsitration for children and families (ACF

Administration for healthy living for Seniors (AHLS)

What is the CMS program to monitor and improve utilization and quality of care for medicare beneficiaries (select 1)

Quality Improvement Organization QIO

Health Insurance marketplace (HIM)

American Hospital Association (AHA)

State Childrens Health Insurance Program SCHIP

Which of the following is true of the patient care Partnership (select all that apply)

It replaces the "patient's bill of rights"

It was adopted by the AHA

Outlines what a provider can expect

It is a plain language brocure

Addresses patient expectations from admission to dismissal only

Whiche of the following is not a typical goal for reengineering patient access (select one)

Place the focus on customer service to improve the initial patient impression

Identify ways to decrease wait times

Free up staff time for training on new technology and regulations

Preregister patients whenever pssible

Which of the following is not gathered during preregistration or preadmission (select one)

History of chief complaint

Patient demographics

Financial information

Socioeconomic information

What is the term for diagnostic medical testing before surgical or invasive procedures to determine hospitalization/surgical suitability (select one)

Therapeutic medical screening

Preadmission testing

Preadmission screening

Diagnostic medical screening

Which of the following is not true of precertification and preauthorization (select one)

The key success factor is implementing a strong customer service philosophy and forming a feeling of partnership between the patient and provider

It means getting authorization from an insurance company review organization approving the medical necessity of the service

It involves getting authorization to treat and authorization for an average length of stay/number of services for the patient's condition

Failure to preauthorize can result in total denial of claims with related increases in appeals, time spent by billing staff in rework and lost revenue

Which of the following is not a suggested practice before seeing a patient in the office (select one)

Gathering information (new vs. Established patient, purpose of appointment, name of referring physician/PCP, insurance information, etc)

Mailing the Notice of Privacy Practices

Pulling charts and preparing fee tickets

Obtaining referrals for visits

Which of the following is not a recommended question to answer during insurance verification (select one)

Is precertification required? Has it been obtained?

What is the deductible amount and has any portion of it been met

What is the address and telephone number of the claims office

Has the policy holder ever been late with a premium payment

What information is needed to calculate the patient's estimated responsibility for a hospital stay (select all that apply)

ALOS for the diagnosis

Average cost per day by type of service

Admitting physician's estimated length of stay

The hospital's flat rate procedures/drg/contractural payer allowance

The daily room charge by type

Patient third-party insurance plan benefit levels

Which of the following is not true of the requirements to notify beneficiaries when they are an outpatient receiving observation services and not an inpatient (select one)

The requirement is part of the NOTICE Act and MOON is the standardized notice used

The requirement is for both written and oral notification

The notification must be provided within 24 hours to patients who are in observation status for more than 12 hours

If the beneficiary/representative does not sign the form, the following are required: staff member name, signature, and title, certification that the notification was presented with date and time, and an annotation in the additional information section of the form

Which of the following is not true of the ABN (select one)

The ABN must contain a brief description of the service, the estimated cost, and the reason the service is not expected to be covered

A signed ABN supports Medicare's rule that a beneficiary is not protected from financial liability if that person had or should have had knowledge that a service was noncovered.

The ABN must be signed and faxed to Medicare no later than 24 hours after the service is performed

While it is usually inappropriate to use ABNs in the ER, it is also inappropriate to just write off all noncovered ER services as this could be construed as an inducement

Entities that issue ABNs sare know by CMS as "notifiers"

What is the name for ABN triggering event when there is a discontinuation in the services being provided (select one)

Initiation

Reduction

Cessation

Termination

What are some of the critical tasks performed by case management/utilization review (select all that apply)

Preventing unnecessary services or treatment

Evaluating an individual's safety and ability to live independently at home

Obtaining appropriate medical care

Arranging for transportation to and from Doctor appointments

What type of care would be provided in the following scenario - A woman is the primary caregiver for her husband, who has multiple sclerosis. The patient needs an alternate caregiver while his wife recovers from an injury

Respite care

Hospice care

SNF - skilled nursing facility

Home health

To qualify for SNF coverage, Medicare requires a person to have been a hospital inpatient for at least three consecutive days (not including the day of discharge)

True

False

What is the name for a policyholder's written authorization to have insurance benefits paid directly to the provider (select one)

Conditional payments

Provisional benefits

Assignment of benefits

Authorization of payments

In what situation is a person prevented from consenting to service (select all that apply)

The person is an emancipated minor

The person is uninsured

The person is intoxicated

The person is declared mentally incompetent by the courts

Should a correction be required to a medical record, an authorized person should use correction fluid to neatly obscure the error and continue the note

True

False

Which of the following is authorized to make entries in the patient's medical record (select all that apply)

Treating/attending physician

A physician extender

Licensed, registered nurse

A financial counselor

A student from an accredited health profession program (under the supervision of his or her clinical instructor)

What does the Acronym NCD stand for (select one)

National Coverage Determination

National coverage Department

New Coverage Determination

New coverage Direction

Which type of LCD/NCD provides potential coverage circumstances, but most likely does not provide specified diagnoses, signs, symptoms, or ICD-10 codes that will be covered or non-covered (select one)

Definitive LCD/NCD

Non-definitive LCD/NCD

Which of gthe following is not true of MSP laws (select one)

Until 2010, Medicare was the primary payor for nearly all Medicare covered services

Before becoming entitled to Medicare, beneficiaries receive an IEQ that askes about any other healthcare coverage that might be primary to Medicare

Medicare considers it a fraudulent or abusive practice to regularly submit claims that are the responsibility of another insurer under the MSP provision

The CWF is a CMS file that contains Medicare patient eligibilty and utilzation date from the IEQ and ongoing MSPQs

Which of the following is true of financial policies in patient access/front desk (select all that apply)

They should describe trhe provider's policies in general tersm only to allow for flexible legal interpretation

They should clearly state when charges are due and payable; provide discount information; define acceptable methods of payment; outline charity guidelines and application procedures; and explain how accounts may be sent to a collection agency

Patient access/front desk staff should not discuss thes policies with pateints; instead, they should refer patients to a desingnated billing staff member

An effecgtive policy for collecting at the time of service will improve cash flow and will reduce AR days, the cost of patient statements, bad debt, and follow-up time

Which of the following is true of a practice terminating a patient-physician relationship (select one)

The patient-physician relationship can be extended only for continued failure to pay

The patient must acknowledge in writing the terminatyion of the patient-physician relationship

A physician is legally obligated to provide medical care to a patient until the patient-physician relationship is properly ended

A physician is legally obligated to provide medical care to a patient until the patient establishes a relationship with a new provider

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