Question 1

An employer group health plan (EGHP)  is contributed to by an employer or employee pay-all plan and provides coverage to employees and dependents without regard to the enrollee's employment status. EGHP provisions are applicable __________.

Accepted Answer

A)   for reimbursing commercial claims only
B)   regardless of the size of the employer
C)   to employers with 100 employees or more
D)   when employees only have full-time statusE) A) and D)
F) A) and B)

Question 2

When office-based services are performed in a facility, such as a hospital or outpatient setting, payments are reduced because the doctor did not provide supplies, utilities, or the costs of running the facility. This is known as the __________ differential.

Accepted Answer

A)   fee schedule
B)   limiting charge
C)   resource utilization
D)   site of serviceE) B) and C)
F) A) and D)

Question 3

Diagnosis-related groups are organized into mutually exclusive categories called __________, which are loosely based on body systems.

Accepted Answer

A)   intensity of resources
B)   major diagnostic categories
C)   risk of mortality
D)   severity of illnessE) B) and D)
F) C) and D)

Question 4

Which replaced the reasonable cost-based payment system for long-term (acute)  care hospitals?

Accepted Answer

A)   cost-based system
B)   per diem system
C)   prospective payment system
D)   retrospective payment systemE) A) and D)
F) None of the above

Question 5

DRG reimbursement rates are recalculated according to a(n)  __________ adjustment, which results in increased Medicare payments for hospitals that treat a high percentage of low-income patients.

Accepted Answer

A)   disproportionate share hospital
B)   indirect medical education
C)   risk of inpatient patient mortality
D)   severity of inpatient illnessE) A) and B)
F) All of the above

Question 6

Home Assessment Validation and Entry (HAVEN)  __________ software is then used to collect OASIS assessment data for transmission to state databases.

Accepted Answer

A)   data entry
B)   editing
C)   encrypting
D)   grouperE) B) and D)
F) None of the above

Question 7

Which are databases that use reporting interfaces to consolidate multiple databases, allowing reports to be generated from a single request?

Accepted Answer

A)   data warehouses
B)   electronic health records
C)   resource allocations
D)   third-party administratorsE) None of the above
F) B) and C)

Question 8

A physician assistant (PA)  must be legally authorized and licensed by the state to furnish services, have graduated from an accredited physician assistant educational program, and have passed the national certification examination of the __________.

Accepted Answer

A)   AHA
B)   AMA
C)   ANA
D)   NCCPAE) All of the above
F) B) and C)

Question 9

Chargemaster __________ is the process of updating and revising key elements of the chargemaster to ensure accurate reimbursement.

Accepted Answer

A)   computerization
B)   documentation
C)   maintenance
D)   revenue generationE) B) and C)
F) A) and B)

Question 10

Which includes all outpatient procedures and services provided during one day to the same patient?

Accepted Answer

A)   limited data set
B)   diagnosis-related group
C)   outpatient encounter
D)   relative value unitE) A) and D)
F) B) and D)

Question 11

Charging write-off or adjustment amounts to beneficiaries is called __________, and it is prohibited by Medicare regulations.

Accepted Answer

A)   accepting assignment
B)   allowable charges
C)   assigning benefits
D)   balance billingE) A) and C)
F) All of the above

Question 12

Which is associated with a particular category of patient and is established by the payer prior to the provision of health care services?

Accepted Answer

A)   prospective cost-based rate
B)   prospective price-based rate
C)   retrospective reasonable cost system
D)   site-of-service differentialE) A) and B)
F) B) and C)

Question 13

A clinical nurse specialist (CNS)  is a(n)  __________ practice registered nurse licensed by the state in which services are provided, has a graduate degree in a defined clinical area of nursing from an accredited educational institution, and is certified.

Accepted Answer

A)   advanced
B)   clinical
C)   limited
D)   medicalE) A) and B)
F) None of the above

Question 14

The ambulance fee schedule payment system replaced a __________ for providers and suppliers of ambulance services.

Accepted Answer

A)   prospective cost-based system
B)   prospective price-based system
C)   retrospective reasonable cost payment system
D)   site-of-service differential systemE) A) and C)
F) B) and C)

Question 15

Medicare reimburses laboratory services according to a(n)  __________, which is based on the submitted charge, national limitation amount, or local fee schedule amount, whichever is lowest.

Accepted Answer

A)   ambulatory outpatient center rate
B)   clinical laboratory fee schedule
C)   outpatient prospective payment system
D)   pathology diagnostic fee scheduleE) A) and B)
F) A) and D)

Question 16

Physician services standardized to measure the value of a service as compared with other services provided are called __________, and they consist of physician work, practice expense, and malpractice expense payment components.

Accepted Answer

A)   allowable charges
B)   physician fee schedules
C)   price-based rates
D)   relative value unitsE) A) and D)
F) All of the above

Question 17

Revenue cycle monitoring involves assessing the revenue cycle to ensure __________ stability using standards of measurement (e.g., cash flow) .

Accepted Answer

A)   data analytics
B)   financial viability
C)   resource allocation
D)   validation and verificationE) A) and D)
F) A) and B)

Question 18

Resource allocation monitoring uses data __________ to measure whether a health care provider or organization achieves operational goals and objectives within the confines of the distribution of financial resources.

Accepted Answer

A)   analytics
B)   encryption
C)   mining
D)   warehousesE) B) and D)
F) B) and C)

Question 19

Inpatient rehabilitation facilities use __________ software for computerized data entry to create a file in a standard format that can be electronically transmitted to a national database.

Accepted Answer

A)   HAVEN
B)   IRVEN
C)   OASIS
D)   RAVENE) A) and B)
F) A) and C)

Question 20

Institutional and other selected providers submit __________ claim data to payers for reimbursement of patient services.

Accepted Answer

A)   CMS-1500
B)   UB-92
C)   UB-02
D)   UB-04E) B) and D)
F) None of the above

Exam 9: Cms Reimbursement Methodologies

Physician services standardized to measure the value of a service as compared with other services provided are called __________, and they consist of physician work, practice expense, and malpractice expense payment components.

Correct AnswerverifiedShow Answer

Which replaced the reasonable cost-based payment system for long-term (acute) care hospitals?

Correct AnswerverifiedShow Answer

A clinical nurse specialist (CNS) is a(n) __________ practice registered nurse licensed by the state in which services are provided, has a graduate degree in a defined clinical area of nursing from an accredited educational institution, and is certified.

Correct AnswerverifiedShow Answer

Which are databases that use reporting interfaces to consolidate multiple databases, allowing reports to be generated from a single request?

Correct AnswerverifiedShow Answer

Inpatient rehabilitation facilities use __________ software for computerized data entry to create a file in a standard format that can be electronically transmitted to a national database.

Correct AnswerverifiedShow Answer

Which includes all outpatient procedures and services provided during one day to the same patient?

Correct AnswerverifiedShow Answer

Diagnosis-related groups are organized into mutually exclusive categories called __________, which are loosely based on body systems.

Correct AnswerverifiedShow Answer

The ambulance fee schedule payment system replaced a __________ for providers and suppliers of ambulance services.

Correct AnswerverifiedShow Answer

When office-based services are performed in a facility, such as a hospital or outpatient setting, payments are reduced because the doctor did not provide supplies, utilities, or the costs of running the facility. This is known as the __________ differential.

Correct AnswerverifiedShow Answer

Revenue cycle monitoring involves assessing the revenue cycle to ensure __________ stability using standards of measurement (e.g., cash flow) .

Correct AnswerverifiedShow Answer

Chargemaster __________ is the process of updating and revising key elements of the chargemaster to ensure accurate reimbursement.

Correct AnswerverifiedShow Answer

Home Assessment Validation and Entry (HAVEN) __________ software is then used to collect OASIS assessment data for transmission to state databases.

Correct AnswerverifiedShow Answer

Charging write-off or adjustment amounts to beneficiaries is called __________, and it is prohibited by Medicare regulations.

Correct AnswerverifiedShow Answer

Which is associated with a particular category of patient and is established by the payer prior to the provision of health care services?

Correct AnswerverifiedShow Answer

Institutional and other selected providers submit __________ claim data to payers for reimbursement of patient services.

Correct AnswerverifiedShow Answer

DRG reimbursement rates are recalculated according to a(n) __________ adjustment, which results in increased Medicare payments for hospitals that treat a high percentage of low-income patients.

Correct AnswerverifiedShow Answer

Medicare reimburses laboratory services according to a(n) __________, which is based on the submitted charge, national limitation amount, or local fee schedule amount, whichever is lowest.

Correct AnswerverifiedShow Answer

A physician assistant (PA) must be legally authorized and licensed by the state to furnish services, have graduated from an accredited physician assistant educational program, and have passed the national certification examination of the __________.

Correct AnswerverifiedShow Answer

An employer group health plan (EGHP) is contributed to by an employer or employee pay-all plan and provides coverage to employees and dependents without regard to the enrollee's employment status. EGHP provisions are applicable __________.

Correct AnswerverifiedShow Answer

Resource allocation monitoring uses data __________ to measure whether a health care provider or organization achieves operational goals and objectives within the confines of the distribution of financial resources.

Correct AnswerverifiedShow Answer

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