Center For Research On Computation And Society (Crcs-I) Practice Test
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- 1.Which of the following is true of Patient Care Partnership? (Select all that apply.)
- A.
It replaces the "Patient's Bill of Rights.'
- B.
It was adopted by the AHA
- C.
It outlines what a provider can expect from a patient.
- D.
It is a plain-language brochure.
- E.
It addresses patient expectations from admission to dismissal only.
- 2.Which of the following is true of protected health information (PHI)? (Select all that apply.)
- A.
It refers only to any single piece of data that could directly match patients with their medical information.
- B.
It can be shared without explicit consent for treatment, payment, or healthcare operations (TPO).
- C.
It cannot be shared for marketing purposes without explicit consent.
- D.
It cannot be shared with law enforcement agencies without consent or proper notification to the patient, expect under court order.
- 3.The savings results from HIPAA's administrative simplification rules have exceeded initial projections.
- A.
True
- B.
False
- 4.Which of the following is not an example of an advanced directive? (Select one.)
- A.
Living Will
- B.
Patient Care Partnership brochure
- C.
Healthcare Power of Attorney or Durable Power of Attorney for Healthcare.
- D.
DNR order
- 5.Which of the following is not an example of an administrative sanction for inappropriate/fraudulent behavior on the part of a provider?
- A.
Denial or revocation of the provider number applications.
- B.
Suspension of provider payments.
- C.
Application of CMPs.
- D.
Inclusion in a published "watch" list of providers.
- 6.Which of the following is true of TJC? (Select one.)
- A.
All hospitals must be accredited by TJC.
- B.
TJC will conduct an audit of a hospital every 39 months.
- C.
TJC will conduct an audit of a laboratory every 36 months.
- D.
TJC can audit a healthcare facility without advance notice as early as 6 months after its initial audit.
- 7.To qualify for SNF cover, Medicare requires a person to have been a hospital inpatient for at least three consecutive days (not including the day of discharge.)
- A.
True
- B.
False
- 8.A single general consent document is signed to cover all procedures and services being performed in any 24-hour period.
- A.
True
- B.
False
- 9.What is the name for a policyholder's written authorization to have insurance benefits paid directly to the provider?
- A.
Conditional payments
- B.
Provisional benefits
- C.
Assignment of benefits
- D.
Authorization of payments
- 10.In the ER, failure of a patient, who is aware of what is happening, to object to treatment is implied consent - in fact.
- A.
True
- B.
False
- 11.In what situation is a person prevented from consenting to services? (Select all that apply.)
- A.
The person is an emancipated minor.
- B.
The person is uninsured.
- C.
The person is intoxicated.
- D.
The person is declared mentally incompetent by the courts.
- 12.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.
- A.
True
- B.
False
- 13.Which of the following is authorized to make entries in the patient's medical record? (Select all that apply.)
- A.
Treating/attending physician
- B.
A physician extender
- C.
A licensed, registered nurse
- D.
A financial counselor
- E.
A student from an accredited health profession program (under the supervision of his or her clinic instructor.
- 14.Telephone orders from a referring physician may be edited for clarity by an individual authorized to received verbal orders.
- A.
True
- B.
False
- 15.What does the acronym NCD stand for? (Select one.)
- A.
National Coverage Determination
- B.
National Coverage Department
- C.
New Coverage Determination
- D.
New Coverage Direction
- 16.Which type of LCD/NCD provides potential coverage circumstances, but most likely does not provide specific diagnosis, signs, symptoms, or ICD-10 codes that will be covered or non-covered? (Select one.)
- A.
Definitive LCD/NCD
- B.
Non-definitive LCD/NCD
- 17.Which of the following is not true of MSP laws? (Select one.)
- A.
Until 2010, Medicare was the primary payer for nearly will Medicare-covered services.
- B.
Before becoming entitled to Medicare, beneficiaries receive an IEQ that asks about any other healthcare coverage that might be primary to Medicare.
- C.
Medicare considers it a fraudulent or abusive practice to regularly submit claims that are the responsibility of another insurer under the MSP provision.
- D.
The CWF is a CMS file that contains Medicare patient eligibility and utilization data from the IEQ and ongoing MSPQs.
- 18.Which of the following is true of financial policies in Patient Access/Front Desk? (Select all that apply.)
- A.
They should describe the provider's policies in general terms only to allow for flexible legal interpretation
- B.
They should clearly state when charges are due and payble; 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.
- C.
Patient Access/Front Desk staff should not discuss these policies with patients; instead, they should refer patients to a designated Billing staff member.
- D.
An effective 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.
- 19.Which of the following is true of the Medicare Part A spell of an illness? (Select all that apply)
- A.
It is also known as the benefit period
- B.
It is also known as the deductible period
- C.
It begins when a beneficiary enters the hospital and ends 30 days after discharge from the hospital or from a SNF
- D.
It begins when a beneficiary enters the hospital and ends 60 days after discharge from the hospital or from a SNF
- 20.Which of the following is not covered by Medicare for qualified beneficiaries? (Select all that apply.)
- A.
Cosmetic surgery
- B.
Chiropractic services (limited)
- C.
Routine eye care and most eyeglasses in the absence of disease
- D.
Kidney dialysis and kidney transplants
- E.
Hearing aids and exams
- 21.Which of the following is not a registration element shared by HMOs and PPOs? (Select one.)
- A.
Use of program practitioners
- B.
Use of specific healthcare facilities
- C.
Precertification/preauthorization requirements
- D.
State-mandated coverage limits
- 22.If a patient changes Medicare Advantage status during an inpatient stay for an inpatient institution, the patient's status at admission or start of care determines liability.
- A.
True
- B.
False
- 23.Which of the following is not true of MACs? (Select one.)
- A.
They are the private firms that process Medicare claims
- B.
They were formerly known as fiscal intermediaries or carriers
- C.
They enroll providers in the Medicare program, provide education on Medicare billing requirements, and answer both provider and patient inquiries
- D.
There is one MAC in each of the 50 states
- 24.Beginning April 1, 2019, providers must include only the new MBI number, not the old HICN number, on claims.
- A.
True
- B.
False
- 25.What is the term for health insurance that covers individuals, often as an employment benefit? (Select one.)
- A.
Self-insured
- B.
Commercial insurance
- C.
Liability insurance
- D.
Self-pay
- E.
HSA
- 26.What type of insurance sometimes includes "med-pay" or "no-fault" coverage
- A.
Self-insured
- B.
Commercial insurance
- C.
Liability insurance
- D.
Self-pay
- E.
HSA
- 27.Coordination of benefits involves determining which plan or insurance policy will pay first if two health plans or insurance policies cover the same benefits
- A.
True
- B.
False
- 28.In which of the following situations is Medicare the primary payer? (Select all that apply.)
- A.
Services covered by workers' compensation
- B.
Care related to an accident for which liability or no-fault coverage exists
- C.
Patients 65 or older with group coverage from their own or their spouses' employment with an employer who has 20 or more employees
- D.
A patient admitted to an acute care hospital with Medicare insurance and the coverage changes to a Medicare HMO in the middle of the stay
- 29.Which of the following is not true of coordination of benefits? (Select one.)
- A.
Group health plans are always secondary to Medicare
- B.
Medicaid is always the payer of last resort except for Indian Health Service
- C.
TRICARE is also the payer of last resort except for Medicaid, TRICARE supplements, the Indian Health Service, and other programs or plans as identified by the TRICARE Management Activity
- D.
Almost all payers are secondary to any liability or property and casualty insurance
- 30.A person's own coverage is primary to that of a spouse
- A.
True
- B.
False
- 31.When children are covered by both parents, what does the "birthday rule" dictate? (Select one.)
- A.
The coverage of the older parent is primary
- B.
The coverage of the younger parent is primary
- C.
The coverage of the parent with the first birthday in the calendar year is primary
- D.
The coverage of the parent with the last birthday in the calendar year is primary
- 32.What is the HIPAA-required standard transaction code for healthcare claim status response? (Select one.)
- A.
270
- B.
271
- C.
277
- D.
835
- 33.Which of the following is not true of ICD-10 codes? (Select one.)
- A.
ICD stands for International Classification of Diagnoses
- B.
The code set contains 68,000 codes for great specificity in coding
- C.
They should reflect the principal diagnosis and discharge diagnosis to the highest level of specificity
- D.
They should reflect any coexisting diagnosis to the lowest level of specificity
- 34.What type of code helps identify non-payable complications, such as hospital-acquired conditions? (Select one.)
- A.
Non-payable condition (NPC)
- B.
Hospital-acquired complication (HAC)
- C.
Present on admission (POA)
- D.
Diagnosis complication code (DCC)
- 35.Which type of claim requires HCPCS/CPT codes? (Select one.)
- A.
A. Inpatient claims
- B.
B. Outpatient claims
- 36.Which of the following is not true of HCPCS and CPT codes? (Select one.)
- A.
A. The HCPCS is divided into three levels
- B.
B. Level I of HCPCS is the CPT, a five-digit numeric code that identifies medical services and procedures furnished by physicians and other healthcare professionals
- C.
C. Level I of HCPCS includes codes for items or services that are regularly billed by suppliers other than physicians
- D.
D. Level II of the HCPCS is five-digit alpha/numeric code that identifies products, supplies, and services not included in the CPT codes when used outside a physician's office
- 37.Which of the following are the three primary components used in the selecting a level of E&M service? (Select one.)
- A.
A. History, examination, and counseling
- B.
B. Examination, medical decision-making, and counseling
- C.
C. History, examination, and medical decision-making
- D.
D. Examination, medical decision-making, and coordination of care
- 38.Which of the following is not true of HCPCS and CPT modifiers? (Select one.)
- A.
A. They can define HCPCS and CPT codes to a broader level
- B.
B. They are two-digit numeric or alphanumeric code
- C.
C. They can indicate that a service or procedure was altered by some circumstance that impacts reimbursement
- D.
D. They can clarify the anatomic site of a procedure
- 39.The National Provider Identifier (NPI) is assigned by Medicare to identify participating providers
- A.
True
- B.
False
- 40.Which of the following are indicated by an NDC? (Select one.)
- A.
A. Drug labeler, type of product, and size and type of package
- B.
B. Type of product, size and type of package, and expiration date
- C.
C. Drug labeler, type of product, and related ICD-10 code(s)
- D.
D. Type of product, size and type of package, and storage requirement
- 41.An MS-DRG payment is the total payment for a case, regardless of actual charges (unless an outlier is paid in certain cases.)
- A.
True
- B.
False
- 42.CMS allows a hospital to file subsequent inpatient DRG adjustments up to 90 days from thedate of the remittance advice for Medicare beneficiaries.
- A.
True
- B.
False
- 43.The elements required to assign an APC are HCPC/CPT, E&M, ICD-10, and MS-DRG.
- A.
True
- B.
False
- 44.The RBRVS includes a standard for the rates of increase in Medicare expenditures for physician services.
- A.
True
- B.
False
- 45.Which of the following is not one of the RVUs used in determining the fee schedule payment? (Select one.)
- A.
A. Work required (Work RVU)
- B.
B. Practice expense (PE)
- C.
C. Malpractice insurance expense (MP)
- D.
D. Geographic indicator (GI)
- 46.Which payment methodology ranks physician-charge data accumulated over time from lowest to highest, then uses a specific point (for example, the 75th percentile) as the basis for payments? (Select one.)
- A.
A. UCR
- B.
B. RUG
- C.
C. Capitation
- D.
D. Per diem
- 47.Which payment methodology is used to determine payment for skilled nursing care? (Select one.)
- A.
A. UCR
- B.
B. RUG
- C.
C. Capitation
- D.
D. Fee-for-Service
- 48.Which of the following is not true of a CAH? (Select one.)
- A.
A. They must maintain no more than 25 inpatient beds that may be used for swing bed services
- B.
B. They may operate a rehabilitation/psychiatric DPU, each with up to 10 beds
- C.
C. They can have an ALOS of 72 hours or less per patient for acute care (excluding swing bed services and beds within DPUs)
- D.
D. They must furnish 24/7 emergency care services
- 49.Which of the following is included in a chargemaster? (Select all that apply.)
- A.
A. Description and price of an item and its CPT or HCPCS codes
- B.
B. General ledger account an item impacts
- C.
C. Inventory control information for supplies and medications
- D.
D. NPIs of providers authorized to use an item
- 50.Which of the following is not true of best practices for reviewing the chargemaster? (Select one.)
- A.
A. The review should be done at least every other year
- B.
B. The review should check for items to be added or deleted
- C.
C. The review is important because assigning an incorrect code could be construed as fraud
- D.
D. Departments directors/managers should be included in the review
- 51.Because payer contracts are regulated at the state level, all contracts for payers in a given state are the same
- A.
True
- B.
False
- 52.What are the criteria for a locum tenens physician to be paid for services provided to a Medicare patient? (Select all that apply.)
- A.
A. The regular physician is unable to provide service
- B.
B. The locum tenens physician is part of the regular physician's practice
- C.
C.The patient had a previously-scheduled appointments or treatment with the regular physician
- D.
D. The substitute physician does not provide services to the patient for more than 60 days
- E.
E. The patient would prefer to see someone other than the regular physician
- 53.Which of the following is another name for the UB-04? (Select one.)
- A.
A. CMS-1450
- B.
B. CMS-1500
- C.
C. MSN
- D.
D. EOB
- 54.The UB-04 form contains how many data elements? (Select one.)
- A.
A. 76
- B.
B. 81
- C.
C. 83
- D.
D. 99
- 55.What type of UB-04 code consists for two digits and a date that together clarify a significant event or condition related to a claim? (Select one.)
- A.
A. Condition code
- B.
B. Occurrence code
- C.
C. Occurrence span code
- D.
D. Revenue code
- 56.What is the revenue code for Emergency Room General? (Select one.)
- A.
A. 0120
- B.
B. 0310
- C.
C. 0450
- D.
D. 0550
- 57.In the UB-04, where is the type of facility providing the service indicated? (Select one.)
- A.
A. First digit of the bill code in field locator 4
- B.
B. Second digit of the bill code in field locator 4
- C.
C. Third digit of the bill code in field locator 4
- 58.What is the name of the quarterly statement reflecting services received, charges submitted, charges allowed, amount for which the beneficiary is responsible, and the amount that was paid to the provider or beneficiary? (Select one.)
- A.
A. Itemized statement
- B.
B. Data mailer
- C.
C. MSN
- D.
D. Chargemaster
- 59.Which of the following is not an exception to the mandatory filing rule? (Select one.)
- A.
A. Medicare is listed as the secondary payer
- B.
B. The claim is for services that were provided outside of the United States
- C.
C. The provider attempted to obtain a signed ABN but the beneficiary refused to sign it
- D.
D. The provider has been debarred or excluded from the Medicare program
- 60.What is the deadline to file a Medicare claim for services rendered on September 23, 2018? (Select one.)
- A.
A. January 1, 2019
- B.
B. September 23, 2019
- C.
C. December 31, 2019
- D.
D. December 31, 2020
- 61.What is the consequence when timely-filing limits are not met? (Select one.)
- A.
A. The patient is billed for the entire remaining balance
- B.
B. The claim is written off, as billing the patient is not allowed
- 62.A bill with late charges (posted after the DOS, after lag days have passed, or after the bill has dropped) will often have to be rebilled, causing delays in account resolution.
- A.
True
- B.
False
- 63.What is the name of the Medicare rule that all diagnostic and clinically related non-diagnostic outpatient services provided within a certain number of days of an inpatient admission must be combined to the inpatient claim when provided by an entity wholly owned or operated by the inpatient hospital? (Select one.)
- A.
A. 3-Day Payment Window Rule
- B.
B. 3-Day Bundle Rule
- C.
C. 5-Day Payment Window Rule
- D.
D. 7-Day Combined Charges Rule
- 64.Which of the following must comply with rule similar to the one in the question above, but with a one-day time frame? (Select all that apply.)
- A.
A. Inpatient psychiatric hospitals
- B.
B. Teaching hospitals
- C.
C. Children's hospitals
- D.
D. Inpatient rehabilitation facilities
- 65.Which of the following is not true of electronic billing? (Select one.)
- A.
A. It results in faster entry into the payer system
- B.
B. It offers proof of receipt
- C.
C. It facilitates the process of sending attachments
- D.
D. There can be challenges with payer acceptance and upload/download issues
- 66.What does the acronym NCCI stand for? (Select one.)
- A.
A. National Clean Claims Initiative
- B.
B. New Clinical Code Institute
- C.
C. Non-payable Claim Coding Indentifiers
- D.
D. National Correct Coding Initiative
- 67.Which of the following is not true of MUEs? (Select one.)
- A.
A. They are a unit of service edit for HCPCS/CPT codes for services rendered by a provider to a single beneficiary on the same date of service
- B.
B. Adding an appropriate modifier may allow an MUE claim to be processed appropriately
- C.
C. They are a post-payment edit to alert a beneficiary of potential fraud or abuse on a claim
- D.
D. In many cases, they cannot be appealed
- 68.What does the acronym RTP stand for? (Select one?)
- A.
A. Routed to provider
- B.
B. Routed to payer
- C.
C. Returned to provider
- D.
D. Returned to payer
- 69.Which of the following is not one of the OIG's seven elements of a compliance plan? (Select one.)
- A.
A. Written policies and procedures
- B.
B. Pre-employment background checks
- C.
C. Effective training and education
- D.
D. Responding to offenses and developing corrective action plans
- 70.Which of the following is true of statue of limitations? (Select all that apply.)
- A.
A. The period of time is usually less for open-end or oral agreements, greater for judgments, and greatest for notes or written agreements
- B.
B. The period is usually less for open-end or oral agreements, greater for notes or written agreements, and greatest for judgments
- C.
C. A statue of limitations may not be extended under any circumstances
- D.
D. A statue of limitations may be extended by obtaining a partial payment on the principal account
- 71.Which of the following is not a recommended element of a written collection policy? (Select one.)
- A.
A. Minimum acceptable payments
- B.
B. Charity care requirements and protocols
- C.
C. Discount policy
- D.
D. Courtesy discharge policy
- E.
E. Age when an account is considered uncollectible and prepared for a bad-debt write-off
- 72.Which of the following is not true of a discharged bankruptcy? (Select one.)
- A.
A. It releases the guarantor/patient from financial responsibility of any and all account balances listed on the bankruptcy petition
- B.
B. The account balance is to be written off to the appropriate transaction code
- C.
C. It covers any patient accounts that occur within six months following the notification
- D.
D. It is usually entered within six months when a Chapter 7 bankruptcy is deemed to have no assets
- 73.Which of the following is not true of a dismissed bankruptcy? (Select one.)
- A.
A. It is a court ruling whereby the bankruptcy is rejected
- B.
B. The most common reason for dismissal is the debtor agreeing to pay each creditor a portion of the debt owed
- C.
C. It means a creditor can bill the debtor directly
- D.
D. It means a creditor can refer the account to a collection agency or pursue litigation
- 74.Even if a responsible party does not specifically list a hospital debt in a Chapter 7 filing, the debt is automatically included in the petition.
- A.
True
- B.
False
- 75.Which of the following is not true of determining the responsible party for an account? (Select one.)
- A.
A. The responsible party is the adult patient him/herself, even in the case of injuries caused by the negligence of another party
- B.
B. In some states, spouses are responsible for each other's debts incurred during the marriage, even if the marriage ends or the other spouse dies
- C.
C. Adult children of a deceased person are legally responsible for any debts related to the deceased person's medical bills
- D.
D. Both parents are jointly and fully responsible for a minor patient, whether married or not and regardless of the language in a divorce decree
- 76.Which of the following is not true of the steps to take when receiving notice that a patient is deceased? (Select one.)
- A.
A. Check if a legitimate estate exists and file an appropriate caveat to the estate
- B.
B. Check the register of wills for an estate
- C.
C. Change the mailing address to "The family of [patient name]"
- D.
D. If there is no estate and no one assumes financial responsibility, write off any self-pay balance remaining after insurance liability is paid
- 77.Which of the following is not true of courtesy discharge? (Select one.)
- A.
A. It improves patient-hospital relations
- B.
B. It improves traffic flow
- C.
C. It reduces need for additional staff at peak discharge times
- D.
D. It results in more billing errors because there is one less opportunity to validate information
- 78.Which of the following is not a common stall or delay with third-party payers? (Select one.)
- A.
A. Bill never received by payer
- B.
B. COB or MSP problems
- C.
C. Medical record/chart needed for review
- D.
D. Contractual requirement to hold a claim for a certain number of days
- 79.Which of the following is not a suggested tip for making collection efforts with internal resources? (Select one.)
- A.
A. Call frequently and have all questions and facts ready
- B.
B. Start with accounts with lower balances and work up to those with high balances
- C.
C. Fax needed documents and then call to ensure they were received
- D.
D. Maintain and review correspondence about denials, delays, disputes, and so on
- 80.What is the name of a statement by a collector along the lines of "This is an attempt to collect a debt and any information obtained will be used for that purpose"? (Select one.)
- A.
A. Collection acknowledgment
- B.
B. Collector warning
- C.
C. Mini Miranda
- D.
D. Statue of collection
- 81.A patient account can be forwarded to third-party collections only after the provider has attempted to collect balance for 90 days.
- A.
True
- B.
False
- 82.What is the name for someone who moves or changes residence and fails to notify creditors, but normally has a forwarding address? (Select one.)
- A.
A. Intentional skip
- B.
B. Unintentional skip
- C.
C. False skip
- 83.Which of the following is not a GAAP applying to the cashier role? (Select one.)
- A.
A. Endorse checks immediately with "Payable to [name of office] Only"
- B.
B. Issue receipts to customers on all cash payments and deposit them the same day as received
- C.
C. Store payments before they are deposited and other valuables in a fireproof safe
- D.
D. Maintain a payment log
- E.
E. Segregate duties
- 84.What is the metric determined by dividing total revenue/charges for the period by number of days in the period? (Select one.)
- A.
A. Average Patient Charge (APC)
- B.
B. Average Daily Revenue (ADR)
- C.
C. Average Days of Revenue in Accounts Receivable (ADRR)
- D.
D. Average Days Cash on Hand (ADCH)
- 85.Which of the following is an estimate of the time needed to collect the accounts receivable? (Select one.)
- A.
A. APC
- B.
B. ADDR
- C.
C. AR
- D.
D. ADRR
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