PATIENT ACCESS SERVICES

1. The medical record is a legal document.

True

False

2. What is an appropriate transfer?

The receiving facility has available space

The receiving facility has qualified staff

The transferring hospital provides medical treatment to minimize risks

All of the above

3. Necessary information collected by financial/insurance class include:

A copy of both sides of the insurance card

Name of PCP

Complete demographic information

All of the above

4. Medicaid is a health insurance program that covers which people:

People who are 65 years and older

Certain low-income people

People who are disabled

People with ESRD that requiring dialysis or a kidney transplant

5. An ABN must include:

Listing of the service that is not covered by the diagnosis

Reason denial is likely

Patient’s signature

All of the above

6. A breach of Patient Confidentiality is subject to:

Criminal charges

Fines

Prison term

All of the above

7. Medicare provides insurance to:

People with end stage renal disease (ESRD requiring dialysis or a kidney transplant)

People who are 65 years or older

People who are disabled

All of the above

8. Standard Code Sets include:

CPT

ICD-9

HCPCS

All of the above

9. Affiliated health coverage includes:

24 hour access to a registered nurse

Referral services for physicians

Customer service and/or feedback

All of the above

10. TRICARE healthcare plans for beneficiaries include:

TRICARE Prime

TRICARE Extra

TRICARE Standard

All of the above

11. The two main governing bodies effecting healthcare change are:

CMS and AHCA

CMS and FDA

CMS and DHHS

DHHS and CDC

12. HIPAA’s key provisions include:

Guaranteed access to health insurance for small businesses

Guaranteed renewal of insurance regardless of health status

Limitations on pre-existing conditions

All of the above

13. All states must cover the services listed below except:

Inpatient and outpatient hospital services

Laboratory and X-ray services

Dental care

Well baby/child care

14. The misuse of a person, substance, service, or financial matter such that harm is cause is known as what?

Fraud

Kickbacks

Abuse

Misrepresentation

15. Medicare has how many parts:

1

2

3

4

16. Medicaid is funded and administered through:

State and federal funding

Federal funding

State funding

Self funded

17. A patient is more likely to pay their estimated portion of the bill:

After the insurance has paid

Before or at the time of admission

After the patient has been discharged

None of the above

18. The National Provider Identifier (NPI) consists of how many digits?

10

6

5

8

19. The Patient Bill of Rights guarantees the basic rights listed below except:

Privacy

Refusal to pay

Confidentiality

Continuity of care

20. CMS is the acronym for:

Centers for Medicaid and Medicare Services

Center for Medicaid and State Operations

Center for Medicare Services

Centers for Medicare and Medicaid Services

21. The RBRVS consist of which major elements?

RVU

MVPS

Limiting charge

All of the above

22. The last 60 days are called:

Lifetime Reserve Days

Full Days

Coinsurance Days

Covered Days

23. Medicare Part A provides coverage for which services except:

Home health services

Skilled nursing facilities

Preventative care

Inpatient hospital services

24. What is the acronym QIO?

Quality Improvement Organization

Quality Insurance Organization

Quick Improvement Options

Quality Inspection Office

25. To qualify for Medicare coverage for Skilled Nursing Facility care, a beneficiary must be in a hospital for at least:

Three (3) consecutive days, not counting the day of discharge, before entering a SNF

Three (5) consecutive days, including the day of discharge, before entering a SNF

Three (3) consecutive days, including the day of discharge, before entering a SNF

Three (5) consecutive days, not counting the day of discharge, before entering a SNF

26. Medicare Part B pays for all of the following except:

Physician services

Hospice care

Outpatient hospital services

Medical equipment and supplies

27. Medicaid is also known as:

Title XVIII

Title XVII

Title XIII

Title XIX

28. The components of the OIG Compliance Plan include all of the following except:

Auditing and monitoring

Ineffective lines of communication

Written policies and procedures

Effective training and education

29. Under EMTALA, what is the purpose of the examination?

To determine if the patient needs to be admitted

To determine if the patient is stable

To determine if the patient is in an emergency medical condition

30. Medicare is also know as:

Title XVIII

Itle XVII

Title XIII

Title XIX

31. PAT is the acronym for:

Patient Account Technician

Patient Accounting Technician

Pre-Admission Testing

Pre-Admission Test

32. The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 required what:

Required EGHP with 50 or more employees to be primary to Medicare

Required EGHP with 15 or more employees to be primary to Medicare

Required EGHP with 40 or more employees to be primary to Medicare

Required EGHP with 20 or more employees to be primary to Medicare

33. Criteria pertaining to the maintenance of the patient’s medical record include all of the following except:

Specific authorizations are required for diagnoses such as HIV/AID, psychiatric, alcohol, or drug dependency conditions

Information can be released without the patient’s written consent

Records shall be stored in areas free from water damage, insects and theft

34. When is an Advance Directive activated?

When the patient is taken into surgery

When the patient is admitted

Per the patient’s request

When the patient becomes incapacitated

35. The intentional or illegal deception or misrepresentation made for the purpose of personal gain, or to harm or manipulate another person or organization is:

Fraud

Kickbacks

Abuse

Misrepresentation

36. The Patient Bill of Rights was developed by which association?

AMA

DHHS

CMS

IRS

37. CHAMPVA is the acronym for:

Civil Health and Medical Program of the Veterans Administration

Civilian Health and Medical Program of the Veterans Association

Civilian Health and Medical Program of the Veterans Administration

Civilian Health and Medical Process of the Veterans Administration

38. The limiting charge is what percentage of the fee schedule amount?

120%

150%

115%

125%

39. The State Children’s Health Insurance Program (SCHIP) is also known as:

Title XXI

Title XVII

Title XIII

Title XIX

40. The basic components of the Bill of Rights include:

If the entity accepts Medicare assignment

Private room

Considerate and respectful care

Both A and C

All of the above

41. TRICARE claims must be submitted within:

18 months

1 year

6 months

2 years

42. Advantages to a Living Will include:

Difficult decisions about future care are made while the patient is competent and alert

It states the patients’ desire regarding organ donation at the time of death

The patients directions allows them to die under circumstances that they have chosen

Both A and C

All of the above

43. ANSI X12 837I is the transaction standard for which of the following:

Healthcare claims status

Eligibility for a health plan

Institutional claim

None of the above

44. The mission of the QIO includes all of the following except:

Quality

Effectiveness

Efficiency

Privacy

45. General admitting responsibilities include all of the following except:

Public Relations

Recognition of Financial Risks

Insurance Verification

Insurance Claims Filing

46. Information to be gathered during the scheduling process include:

Admission data

Employer information

Reason for seeking treatment

Both A and B

All of the above

47. Utilization Review and/or Case Management are responsible for all of the following except:

Approve payment of claims

Reduction of unnecessary admissions

Assist with the appeals process for denials

Advise the patient of discharge

48. The admission of a patient to a hospital requires decision by all of the following except:

Admitting physician

Admitting clerk

Hospital administrator

Administrator on call

49. All of the following are parts to HIPAA’s Administrative Simplification except:

NPI

Health savings accounts

Security requirements

Electronic transactions and code set standards

50. HIPAA is the acronym for:

Health Information Portable and Accountable Act

Health Insurance Portable and Accountable Act

Health Insurance Portability and Accountability Act

Health Information Portability and Accountability Act

51. Traditionally, the admission process includes all of the following except

Storage of valuables

Collecting patient demographics

Guest services

Collecting financial data

52. The Division of Access services include all of the following except:

Pre-certification

Discharge of the patient

Inpatient admitting

Outpatient registration

53. Which act removed the age limit previously imposed on a spouse for health plan coverage?

TEFRA

BBA

COBRA

DEFRA

54. The statements regarding Pre-certification are true except:

Is ultimately the policyholder’s responsibility

Is preferably obtained prior to the care provided Guarantees payment of the claim

Guarantees payment of the claim

Includes authorization for an average length of stay based on data received

55. Patient admission to a hospital can be ordered by:

Hospital administration

Treating physician

Admitting clerk

All of the above

56. The False Claims Act is also known as:

Qui Tam Statute

Lincoln Act

Informer Act

All of the above

57. The advantages of pre-admitting patients include all of the following except:

Pre-certification is not obtained

Admission time is reduced

Second opinion surgeries can be identified

Special needs can be accommodated

58. TRICARE for Life beneficiaries must have:

Medicare Part A

Medicare Part B

Medicare Part A and B

All of the above

59. The Medicare spell of illness or Benefit period begins when the patient enters the hospital and ends:

30 consecutive days after discharge from the hospital or from a skilled nursing facility

60 consecutive days after discharge from the hospital or from a skilled nursing facility

90 consecutive days after discharge from the hospital or from a skilled nursing facility

180 consecutive days after discharge from the hospital or from a skilled nursing facility

60. An ABN (Advanced Beneficiary Notice) must be completed by a Medicare beneficiary when?

After Part B services are furnished and have been denied by Medicare as not “reasonable and necessary”

After Part A services are furnished and have been denied by Medicare as not “reasonable and necessary”

Before Part B services are furnished and have been denied by Medicare as not “reasonable and necessary”

Before Part A services are furnished and have been denied by Medicare as not “reasonable and necessary”

61. Examples of false and fraudulent schemes include all of the following except:

Kickbacks for inappropriate patient referrals

Providing services deemed medically necessary for financial gain

Billing for services not rendered

Misrepresenting services, supplies and procedures provided to patients

62. HCPCS codes are used for:

Institutional services

Physician services

Dental services

None of the above

63. How many components are there in the OIG Compliance Plan?

5

6

7

8

64. TRICARE covers all of the following individuals except:

Veterans of the uniformed services

Active duty members of the uniformed services

Retired members of the uniformed services

Family members of active duty and retired members of the uniformed services

65. The law that governs patient confidentiality is:

Privacy Act of 1974

Health Insurance Portability and Accountability Act of 1996

The False Claims Act

The Balanced Budget Act of 1997

66. Disadvantages of not collecting deposits prior to admission include:

Reduces bad debt

May cause public relations issues between the patient and the doctor

Increases hospital collections

Reduces the overall accounts receivable

67. The DHHS include all of the programs listed below except:

Medicare

CMS

Child Support Enforcement

AFDC

68. An Advanced Directive should be discussed with the patient:

When the patient becomes incapacitated

During the admission process

Before any surgical procedures are performed

All of the above

69. Which act provided for the Resource Based Relative Value Scale?

OBRA of 1986

COBRA of 1985

OBRA of 1989

DEFRA of 1984

70. The transaction standard for Enrollment and Disenrollment in a health plan is:

837

834

820

148

71. Which legislation enacted the most significant changes to the Medicare an Medicaid Programs since their inception?

TEFRA

BBA

COBRA

DEFRA

72. DEERS is operated by:

TRICARE

DOD

DHHS

DRG

73. Individuals eligible for TRICARE must be:

CHAMPUS eligible

CHAMPVA eligible

Listed in DEERS

Both A and C

Both B and C

74. What is a Non-Availability statement?

Required before non-emergency inpatient services may be provided to a TRICARE beneficiary by a non-Military Treatment Facility

Required before emergency inpatient services may be provided to a TRICARE beneficiary by a Military Treatment Facility

Required before emergency outpatient services may be provided to a TRICARE beneficiary by a non-Military Treatment Facility

Required before non-emergency outpatient services may be provided to a TRICARE beneficiary by a non-Military Treatment Facility

75. The Relative Value Unit (RVU) is comprised of all of the following except:

Work required

Limiting charge

Practice expense

Malpractice insurance

76. The Defense Enrollment Eligibility Reporting System is used to:

Confirm eligibility

Release insurance benefits

Obtain non-availability data

Both A and C

All of the above

77. Part A Medicare coverage has a limit of how many days which can be paid by Medicare?

100

150

180

200

78. The Catchment Area of a Military Treatment Facility is defined as:

Area within a 20 mile radius of a MTF

Area within a 25 mile radius of a MTF

Area within a 30 mile radius of a MTF

Area within a 40 mile radius of a MTF

79. Good insurance verification processes include all of the following except:

Who is the policy holder

Address of the patient

Deductible amount and has any portion been met

Is a second surgical opinion required

80. TRICARE is considered secondary payer in the following situations except:

Workers Compensation

Medicare

Personal Injury Protection

Medicaid

81. A provider must file an appeal for a TRICARE claim within:

30 days of the receipt of a CEOB

45 days of the receipt of a CEOB

60 days of the receipt of a CEOB

90 days of the receipt of a CEOB

82. Emphasis on patient accounting falls on which department:

Admission and Registration

Financial Services Department

Both A and B

None of the above

83. The registration process includes:

Creating the permanent patient medical record for the stay

Assuring the accuracy of the patient account record

Insurance verification

Collection of information necessary to produce a clean claim

Patient Access Services