A
A patient is scheduled for an appointment tomorrow, and the CMAA notices the authorization number has expired and must be extended or a new authorization number obtained. Which of the following steps of the revenue cycle involves obtaining and verifying prior authorizations for certain procedures?
A) Patient check-in
B) Utilization management review
C) Health care encounter and documentation
D) Payer adjudication
B) Utilization management review
A patient is not filling their blood pressure medication. After speaking with the patient, it is determined that they are having difficulty paying for the medications. Which of the following Medicare plans can assist the patient with prescription medication costs?
Part A
Part B
Part D
Part C
Part D
True or False?
Is 837P/CMS1500 used to report outpatient and professional services to the third party payer?
True
What is the definition of timely filling?
A) the process of balancing dail transaction logs before posting
B) the period in which a patient must pay their deductible balance
C) the percentage of billed services paid by the patient
D) the length of time in which a health care organization may submit a claim to a third-party payer from the date of service
D) the length of time in which a health care organization may submit a claim to a third-party payer from the date of service
Which statement accurately describes charge capture and coding in the revenue cycle?
A) it involves entering CPT, HCPCS, and ICD-10-CM codes related to the visit to prepare claims for insurance submission
B) it takes palce after payer adjucation is complete
C) it is performed primarily during the intial scheduling call
D) it guarantees automatic payment regardless of claim accuracy.
A) it involves entering CPT, HCPCS, and ICD-10-CM codes related to the visit to prepare claims for insurance submission
Which of the following would qualify a patient to be eligible for Medicare?
A) A 55-year-old patient
B) A healthy 5-year-old patient
C) A 55-year-old patient who has end-stage renal disease
D) A 5-year-old patient with acute tonsilitis
C) A 55-year-old patient who has end-stage renal disease
A patient presents to the office and pays the set amount for the office visit of $25. Which of the following types of payment was received from the patient?
A) Coinsurance
B) Premium
C) Deductible
D) Copay
D) Copay
True or False? Is pay-for-performance a paymeny module where the provider agrees to a set reimbursement amount per patient per month?
True
True or False?
Is 8371/UB04 form used to report inpatient services to the third party payer?
True.
Why do insurance payers require preauthorization for certain medical services?
A) to avoid paying for treatments they consider medically unnecessary
B) to speed up the patient check-in process on the day of the appointment
C) to automatically adjust the patient's deductible amount
D) to assign coding variables prior to clinical evaluation.
A) to avoid paying for treatments they consider medically unnecessary
Which of the following insurance programs include income levels?
A) Medicare
B) Medicaid
C) BlueCross Blue Shield
D) TRICARE
B) Medicaid
True or False?
Is Capitation a payment module that reimburses for the services or procedures performed?
What is a contractual adjustment?
A) the length of time an organization has to submit a claim
B)the fixed copay amount paid by the patient during an office visit
C)the difference between the billed amount and the allowed amount
D)the monthly amount paid to maintain health insurance coverage
C) the difference between the billed amount and the allowed amount.
A) they replace the need for professional billing spcialists
B) they increase efficiency and streamline processes like scheduling, charge capture, and reporting through automation.
C) they eliminate the requirement for medical neccisity reviews prior to procedures
D) they handle external referrral decisions directly without clinical oversight.
B) they increase efficiency and streamline processes like scheduling, charge capture, and reporting through automation.
True or False? Does Value-based reward the provider with incentive payments for meeting defined program performance standards?
True.
There are many health care payment models. When the provider receives an incentive for providing an annual wellness visit, which of the following payment models is the provider participating in?
A) Capitation
B) Fee-for-service
C) Value-based
C) Value-based
What is this an example of?
A) Capitation
B)Value-based
C)Pay-for-performance
D) Fee-for-service
A) capitation
What general documentation is required when encountering patients?
A) Patient license number
B) Medical history
C) Patient nationality
D) Patients work place
B) Medical history
True or False? Does Fee-For-Service change the focus to value-based care rather than volume-based care?
False
5. A patient is scheduled for an upcoming service, but their prior authorization number has expired. Obtaining and verifying a new authorization falls under which phase of the revenue cycle?
A. Patient check-in
B. Health care encounter and documentation
C. Utilization management review
D. Payer adjudication
C. Utilization management review
A 68-year-old patient is admitted to the hospital for kidney stones and does not have a managed care plan. Which of the following parts of Medicare provides coverage for inpatient hospital services to the beneficiary?
Part A
Part B
Part D
Part C
Part A
Why is it important to balanance daily transactions in a healthare organization?
A) to ensure claims are submitted within 24hrs
B) because entry errors are easier to find and correct before posting
C) to reduce the patients out-of-pocket costs
D) to automatically apply contractual adjustments to patient accounts
B) because entry errors are easier to find and correct before posting
When does a patients coinsurance go into effect?
A) before the monthly premium is paid
B) Once the patient has met their annual deductible
C)Immediately at the start of every calendar year
D)After the entire bill is fully paid by insurance
B) once the patient has met their annual deductible.
When does the healthcare revenue cycle start and finish?
A) starts when clinical documentation begins and ends when the claim is submitted
B) starts when the patient registration and scheduling and ends when the claim is paid in full
C) starts when the patient arrives for check-in and ends when the initial claim is coded
D) starts during utilization management review and ends when a referral is generated.
B) starts when the patient registration and scheduling and ends when the claim is paid in full
A. Whenever a claim requires charge capture and coding
B. When a patient requires specialized evaluation and care beyond primary care
C. Only after an insurance claim has undergone payer adjudication
D. When a practice management system undergoes a scheduled update
B. When a patient requires specialized evaluation and care beyond primary care