MSC
Common stalls and delays with third party payers include all of the following except:
A. Bill never received by payer
B. COB or MSP problems
C. Medical record/chart needed for review
D. Excessive number of staff working claims
D. Excessive number of staff working claims
Explanation
The correct answer is "Excessive number of staff working claims". This option is the exception because it does not contribute to stalls and delays with third party payers. The other options, such as bills not being received by the payer, COB or MSP problems, and the need for medical records/charts for review, are all potential causes of stalls and delays in the payment process. However, having an excessive number of staff working claims would typically help expedite the process rather than cause delays.
Medicare is secondary in each of the following situations except for:
A. Services covered by workers' compensation, including the Black Lung Benefits Act
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. Patients with ESRD who have completed their 30-month COB period.
D. Patients with ESRD who have completed their 30-month COB period.
Explanation
Patients with ESRD who have completed their 30-month COB period are not an exception to Medicare being secondary. In this situation, Medicare would still be considered secondary to any other insurance coverage the patient may have. This means that Medicare would only cover costs that are not already covered by the primary insurance.
Should a correction be required to a medical record, an authorized person should draw a single line through to error, initial it, and continue the note.
True or False?
True
Explanation
When a correction is needed in a medical record, it is important to maintain the integrity of the original information. Drawing a single line through the error and initialing it ensures that the correction is clearly marked and attributed to the authorized person making the correction. By continuing the note after initialing, it is clear that the correction is a part of the original record. This procedure helps to maintain transparency and accuracy in medical documentation. Therefore, the statement "Should a correction be required to a medical record, an authorized person should draw a single line through the error, initial it, and continue the note" is true.
HEAT stands for:
A. Health Care Extension Action Team
B. Health Care Executive Assistance Team
C. Health Care Fraud Elimination Team
D. Health Care Fraud Prevention and Enforcement Action Team
D. Health Care Fraud Prevention and Enforcement Action Team
Explanation
The correct answer is Health Care Fraud Prevention and Enforcement Action Team. This team is responsible for preventing and enforcing actions against health care fraud. They work towards eliminating fraudulent activities in the health care industry and ensuring that proper measures are taken to prevent such frauds in the future.
What is the frequency of coverage for intensive behavioral therapy for obesity?
A. One visit every week for month 1
B. One visit every other week for months 2-6
C. One visit every week for months 1-3
D. One visit every other week for months 4-6
E. One visit every month for months 7-12
F. A B and E
G. D C and E
H. A B and C
Correct Answer A B and E
A. One visit every week for month 1
B. One visit every other week for months 2-6
E. One visit every month for months 7-12
Which of the following is not a true statement about the steps to be taken when notice is received that a patient is deceased?
A. Check if a legitimate estate exists and file an appropriate caveat to the estate.
B. Check the register of wills for an estate.
C. Change the mailing address to "The Family of [Patient Name]."
D. If there is no estate and no one assumes financial responsibility, write off any remaining self-pay balance.
C. Change the mailing address to "The Family of [Patient Name]."
Explanation
The statement "Change the mailing address to 'The Family of [Patient Name].'" is not a true statement about the steps to be taken when notice is received that a patient is deceased. The correct steps include checking if a legitimate estate exists and filing an appropriate caveat to the estate, checking the register of wills for an estate, and if there is no estate and no one assumes financial responsibility, writing off any remaining self-pay balance. Changing the mailing address to "The Family of [Patient Name]" is not a necessary step in this process.
Which of the following is not a true statement about the Medicare Participating Physician Program?
A. It is also called "accepting assignment."
B. It is imperative that assignment be obtained prior to discharge, when applicable.
C. It enables providers to ask the beneficiary to pay the entire charge at the time of service.
D. It offers higher fee schedule payments and fewer collection efforts.
C. It enables providers to ask the beneficiary to pay the entire charge at the time of service.
Explanation
The Medicare Participating Physician Program, also known as "accepting assignment," does not enable providers to ask the beneficiary to pay the entire charge at the time of service. This program actually offers higher fee schedule payments and fewer collection efforts, and it is imperative to obtain assignment prior to discharge, when applicable.
An emancipated minor is able to give his or her own consent to receive treatment.
True or False?
True
Explanation
An emancipated minor refers to a person who is under the legal age of adulthood but has been granted legal independence from their parents or guardians. As a result, they are considered to have the same legal rights and responsibilities as an adult. This includes the ability to make decisions about their own healthcare, including giving consent to receive treatment. Therefore, the statement that an emancipated minor is able to give their own consent to receive treatment is true.
The organization that ensures the quality, effectiveness, and efficiency of healthcare provided to Medicare beneficiaries and reviews all written quality-of-service complaints submitted by Medicare beneficiaries is:
A. CLIA
B. ACL
C. QIO
D. TJC
C. QIO
Explanation
The Quality Improvement Organization (QIO) is the organization responsible for ensuring the quality, effectiveness, and efficiency of healthcare provided to Medicare beneficiaries. They also review all written quality-of-service complaints submitted by Medicare beneficiaries. The QIO plays a crucial role in monitoring and improving the quality of healthcare services provided to Medicare beneficiaries.
What is the recommendation for the percentage of scheduled admissions to be pre-registered within 24 hours of the service date?
A. 40% - 50%
B. 50% - 70%
C. 60% - 80%
D. 70% - 90%
D. 70% - 90%
Explanation
The recommendation for the percentage of scheduled admissions to be pre-registered within 24 hours of the service date is 70% - 90%. This means that it is recommended for 70% to 90% of the scheduled admissions to be pre-registered within 24 hours of the service date. Pre-registering admissions helps in streamlining the process and ensures that necessary information is collected beforehand, saving time and improving efficiency.
Which of the following is not a true statement about a discharged bankruptcy?
A. It releases the guarantor/patient from financial responsibility of any and all account balances listed on the bankruptcy petition.
B. The account balance is to be written off to the appropriate transaction code.
C. It covers any patient accounts that occur within six months following the notification.
D. It is usually entered within six months when a Chapter 7 bankruptcy is deemed to have no assets.
C. It covers any patient accounts that occur within six months following the notification.
Which of the following are 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
D. Kidney dialysis and kidney transplants
E. Hearing aids
A. Cosmetic surgery
C. Routine eye care and most eyeglasses
E. Hearing aids
Explanation
Medicare provides coverage for a wide range of medical services for qualified beneficiaries. However, there are certain services that are not covered. Cosmetic surgery is not covered by Medicare as it is considered elective and not medically necessary. Routine eye care and most eyeglasses are also not covered, although Medicare does cover certain eye-related conditions such as cataract surgery. Similarly, hearing aids are not covered by Medicare, although there may be some exceptions for certain Medicare Advantage plans. Kidney dialysis and kidney transplants are covered by Medicare for qualified beneficiaries.
In the ER, failure of a patient, who is aware of what is happening, to object to treatment is implied consent--by law.
True or False?
False
Explanation
The statement is false because implied consent by law does not apply in the given scenario. Implied consent typically refers to situations where a patient is unconscious or unable to provide explicit consent, and treatment is necessary to save their life or prevent serious harm. In the case described, the patient is aware of what is happening, and their failure to object does not automatically imply consent. Informed consent, where the patient provides explicit consent after being fully informed about the treatment, is required in such situations.
If a triggering event for an ABN occurs when there is a discontinuation in the services being provided, it is called:
A. Initiation
B. Reduction
C. Cessation
D. Termination
D. Termination
Explanation
When there is a discontinuation in the services being provided, it is referred to as "termination." This term signifies the end or conclusion of the services, indicating that they have been stopped or discontinued. It is different from initiation, which implies the beginning or start of something, reduction, which suggests a decrease in the services, and cessation, which means the act of ceasing or stopping something. Therefore, "termination" is the most appropriate term to describe the scenario described in the question.
Which of the following is not gathered during pre-registration or pre-admission?
A. History of chief complaint
B. Patient demographics
C. Financial information
D. Socioeconomic information
A. History of chief complaint
Explanation
During pre-registration or pre-admission, the history of the chief complaint is not gathered. This information is typically collected during the initial assessment or examination of the patient, after they have been admitted or registered. Pre-registration or pre-admission mainly focuses on gathering patient demographics, such as name, address, contact information, and insurance details, as well as financial and socioeconomic information to determine eligibility for financial assistance or support.
A superbill is:
A. An invoice to document the services ordered or rendered during a patient visit.
B. Often referred to as an invoice of services.
C. A tool to eliminate the need for transcribing medical record notes from a patient chart.
D. All of the above.
D. All of the above.
Explanation
A superbill is a document that serves as an invoice to record the services that were either ordered or provided during a patient's visit. It is often referred to as an invoice of services because it lists the specific procedures, tests, or treatments that were performed. Additionally, a superbill can be considered a tool to eliminate the need for transcribing medical record notes from a patient chart, as it provides a concise
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 an SNF.
D. It begins when a beneficiary enters the hospital and ends 60 days after discharge from the hospital or from an SNF.
A. It is also known as the benefit period.
D. It begins when a beneficiary enters the hospital and ends 60 days after discharge from the hospital or from an SNF.
Explanation
The Medicare Part A spell of an illness is also known as the benefit period. It begins when a beneficiary enters the hospital and ends 60 days after discharge from the hospital or from an SNF.
A single general consent document is signed to cover all procedures and services being performed in any 24-hour period.
True or False?
False
Explanation
The statement is false because it is not common practice to have a single general consent document that covers all procedures and services performed in any 24-hour period. In reality, separate consent forms are typically required for each specific procedure or service to ensure that patients fully understand and agree to the risks, benefits, and alternatives of each individual treatment. Having separate consent forms also helps to ensure that patients are giving informed consent for each specific procedure or service.
Which of the following is not a true statement about the ABN?
A. The ABN must contain a complete description of the test(s) in question and the reason(s) that denial is likely.
B. Patients sign and date the ABN to indicate they understand and agree to pay for the tests if they are deemed noncovered.
C. The ABN must be signed and faxed to Medicare no later than 24 hours after the test is performed.
D. A beneficiary should not be given an ABN unless there is genuine doubt of Medicare payment.
E. Entities that issue ABNs are known by CMS as "notifiers."
C. The ABN must be signed and faxed to Medicare no later than 24 hours after the test is performed.
Explanation
The correct answer is "The ABN must be signed and faxed to Medicare no later than 24 hours after the test is performed." This statement is not true because the ABN does not need to be faxed to Medicare within 24 hours after the test is performed. The ABN must be given to the patient before the test is performed, and the patient must sign and date it to indicate their understanding and agreement to pay if the test is deemed noncovered. The ABN does not need to be sent to Medicare unless requested.
Which of the following is not a typical goal for reengineering Patient Access?
A. Place the focus on customer service so that the initial impression is a positive one.
B. Identify mechanisms to decrease wait times.
C. Free up staff time for training on new technology and regulations.
D. Make the process a positive and painless experience for the patient, guarantor, and/or family.
C. Free up staff time for training on new technology and regulations.
Explanation
The goal of reengineering Patient Access is to improve efficiency and effectiveness in the registration and scheduling processes. This includes focusing on customer service, decreasing wait times, and making the process positive and painless for patients and their families. However, freeing up staff time for training on new technology and regulations is not a typical goal for reengineering Patient Access. This is because staff training is necessary to ensure that employees are knowledgeable and competent in using new technology and complying with regulations, which ultimately contributes to improving patient access.
Which of the following accurately describe HICN formats and suffixes?
A. HICNs will either have 6 or 9 numeric digits.
B. The suffix for a husband, age 65 or over, is B1.
C. The suffix for a widow, age 65 or over and first claim, is D.
D. All Of the above
D. All of the above
Explanation
HICNs can have either 6 or 9 numeric digits. The suffix "B1" is used for husbands who are 65 years or older, while the suffix "D" is used for widows who are 65 years or older and filing their first claim.
Which of the following is not part of Medicare's requirements to consider an item or service medically necessary?
A. It must be established as safe and effective
B. It must be consistent with the symptoms or diagnosis of the illness or injury.
C. It must be considered cost effective.
D. It must not be furnished primarily for convenience.
C. It must be considered cost effective.
Explanation
The given answer states that the requirement for an item or service to be considered medically necessary is that it must be considered cost effective. However, this statement is incorrect. The other options provided in the question are all valid requirements for Medicare to consider an item or service medically necessary. The fact that an item or service is cost-effective is not a requirement for Medicare, as the focus is primarily on the safety, effectiveness, and relevance to the illness or injury being treated.
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 or False?
True
Explanation
To qualify for SNF (Skilled Nursing Facility) coverage, Medicare requires a person to have been admitted to a hospital and stayed as an inpatient for a minimum of three consecutive days. This means that the person must have been formally admitted to the hospital and not just receiving outpatient treatment. The day of discharge is not counted towards the three-day requirement. Therefore, the statement is true.
What is the term for patient screening before surgical or invasive procedures to determine hospitalization and/or surgical suitability?
A. Therapeutic drug monitoring (TDM)
B. Pre-admission testing (PAT)
C. Pre-admission screening (PAS)
D. Diagnostic medical screening (DMS)
B. Pre-admission testing (PAT)
Explanation
Pre-admission testing (PAT) refers to the process of screening patients before surgical or invasive procedures to assess their suitability for hospitalization and surgery. This testing helps healthcare providers evaluate the patient's overall health condition, identify any potential risks or complications, and determine the appropriate course of action. PAT involves various diagnostic tests, such as blood tests, imaging scans, and electrocardiograms, to ensure that the patient is physically fit for the procedure. By conducting PAT, healthcare professionals can minimize the chances of adverse events during surgery and optimize patient outcomes.
Which of the following is not a goal of The Patient Bill of Rights?
A. To stress the importance of the relationship between patients and providers
B. To ensure patients do not experience discrimination in billing and collections
C. To help patients feel more confident in the U.S. healthcare system
D. To stress the role that patients have to take to get and stay healthy
B. To ensure patients do not experience discrimination in billing and collections
Explanation
The Patient Bill of Rights aims to stress the importance of the relationship between patients and providers, help patients feel more confident in the U.S. healthcare system, and stress the role that patients have to take to get and stay healthy. However, it does not specifically address the goal of ensuring patients do not experience discrimination in billing and collections.