Question 1

All of the following are an unethical and/or illegal practice EXCEPT:

Accepted Answer

A)  upcoding. 
B)  unbundling. 
C)  billing for services provided. 
D)  billing for levels of service not supported by documentation. 
E)  medically unnecessary procedures performed to increase reimbursement. 
A)  upcoding. 
B)  unbundling. 
C)  billing for services provided. 
D)  billing for levels of service not supported by documentation. 
E)  medically unnecessary procedures performed to increase reimbursement.

Question 2

Which of the following is a dollar amount determined by a hospital's operating costs and whether it is located in an urban area with a population of more than 1 million?

Accepted Answer

A)  Relative weight 
B)  IPPS rate 
C)  Reimbursement rate 
D)  Population rate 
E)  RUG-III 
A)  Relative weight 
B)  IPPS rate 
C)  Reimbursement rate 
D)  Population rate 
E)  RUG-III

Question 3

The amount the provider receives from the insurance plan is the:

Accepted Answer

A)  remittance. 
B)  reimbursement. 
C)  disbursement. 
D)  Both A and B 
E)  Both b and c 
A)  remittance. 
B)  reimbursement. 
C)  disbursement. 
D)  Both A and B 
E)  Both b and c

Question 4

Which of the following refers to health insurance policies sold by private insurance companies to fill "gaps" in Medicare plan coverage?

Accepted Answer

A)  Medicare Part C 
B)  Medigap 
C)  Medicaid 
D)  PPOs 
E)  All of the above 
A)  Medicare Part C 
B)  Medigap 
C)  Medicaid 
D)  PPOs 
E)  All of the above

Question 5

A compliance plan should include which of the following?

Accepted Answer

A)  Education and training sessions 
B)  Ongoing internal audits 
C)  Effective communication 
D)  Code of ethics 
E)  All of the above 
A)  Education and training sessions 
B)  Ongoing internal audits 
C)  Effective communication 
D)  Code of ethics 
E)  All of the above

Question 6

All of the following are categories of hospital acquired conditions (HACs), EXCEPT:

Accepted Answer

A)  myocardial infarction. 
B)  blood incompatibility. 
C)  catheter-associated urinary tract infection. 
D)  falls and trauma. 
E)  air embolism. 
A)  myocardial infarction. 
B)  blood incompatibility. 
C)  catheter-associated urinary tract infection. 
D)  falls and trauma. 
E)  air embolism.

Question 7

Which of the following is a bill for healthcare services or supplies?

Accepted Answer

A)  Explanation of benefits 
B)  Adjudication 
C)  Service plan 
D)  Remittance advice 
E)  Claim 
A)  Explanation of benefits 
B)  Adjudication 
C)  Service plan 
D)  Remittance advice 
E)  Claim

Question 8

An explanation of benefits (EOB) is also referred to as a(n):

Accepted Answer

A)  service plan. 
B)  bill. 
C)  remittance advice. 
D)  adjudication. 
E)  claim. 
A)  service plan. 
B)  bill. 
C)  remittance advice. 
D)  adjudication. 
E)  claim.

Question 9

The 14,000 ICD-9-CM codes are categorized by the DRG system into ________ major diagnostic categories (MDCs).

Accepted Answer

A)  10 
B)  25 
C)  50 
D)  75 
E)  100 
A)  10 
B)  25 
C)  50 
D)  75 
E)  100

Question 10

Which of the following refers to a person who is entitled to received benefits from a plan?

Accepted Answer

A)  Beneficiary 
B)  Third party 
C)  Provider 
D)  All of the above 
E)  None of the above 
A)  Beneficiary 
B)  Third party 
C)  Provider 
D)  All of the above 
E)  None of the above

All of the following are an unethical and/or illegal practice EXCEPT:

Which of the following is a dollar amount determined by a hospital's operating costs and whether it is located in an urban area with a population of more than 1 million?

The amount the provider receives from the insurance plan is the:

Which of the following refers to health insurance policies sold by private insurance companies to fill "gaps" in Medicare plan coverage?

A compliance plan should include which of the following?

All of the following are categories of hospital acquired conditions (HACs), EXCEPT:

Which of the following is a bill for healthcare services or supplies?

An explanation of benefits (EOB) is also referred to as a(n):

The 14,000 ICD-9-CM codes are categorized by the DRG system into ________ major diagnostic categories (MDCs).

Which of the following refers to a person who is entitled to received benefits from a plan?

Healthcare Delivery Fundamentals

Health Information Professionals

Accreditation, Regulation, and Hipaa

Fundamentals of Information Systems

Healthcare Records

Organization, Storage, and Management of Health Records

Electronic Health Records

Additional Health Information Systems

Healthcare Transactions and Billing

Health Statistics, Research, and Quality Improvement

Management and Decision Support Systems

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Exam 9: Healthcare Coding and Reimbursement

All of the following are an unethical and/or illegal practice EXCEPT:

Which of the following is a dollar amount determined by a hospital's operating costs and whether it is located in an urban area with a population of more than 1 million?

The amount the provider receives from the insurance plan is the:

Which of the following refers to health insurance policies sold by private insurance companies to fill "gaps" in Medicare plan coverage?

A compliance plan should include which of the following?

All of the following are categories of hospital acquired conditions (HACs), EXCEPT:

Which of the following is a bill for healthcare services or supplies?

An explanation of benefits (EOB) is also referred to as a(n):

The 14,000 ICD-9-CM codes are categorized by the DRG system into ________ major diagnostic categories (MDCs).

Which of the following refers to a person who is entitled to received benefits from a plan?

Healthcare Delivery Fundamentals

Health Information Professionals

Accreditation, Regulation, and Hipaa

Fundamentals of Information Systems

Healthcare Records

Organization, Storage, and Management of Health Records

Electronic Health Records

Additional Health Information Systems

Healthcare Transactions and Billing

Health Statistics, Research, and Quality Improvement

Management and Decision Support Systems

Filters