Question 1

Which data element is collected differently on the CMS-1500 than on the UB-04?

Accepted Answer

A)  Race 
B)  Diagnosis code 
C)  Reason for visit 
D)  Total charges 
A)  Race 
B)  Diagnosis code 
C)  Reason for visit 
D)  Total charges B

Question 2

Medicare claims are processed by:

Accepted Answer

A)  the Centers for Medicare and Medicaid Services (CMS) 
B)  Quality Improvement Organizations (QIOs) 
C)  Medicare Administrative Contractors (MACs) 
D)  individual states 
A)  the Centers for Medicare and Medicaid Services (CMS) 
B)  Quality Improvement Organizations (QIOs) 
C)  Medicare Administrative Contractors (MACs) 
D)  individual states C

Question 3

______________ is a formal system of providing funding for health care for low-income populations.

Accepted Answer

Medicaid

Question 4

A health plan will have lower monthly premiums if

Accepted Answer

A)  the risk pool is smaller 
B)  the people in the risk pool are older 
C)  the deductible and co-insurance is higher 
D)  the network is larger 
A)  the risk pool is smaller 
B)  the people in the risk pool are older 
C)  the deductible and co-insurance is higher 
D)  the network is larger

Question 5

In the ________________, the organization owns the facilities, employs the physicians, and provides essentially all health care services.

Accepted Answer

A)  staff model health maintenance organization (HMO) 
B)  preferred provider organization (PPO) 
C)  indemnity company 
D)  health sharing plan 
A)  staff model health maintenance organization (HMO) 
B)  preferred provider organization (PPO) 
C)  indemnity company 
D)  health sharing plan

Question 6

Which is a way the Affordable Care Act aimed to lower health insurance premiums?

Accepted Answer

A)  increasing the number of healthier covered lives in the risk pool 
B)  underwriting individuals based on biometrics and health status 
C)  allowing insurance to be sold across state lines 
D)  requiring insurance companies to cover pre-existing conditions 
A)  increasing the number of healthier covered lives in the risk pool 
B)  underwriting individuals based on biometrics and health status 
C)  allowing insurance to be sold across state lines 
D)  requiring insurance companies to cover pre-existing conditions

Question 7

What might explain a positive variance in budgeted salary expenses?

Accepted Answer

A)  Salaries were frozen as planned. 
B)  An employee resigned and was not replaced. 
C)  There were merit raises. 
D)  Additional employees were hired to support a new service. 
A)  Salaries were frozen as planned. 
B)  An employee resigned and was not replaced. 
C)  There were merit raises. 
D)  Additional employees were hired to support a new service.

Question 8

Which program pays for the care of a veteran's spouse and dependents?

Accepted Answer

A)  CHAMPVA 
B)  TRICARE 
C)  VHA 
D)  TEFRA 
A)  CHAMPVA 
B)  TRICARE 
C)  VHA 
D)  TEFRA

Question 9

Brett makes $60,000/year before getting a 3% raise in July. How much should the department manager budget for Brett's monthly salary from July through December?

Accepted Answer

A)  $5,000 
B)  $5,150 
C)  $1,800 
D)  $6,180 
A)  $5,000 
B)  $5,150 
C)  $1,800 
D)  $6,180

Question 10

All of the following statements about ambulatory payment classifications (APCs) are true, EXCEPT:

Accepted Answer

A)  patients may be assigned to more than one APC for an encounter. 
B)  APC assignment is based on ICD-10-PCS procedure codes. 
C)  there are approximately 2,000 APCs. 
D)  APCs apply only to ambulatory care. 
A)  patients may be assigned to more than one APC for an encounter. 
B)  APC assignment is based on ICD-10-PCS procedure codes. 
C)  there are approximately 2,000 APCs. 
D)  APCs apply only to ambulatory care.

Question 11

A hospital's case mix index is derived by:

Accepted Answer

A)  organizing each DRG by rank, with the patients in the most frequently occurring DRG listed as 1, and so forth. 
B)  computing the average relative weight of all the cases discharged in a given period. 
C)  the cost of living, regional labor costs, and graduate medical education in the area. 
D)  the sum of gross revenue divided by the number of discharges for a time period. 
A)  organizing each DRG by rank, with the patients in the most frequently occurring DRG listed as 1, and so forth. 
B)  computing the average relative weight of all the cases discharged in a given period. 
C)  the cost of living, regional labor costs, and graduate medical education in the area. 
D)  the sum of gross revenue divided by the number of discharges for a time period.

Question 12

The HIM department is allowed $250 per month for supplies. At the end of the third quarter, the department has spent $3,000 on supplies. This means that the HIM department is:

Accepted Answer

A)  under budget YTD by $750. 
B)  over budget YTD by $2,750. 
C)  exactly as it should be on budget for supplies. 
D)  over budget by $750. 
A)  under budget YTD by $750. 
B)  over budget YTD by $2,750. 
C)  exactly as it should be on budget for supplies. 
D)  over budget by $750.

Question 13

A patient was admitted to an acute care facility for alcoholic liver disease. The patient stayed in the facility for 10 days. The actual charges incurred were $21,821. The PPS rate is $6,487.12. The per diem rate is $672.24 per day. For this case, Medicare will most likely pay:

Accepted Answer

A)  $21,821.00. 
B)  $6,487.12. 
C)  $6, 722.40. 
D)  $672.24. 
A)  $21,821.00. 
B)  $6,487.12. 
C)  $6, 722.40. 
D)  $672.24.

Question 14

When hospitals began to be reimbursed based on diagnosis-related groups, the average patient length of stay decreased. Why?

Accepted Answer

A)  Coding became timelier and more accurate. 
B)  A PPS implies a financial incentive to discharge patients sooner. 
C)  More patients were admitted with illnesses that did not require long stays. 
D)  Diagnoses became more accurate and therefore patients could be treated more quickly. 
A)  Coding became timelier and more accurate. 
B)  A PPS implies a financial incentive to discharge patients sooner. 
C)  More patients were admitted with illnesses that did not require long stays. 
D)  Diagnoses became more accurate and therefore patients could be treated more quickly.

Question 15

The Medicare patient presented to the emergency department with chest pain and shortness of breath. The patient was treated and released. The emergency department charges were $430. The APC amount was $250. Two days later, the patient returned to the emergency department with congestive heart failure and was admitted to the hospital. The length of stay for the admission was 2 days. The inpatient charges were $4,700. The DRG amount was $3,500. What is the expected reimbursement for these visits?

Accepted Answer

A)  $3,500. 
B)  $3,750. 
C)  $4,700. 
D)  $5,130. 
A)  $3,500. 
B)  $3,750. 
C)  $4,700. 
D)  $5,130.

Question 16

Which of the following is NOT a way in which managed care organizations may influence and/or control the patient's choices in selecting health care services?

Accepted Answer

A)  The patient must select a primary care provider. 
B)  Only approved services are reimbursed. 
C)  The managed care organization decides what services are "medically necessary." 
D)  The managed care organization only pays for primary care services. 
A)  The patient must select a primary care provider. 
B)  Only approved services are reimbursed. 
C)  The managed care organization decides what services are "medically necessary." 
D)  The managed care organization only pays for primary care services.

Question 17

Which statement is a common criticism of the prospective payment system?

Accepted Answer

A)  "The PPS makes it more difficult to treat patients on an individualized basis." 
B)  "The PPS makes it harder to budget." 
C)  "The PPS promotes inefficiencies among physicians." 
D)  "The PPS has disincentives for keeping costs down." 
A)  "The PPS makes it more difficult to treat patients on an individualized basis." 
B)  "The PPS makes it harder to budget." 
C)  "The PPS promotes inefficiencies among physicians." 
D)  "The PPS has disincentives for keeping costs down."

Question 18

A family pays a monthly premium of $1,000 for a health insurance plan with a $2,000 deductible, a 10% coinsurance for inpatient stays, and a yearly out-of-pocket maximum for $6,000 per family member. The first medical event of the year was a family member having gallbladder surgery, which was a covered procedure. The charges from the hospital are $26,000, the charges from the surgeon are $1,500, and the charges from the anesthesiologist are $900. For what amount will the family pay out-of-pocket?

Accepted Answer

A)  $6,000 
B)  $1,000 
C)  $4,600 
D)  $2,000 
A)  $6,000 
B)  $1,000 
C)  $4,600 
D)  $2,000

Question 19

The primary care system where a PCP limits access to other parts of the health care delivery system is called a ______________ model.

Accepted Answer

The answer of The primary care system where a PCP...

Question 20

A managed care insurer negotiates with a provider to pay 11% less than the provider's standard charge for a certain service. This reimbursement methodology is called:

Accepted Answer

A)  discounted fee for service. 
B)  fee for service. 
C)  a prospective payment system. 
D)  capitation. 
A)  discounted fee for service. 
B)  fee for service. 
C)  a prospective payment system. 
D)  capitation.

Which data element is collected differently on the CMS-1500 than on the UB-04?

Medicare claims are processed by:

______________ is a formal system of providing funding for health care for low-income populations.

A health plan will have lower monthly premiums if

In the ________________, the organization owns the facilities, employs the physicians, and provides essentially all health care services.

Which is a way the Affordable Care Act aimed to lower health insurance premiums?

What might explain a positive variance in budgeted salary expenses?

Which program pays for the care of a veteran's spouse and dependents?

Brett makes $60,000/year before getting a 3% raise in July. How much should the department manager budget for Brett's monthly salary from July through December?

All of the following statements about ambulatory payment classifications (APCs) are true, EXCEPT:

A hospital's case mix index is derived by:

The HIM department is allowed $250 per month for supplies. At the end of the third quarter, the department has spent $3,000 on supplies. This means that the HIM department is:

A patient was admitted to an acute care facility for alcoholic liver disease. The patient stayed in the facility for 10 days. The actual charges incurred were $21,821. The PPS rate is $6,487.12. The per diem rate is $672.24 per day. For this case, Medicare will most likely pay:

When hospitals began to be reimbursed based on diagnosis-related groups, the average patient length of stay decreased. Why?

Which of the following is NOT a way in which managed care organizations may influence and/or control the patient's choices in selecting health care services?

Which statement is a common criticism of the prospective payment system?

The primary care system where a PCP limits access to other parts of the health care delivery system is called a ______________ model.

A managed care insurer negotiates with a provider to pay 11% less than the provider's standard charge for a certain service. This reimbursement methodology is called:

The Health Care Industry

Collecting and Storing Health Care Data

Sources of Data

Data Quality and Management

Coded Data

Statistics and Data Analytics

Confidentiality and Compliance

Management and Leadership

Performance Improvement and Project Management

Filters

Exam 6: Financial Management

Which data element is collected differently on the CMS-1500 than on the UB-04?

Medicare claims are processed by:

______________ is a formal system of providing funding for health care for low-income populations.

A health plan will have lower monthly premiums if

In the ________________, the organization owns the facilities, employs the physicians, and provides essentially all health care services.

Which is a way the Affordable Care Act aimed to lower health insurance premiums?

What might explain a positive variance in budgeted salary expenses?

Which program pays for the care of a veteran's spouse and dependents?

Brett makes $60,000/year before getting a 3% raise in July. How much should the department manager budget for Brett's monthly salary from July through December?

All of the following statements about ambulatory payment classifications (APCs) are true, EXCEPT:

A hospital's case mix index is derived by:

The HIM department is allowed $250 per month for supplies. At the end of the third quarter, the department has spent $3,000 on supplies. This means that the HIM department is:

A patient was admitted to an acute care facility for alcoholic liver disease. The patient stayed in the facility for 10 days. The actual charges incurred were $21,821. The PPS rate is $6,487.12. The per diem rate is $672.24 per day. For this case, Medicare will most likely pay:

When hospitals began to be reimbursed based on diagnosis-related groups, the average patient length of stay decreased. Why?

Which of the following is NOT a way in which managed care organizations may influence and/or control the patient's choices in selecting health care services?

Which statement is a common criticism of the prospective payment system?

The primary care system where a PCP limits access to other parts of the health care delivery system is called a ______________ model.

A managed care insurer negotiates with a provider to pay 11% less than the provider's standard charge for a certain service. This reimbursement methodology is called:

The Health Care Industry

Collecting and Storing Health Care Data

Sources of Data

Data Quality and Management

Coded Data

Statistics and Data Analytics

Confidentiality and Compliance

Management and Leadership

Performance Improvement and Project Management

Filters