Exam 20: Regulatory and Reimbursement Issues

The effects of the new regulatory and reimbursement laws instigated subtle changes which will have an impact on the physician office as well as outpatient facilities, ancillary services, and hospitals. In order to become, or perhaps soon remain, a Medicare/Medicaid provider, a medical compliance program must be in place. According to the Fox Group's website that includes which of the following measures?

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(Multiple Choice)

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Question 1

Correct Answer:

Verified

A,C,D,E

Which of the following responses is not a benefit of Pay for Performance (P4P) legislation?

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Question 2

Correct Answer:

Verified

The Centers for Medicare and Medicaid Services (CMS) mandated all providers, insurers and any middlemen involved in the health care industry submission of claims for reimbursement or registering of care, the verifying of eligibility, the precertification of services, or any other client- related information to adhere to a uniform format by October 200 2.This action forced all providers to install_______________________ transmission programs in their billing and medical record systems.Standard Text:

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(Short Answer)

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Question 3

Correct Answer:

Verified

Electronic Data Interchange (EDI)
Rationale : The Centers for Medicare and Medicaid Services (CMS) mandated all providers, insurers and any middlemen involved in the health care industry submission of claims for reimbursement or registering of care, the verifying of eligibility, the precertification of services, or any other client- related information to adhere to a uniform format by October 2002. This action forced all providers to install Electronic Data Interchange (EDI) transmission programs in their billing and medical record systems and has altered the methods of communication for all health care professionals.

The __________________________ was developed by Medicare in an effort to control quality and cost and minimize preventable complications.

(Short Answer)

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Question 4

On October 1, 2013, the federal government will implement the mandatory transition to the International Classification of Diseases, Tenth Revision (ICD-10). Of the following responses, which is the most reasonable rationale for the upgrade?

(Multiple Choice)

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Question 5

Which of the following statements is true about the do-not-pay list?

(Multiple Choice)

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Question 6

There has been an impact of the Health Insurance Reform Act, also known as The Patient Protection and Affordable Care Act, on system use and design. Which of the following actions was enacted upon the president's signature?

(Multiple Choice)

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Question 7

One of the biggest pitfalls and concerns to health care providers to the transition to the ICD-10 by 2013 is which of the following?

(Multiple Choice)

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Question 8

Electronic data interchange (EDI) is an effort to help phase out paper claims except under extensive appeal circumstances. The result of this initiative is which of the following?

(Multiple Choice)

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Question 9

The role of the informatics nurse is important to the success of the implementation of the EHR. Which of the following statements is true about the expanded role of the informatics nurse?

(Multiple Choice)

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Question 10

President Obama signed into law on March 23, 2010, The Health Care and Education Reconciliation Act of 2010 (Pub.L.111-152, 124Stat.1029), which amended the Patient Protection and Affordable Care Act (PPAC) and further strengthened the federal grip on health care regulation in the United States. Which of the following statements best reflects the intentions of the act?

(Multiple Choice)

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Question 11

Which of the following statements about Medicare Part A are correct?

(Multiple Choice)

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Question 12

Implementing an electronic health record in a small primary care practice can be cost prohibitive. To assist in the cost of the endeavor, the government has done which of the following?

(Multiple Choice)

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Question 13

The importance of billing codes and reimbursement for services cannot be overstated. Which of the following responses are true regarding accurate code input and claims processing?

(Multiple Choice)

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Question 14

The system called Pay for Performance (P4P) is also known as which of the following?

(Multiple Choice)

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Question 15

Electronic data interchange (EDI) has been instrumental in facilitating the health care process. Which of the following responses best describes the impact of the EDI?

(Multiple Choice)

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Question 16

Which of the following statements is true about the projected results of the increase in federal and state mandated health care cost reform legislation?

(Multiple Choice)

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Question 17

The Patient Protection and Affordable Care Act of March 2010 (PPACA) Section 1561 will, when fully activated by 2014, extend affordable health care to an estimated 32 million more people. Which of the following is not a financial impact of the Act?

(Multiple Choice)

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Question 18

Which type of billing codes is used by Medicare to determine the level of severity and per diem rate?

(Multiple Choice)

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Question 19

Which of the following organizations is the umbrella under which all regulatory agencies eventually fall because the health and welfare of the citizens of the nation are ultimately deemed to be federal responsibility?

(Multiple Choice)

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Question 20

Showing 1 - 20 of 28

Exam 20: Regulatory and Reimbursement Issues

Which of the following responses is not a benefit of Pay for Performance (P4P) legislation?

The __________________________ was developed by Medicare in an effort to control quality and cost and minimize preventable complications.

On October 1, 2013, the federal government will implement the mandatory transition to the International Classification of Diseases, Tenth Revision (ICD-10). Of the following responses, which is the most reasonable rationale for the upgrade?

Which of the following statements is true about the do-not-pay list?

There has been an impact of the Health Insurance Reform Act, also known as The Patient Protection and Affordable Care Act, on system use and design. Which of the following actions was enacted upon the president's signature?

One of the biggest pitfalls and concerns to health care providers to the transition to the ICD-10 by 2013 is which of the following?

Electronic data interchange (EDI) is an effort to help phase out paper claims except under extensive appeal circumstances. The result of this initiative is which of the following?

The role of the informatics nurse is important to the success of the implementation of the EHR. Which of the following statements is true about the expanded role of the informatics nurse?

Which of the following statements about Medicare Part A are correct?

Implementing an electronic health record in a small primary care practice can be cost prohibitive. To assist in the cost of the endeavor, the government has done which of the following?

The importance of billing codes and reimbursement for services cannot be overstated. Which of the following responses are true regarding accurate code input and claims processing?

The system called Pay for Performance (P4P) is also known as which of the following?

Electronic data interchange (EDI) has been instrumental in facilitating the health care process. Which of the following responses best describes the impact of the EDI?

Which of the following statements is true about the projected results of the increase in federal and state mandated health care cost reform legislation?

The Patient Protection and Affordable Care Act of March 2010 (PPACA) Section 1561 will, when fully activated by 2014, extend affordable health care to an estimated 32 million more people. Which of the following is not a financial impact of the Act?

Which type of billing codes is used by Medicare to determine the level of severity and per diem rate?

Which of the following organizations is the umbrella under which all regulatory agencies eventually fall because the health and welfare of the citizens of the nation are ultimately deemed to be federal responsibility?

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