CPAR Exam 2019

The timely filing limit for Medicare claims is:

A. 1 year

The 2019 Medicare Part B Deductible is:

A. 185

An organization that accesses a discounted rate for services from a physician, hospital, or other healthcare provider without direct authorization from the provider (insurance company) is Known as____

A. A silent PPO

Disclosures made regarding a patient's protected health information without their Authorization are considered ______

A. A violation of the privacy rule (HIPPA)

If a CT Scan is ordered for neck pain for a Medicare beneficiary, but Medicare may not cover the CT scan with the diagnosis noted, what form should be signed by the patient prior to service:

A. An ABN

If a CT scan is ordered for neck pain for a Medicare beneficiary, but Medicare may not cover the CT Scan with the diagnosis noted, what form should be signed by the patient?

A. An ABN

When services might not be covered by Medicare, Medicare beneficiaries must be provided:

A. An ABN

Effective and aggressive management of _____ is essential to a robust revenue integrity program and in recent trends, it has moved from an "after-the-fact" initiative to an effective prevention program.

A. Denials

Internal Revenue Code Section 501r requires the hospital to not engage in _____ against an individual to obtain payment for care before the hospital has made reasonable efforts to notify the patient of the Financial Assistance Program and determine if they are eligible.

A. Extraordinary Collection Actions

One of the effective methods used to pre-register patients is via:

A. Face to Face

Which of the following is not true regarding lifetime reserve days?

A. Lifetime reserve days are renewable

Patients with this coverage must have a DMA69 form completed and signed prior to sterilization procedures.

A. Medicaid

Which statement below is NOT true?

A. Medicare Part B does not cover self-administered drugs.

To yield optimum positive results the following recommendations should be considered for front end processes:

A. Ongoing compliance and quality assurance

In a physician practice, which of the following is a part of the post service review?

A. Patient balance follow-up and collections

Which statement is false?

A. Preauthorization guarantees reimbursement of services

ICD-10-PCS is the International Classification of Diseases and:

A. Procedural Coding System

There are different types of diagnosis codes. The _______ is the working diagnosis at the time of admission.

A. Provisional Diagnosis

This Medicaid program pays for medical care of pregnant women, including labor and delivery, for up to 60 days after giving birth.

A. Right from the start

The medical coding and charging for services may be performed manually in a Physician practice via a:

A. Superbill

All of the following can give consent for medical treatment: Competent adult, guardian of a child or of an incompetent adult, emancipated minor, parents of minors, person with durable power of attorney for healthcare, DFCS case manager for foster care children.

A. TRUE

In relation to chapter 13 Bankruptcy - if a motion for dismissal is issued, the hospital may resume collection efforts.

A. TRUE

The goals of the Utilization Review are to ensure health care services are medically necessary, appropriate to the patient's condition and treatment and that each hospital day is necessary.

A. TRUE

The most important responsibilities of Patient Access is ensuring proper identification of the patient by accurately spelling the patient's full name and ensuring the date of birth is correct and appropriate insurance plan has been selected.

A. TRUE

_________ is responsible for auditing, investigating and imposing sanctions when necessary against health care providers.

A. The Office of Inspector General

Missing patient information can lead to incorrectly selecting the correct insurance plan code.

A. True

Intentional misrepresentations that can result in criminal prosecution, civil liability and Administrative sanctions are known as?

Abuse

At least _____ days prior to filing a lien, a letter of intent to file a lien must be sent to the patient and all known possible responsible parties.

B. 15

________ is a document signed by the patient in advance that authorizes a hospital to use certain methods of treatment.

B. Advanced Directive

Failure to submit Medicare credit balance report on a timely basis will result in suspension of future payments from the Medicare program. When payments are suspended, when will the Provider payments be re-instated?

B. After the delinquent submission is accepted by intermediary

Failure to submit the Medicare credit balance report on a timely basis will result in suspension of future payments from the Medicare program. When payments are suspended, when will the provider payments be re-instated?

B. After the delinquent submission is accepted by intermediary

The amount of money set aside to cover an expense is called?

B. An Accrual

The amount of money set aside to cover expenses is called _____.

B. An accrual

When a patient has been admitted to the hospital and has Part A Medicare coverage:

B. An inpatient claim must be submitted even if all the days have been exhausted

There is "no one size fits all" approach to compliance. Organizations must _______ their compliance program based on their organizational needs.

B. Customize

A spouse is responsible for debts of their mates if they don't sign the financial guarantee.

B. FALSE

Patient responsibility on _____ accounts may be known as spend down.

B. Medicaid

Doctor services, outpatient care, and some home health care are services covered by _______.

B. Medicare Part B

PHI (Protected Health Information) can be maintained and stored in the following forms?

B. Paper, Oral and Electronic

On a UB-04, the first diagnosis code must describe the:

B. Principle reason for the care provided

Additional information requests and medical record requests are examples of _________ denials.

B. Soft

Tricare for Life is:

B. Sometimes the primary payer

The CMS 838 is:

B. The Medicare quarterly credit balance report

in 1996 CMS developed the ____________ to reduce the Medicare program's expenditures by detecting inappropriate codes submitted on claims, to promote national coding methodologies, and to eliminate improper coding practices.

B. The correct coding initiative

Information from a medical record is used to record the history of a patient's health care, to facilitate reimbursement from third parties, and ...

B. To assist attorneys seeking settlements in injury cases, other legal issues and research

A simply formal name for mechanisms that help people find their way is:

B. Wayfinding

Regardless of the type of care that is provided, in the context of a physician practice, patients fall into two basic categories:

B: New and Established

What percentage of denials are traced back to the front end?

C. 0.75

A complete medical record contains:

C. All documentation related to the patient's care.

The automatic assignment of a person to a health insurance plan, typically under Medicaid plans is known as____

C. Auto-enrollment

A benefit period is a method Medicare uses to measure inpatient utilization for each Medicare patient. There is no limit on the number of benefits period. What are the 2019 Deductible, Co-Insurance and Life Time Reserve Amounts?

C. Deductible - $1,364.00 Co-Insurance - $341.00 Lifetime Reserve Days - $682.00

DRG stands for:

C. Diagnosis Related Group

______ is a federal law enacted to address Administrative Simplification and Insurance Reform.

C. HIPAA

Payments for claims may be delayed if the claim is audited. What are the two types of audits?

C. Hospital/ Defense Audits and Insurance Company Audits

A physician order for a requested appointment must have the following:

C. ICD10 Code and description

The Medicaid Inpatient and Non-Emergency Outpatient Co-Payment is:

C. Inpatient: $12.50 Non-Emergency Outpatient: $3.00

There are different types of diagnosis codes. The ______ is the condition established after study to be the chief reason for an admission.

C. Principal Diagnosis

The NPI (National Provider Identification) is a 10 digit number providing standard unique healthcare identifiers for the following:

C. Providers, Health plans and Employers

CPT codes are organized into six major sections, including E&M, Anesthesiology, Surgery, Medicine, Pathology/Lab and:

C. Radiology

The OIG guidance is specific to state that "__________" is perhaps the single biggest risk area for hospitals.

C. Submission of accurate claims and information

The complete medical record components are defined by Medicare and Medicaid, the Department of Human Resources in the State, and:

C. The Joint Commission

In a physician practice revenue cycle structure, point of service consists of:

Coding and Charge Capture

The patient has _____ days from the date of the accident to report the claim to their employer. With some exceptions, the Statute of Limitations for filing a claim is one year from the date of injury.

D. 30 days

All of the following codes EXCEPT ______ are frequently used when billing a claim to Medicare on the UB-04.

D. All of the Above

Early HMO's basic models included:

D. All of the above (staff, group, network, direct contract, IRA)

Best practices Post Service Processes to reduce and manage denial includes:

D. All of the answers are correct

Choose the correct statement(s) regarding TRICARE Coordination of Benefits (Double Coverage).

D. All of the answers are correct

Each medical record must contain information that will:

D. All of the answers are correct

Medicare may make additional payments to a facility (above the DRG amount) if one of the following applies:

D. All of the answers are correct

Patient access has a direct impact on several areas of the healthcare provider organization Including the following:

D. All of the answers are correct

Patient overpayments should not be refunded to the patient until the following categories have been exhausted:

D. All of the answers are correct

Physician Office staff should provide hospital schedulers with the following:

D. All of the answers are correct

The Center for Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative (CCI) in 1996 to:

D. All of the answers are correct

The following are considered enforceable elements of a contract:

D. All of the answers are correct

Using the correct insurance plan code and assigning the primary and secondary insurance plan appropriately to each registration, ensures the following:

D. All of the answers are correct

Which of the following are true statements?

D. All of the answers are correct

Who can give consent for treatment?

D. All of the answers are correct

In a physician practice, Pre-service Revenue Cycle consists of:

D. All the answers are correct

Which statement below is NOT true?

D. An ABN must be given to the patient for self-administered drugs.

A claim that fails to meet established coverage guidelines or the care fails to meet certain medical necessity criteria as establish by the payer is what kind of denial?

D. Clinical

In a physician practice, the process in which the care documented in the patient's medical record is reviewed and assigned CPT4, HCPCS, and ICD-10 codes is called _____.

D. Coding & Revenue Capture

The act that requires hospitals to provide emergency treatment to individuals, regardless of insurance status or ability to pay is ______.

D. EMTALA

People who are 65 years of age or older, disabled, or have one of the following two diseases may be covered by Medicare.

D. End Stage Renal Disease and Amyotrophic Lateral Sclerosis

Which of the following is NOT a type of consent for treatment?

D. Entitled Consent

The State Health Benefit Plan provides health insurance coverage to:

D. State employees, teachers and retirees in Georgia

The most apparent difference between a group plan and an individual health plan is:

D. The source of payment premiums

The type of bill used to void or cancel a claim is ____

D. xx8

Proper follow-up on a claim includes:

D: All of the answers are correct

A benefit period is a method Medicare uses to measure inpatient utilization for each Medicare patient, There is no limit on the number of benefits period. What are the 2019 Deductible, Co-Insurance and Life Time Reserve amounts?

Deductible $1364.00 Co-Insurance $341.00 Life Time Recovery Days $682.00

DRG stands for:

Diagnosis Related Group

EMTALA stands for:

Emergency Medical Treatment and Active Labor Act

The practice of acquiring, analyzing, and protecting digital and traditional medical information is known as:

HIM - Health Information Management

__ are organizations that are hired by employers to process claims, administer benefits Per the employer's policies and pay claims as they determine them to be reasonable.

TPA's

TCPA stands for:

Telephone Consumer Protection Act

The _____ is designed to attempt to identify any other coverage the patient may have that could be primary to Medicare.

MSP Questionnaire

This program covers children under the age of eighteen (18), pregnant women, and aged, blind and/ or disabled persons who otherwise would not be Medicaid eligible because their monthly income exceeds the AFDC eligibility standards.

Medically Needy Spend-Down

An ABN (Advanced Beneficiary Notice) should be issued to the patient at the time of:

Pre-Service Review

Diagnosis codes serve the purpose of establishing medical necessity, reflecting the acuity of the illness, and:

Providing data for statistical analysis

In following up on an unpaid claim, simply asking for a status of the claim:

Will always result in honest responses