MOA183 Quiz Chapters2-4

Criminal penalties for HIPAA violations can include prison time and financial penalties up to what maximum amount?

$250,000

Under the Civil Monetary Penalties Law (CMPL), physicians who pay or accept kickbacks face penalties of up to:

$50,000 per kickback plus three times the amount of the remuneration.

Consolidated Omnibus Reconciliation Act (COBRA) insurance is available to former employees of businesses that have a minimum of:

20 employees

In the Patient's Bill of Rights under the Affordable Health Care Act, young adults who are not offered coverage at work are covered by their parents' plan until they reach:

26

How many days does the provider have to correct the patient's medical record once a request has been made?

30

The percentage of all healthcare providers who are physicians and nurses is:

40%

The percentage of all healthcare providers who are allied health professionals is:

60%

A payer that is contractually obligated to make payment for medical services on behalf of the covered person can be: a third-party administrator. a self-insured health benefit plan. an insurance company.

ALL

HIPAA guidelines apply to which of the following types of healthcare administrative transactions? claim status requests and reports eligibility requests and verifications health insurance claims

ALL

Protected health information (PHI) can be disclosed in which of the following circumstances? A coroner requests it to assist in identifying a body. An organ procurement organization requests it to facilitate the donation and transplantation of organs. The U.S. Food and Drug Administration requests it in relation to a product recall.

ALL

The advantage of using electronic data interchange standards (EDI) in the transmission of medical and claims data is: faster processing of transactions. improved data quality. lower operating costs.

ALL

The following is true of Obamacare: preventative care is more accessible. employers are mandated to furnish healthcare or be fined. requires all insurance plans to cover contraceptives at no cost.

ALL

Which of the following is true of self-insured plans? They use third-party administrators. They are regulated by the Employee Retirement Income Security Act (ERISA). They do not abide by state insurance regulations. All of these. They assume the financial risk of providing benefits for employees or members.

ALL

Which of the following is true of the new Patient's Bill of Rights under the Affordable Health Care Act? Insurance companies are banned from limiting choice of doctors. Insurance companies are banned from restricting emergency room care. Insurance companies are prohibited from charging patients for preventative care.

ALL

The HITECH Act is part of the:

American Recovery and Reinvestment Act.

The unique identifier for employers (business entities) that sponsor health insurance plans is the:

Federal Employer Identification Number (EIN).

Which of the following is a characteristic of a preferred provider organization (PPO)? Members select a primary care physician (PCP) as a gatekeeper. Members must obtain referrals to see a specialist. It includes a contracted network of providers. The plan is more restrictive than a health maintenance organization (HMO).

It includes a contracted network of providers.

Disadvantages of managed care include all of the following EXCEPT: It restricts physicians' latitude in caring for patients. It creates an increased administrative burden. It may require physicians to carry additional malpractice insurance. It includes disease management programs based on recent research.

It includes disease management programs based on recent research.

All the following are true regarding an ACO EXCEPT: It participates in a Medicare Shared Savings Program. It needs a patient's authorization to release medical information. It shares the patient's information with its network of providers. It is part of a Medicare Advantage plan.

It is part of a Medicare Advantage plan.

Which of the following is true of an exclusive provider organization (EPO)? Premiums are higher than with a preferred provider organization (PPO). It is regulated under insurance statutes. It is regulated under federal and state health maintenance organization (HMO) regulations. Premiums are lower than with a health maintenance organization (HMO).

It is regulated under insurance statutes.

All the following are true regarding the Affordable Care Act EXCEPT: It cannot deny coverage due to a pre-existing condition. It is also known as Obamacare. It requires people to prove citizenship before receiving services. It offers five different types of government plans.

It requires people to prove citizenship before receiving services.

Healthcare providers who achieve the standards of each HITECH stage by a designated date are eligible for:

Medicare and Medicaid incentive payments.

Fee schedules in managed care contracts are increasingly based on:

Medicare's resource-based relative value scale (RBRVS) with a different conversion factor.

insurance card

Name of insurance policy Insurance policy number Subscribers name

The organization that awards accreditation to managed care organizations is the:

National Committee for Quality Assurance (NCQA).

The unique identifier for physicians, nurses, and other healthcare professionals, organizations, and facilities that provide healthcare services or supplies is the:

National Provider Identifier (NPI).

A person who has a privacy complaint can file it with the:

Office for Civil Rights (OCR).

Advantages of managed care include all of the following EXCEPT: Physicians run the risk of unfavorable evaluations by enrollees. Hospitals and physicians provide services more efficiently. Providers strive to improve the quality of their care. Data is collected and analyzed to measure health outcomes.

Physicians run the risk of unfavorable evaluations by enrollees.

Which stage of HITECH focuses on securing electronic messaging to communicate relevant health information to patients?

Stage 2

An exclusive provider organization (EPO) is similar to a preferred provider organization (PPO) because they both have:

a flexible benefit design.

A payment poster would most likely work in which facility?

a large-group practice.

Which type of safeguard involves having procedures that clearly identify which employees have access to electronic protected health information (EPHI)?

administrative

When compared to individual insurance, group insurance provides:

better benefits and lower costs.

The benefits of a managed care contract to the provider include:

bringing more patients to the practice.

A contract with which of the following payment terms can result in an increased financial risk to the provider?

capitation

Which type of payment method creates an incentive to provide more preventive care? discounted fee-for-service per case per diem capitation

capitation

HIPAA requires that diagnoses and services be reported in a standard, consistent manner; this is accomplished by using uniform:

codes

Code set CPT stands for:

current procedural terminology.

An insurance identification card usually includes all of the following information EXCEPT: name of the insurance policy. detailed benefit information. name of the subscriber. insurance policy number.

detailed benefit information.

Examples of individuals who would qualify for COBRA include:

divorced ex-spouses of covered employees. children of covered employees who are no longer full-time students. employees who quit their jobs. employees who are laid off from their jobs.

Services provided to treat a medical condition that involves the sudden onset of acute symptoms of sufficient severity to threaten a person's life or health are:

emergency care.

Group insurance is issued to an employer to provide coverage for:

employees and all their dependents.

A characteristic of a staff model health maintenance organization (HMO) is that it:

employs salaried physicians.

Under a contract based on a per-case or per-visit rate of compensation, the provider is paid a predetermined rate for each:

episode of care.

Business values incorporated into medical practices as a result of managed care include a(n):

focus on efficiency, cost reduction, and profit.

The contract provision that states a physician cannot seek payment from a patient under a managed care contract in relation to any benefit penalties that were applied based on a utilization review decision is:

hold harmless

The type of health maintenance organization (HMO) plan that involves contracting with individual physicians to create a healthcare delivery system is a(n):

individual practice association (IPA) model.

If the patient is a minor, consent to the disclosure of protected health information (PHI) must be provided by a parent or:

legal guardian

By accepting lower payments from MCOs, physicians are forced to see more patients each day in order to:

maintain income

The maximum allowable fee payable for the provision of a particular contracted service by a physician is called the:

maximum fee

The HITECH Act introduced which concept in regard to electronic health information?

meaningful use

The electronic record that documents a patient's encounters with physicians and other clinicians that is stored within one provider's system is the electronic:

medical record.

The type of health maintenance organization (HMO) that contracts with more than one community-based multispecialty group to provide wider geographical coverage is a(n):

network model.

According to the new Patient's Bill of Rights, the following is true regarding emergency care:

new plans cannot penalize for out of network care.

Which type of safeguard involves controlling access to facility security plans and maintenance records and requiring all visitors to sign in?

physical

Which type of safeguard involves limiting access to computer hardware and software only to properly authorized personnel?

physical

The three types of safeguards that must be in place to be in compliance with the HIPAA Security Rule are:

physical, administrative, and technical.

All of the following are types of health maintenance organizations (HMOs) EXCEPT the: preferred provider model. individual practice association. open access model. group model

preferred provider model.

A medical office specialist must do all the following EXCEPT: explain the ACO to the patient. know the Patient Bill of Rights. be familiar with managed care terms. promote the provider network.

promote the provider network.

Under the HIPAA Privacy Rule, a patient's medical record and payment history are considered:

protected health information.

A managed care contract is considered a legal document between the:

provider and patient.

HITECH Stage 1 requirements include the implementation of a computerized:

provider order entry system.

Under a discounted fee-for-service arrangement, covered services are compensated at a:

reduced percentage of usual and customary charges.

Provisions included in a managed care contract with a provider include:

reimbursement amounts. what is expected of the provider. time limits for submitting claims.

Each medical practice must appoint a person to serve as its Privacy Compliance Officer, who must be familiar with federal and state privacy regulations in order to:

respond to requests for medical records and handle privacy-related complaints.

The type of insurance that provides coverage for a designated period of time is:

short-term health insurance.

With respect to National Committee for Quality Assurance (NCQA) accreditation:

some MCOs are accredited, and some are not.

The overall purpose of HIPAA Transactions and code set Rule is to:

standardize the electronic exchange of protected health information (PHI).

Physician-hospital organizations (PHOs) may include:

surgery centers. laboratories. nursing homes.

The contract issued by a payer, the plan document, or any other legally enforceable instrument under which a covered person may be entitled to covered services is called:

the benefit plan.

A managed care contract should clearly state all of the following EXCEPT: how much the physician will be paid for services. the time limit for submitting claims to the MCO. when payment should be received from the MCO. the list of employers with MCO contracts.

the list of employers with MCO contracts.

The increased demand for medical billers, medical office assistants, and medical coders can be attributed to:

the need for additional staff to file claims and work to obtain timely payment. physician practices' having more responsibility for filing claims. the growth of managed care.

A medical office specialist works as a liaison between:

the provider and patient. the provider and carrier.

All of the following are government plans under the Affordable Care Act EXCEPT: catastrophic. bronze. titanium. silver

titanium

In plans that require the primary care physician (PCP) to play a gatekeeper role, the PCP is given incentives to:

treat the patient as much as possible without a specialist referral unless absolutely necessary.

Insurance information obtained by the medical office specialist:

updated on a regular basis. verified with the insurance company. should be kept in the medical record.