Question 1_4 out of 4 points
What is the value of a remittance advice?
Selected Answer: c.
It states what will be paid and why any changes to charges were made.
Correct Answer: c.
It states what will be paid and why any changes to charges were made.
Response
Feedback:
Rationale: The determi...
Master Test Review
Chapter 1 Test Review
Question 1_4 out of 4 points
What is the value of a remittance advice?
Selected Answer:
c. It states what will be paid and why any changes to charges were made.
Correct Answer: c. It states what will be paid and why any changes to charges were made.
Response Feedback: Rationale: The determination of the payer is sent to the provider in the form of a remittance advice. The remittance advice explains the outcome of the insurance adjudication on the claim,
including the payment amount, contractual adjustments and reason(s) for denial.
Question 2_4 out of 4 points
What is the purpose of National Coverage Determinations?
Selected Answer:
d. To explain CMS policies on when Medicare will pay for items or services.
Correct Answer: d. To explain CMS policies on when Medicare will pay for items or services.
Response Feedback: Rationale: National Coverage Determinations (NCD) explain CMS policies on when Medicare will pay for items or services.
Question 3_4 out of 4 points
How many components are included in an effective compliance plan?
Selected Answer:
d.
7
Correct Answer: d.
7
Response Feedback: Rationale: The following list of components, as set forth in previous OIG Compliance Program Guidance for Individual and Small Group Physician Practices, can form the basis of a voluntary compliance program for a provider practice: • Conducting internal monitoring and auditing through the performance of periodic audits; • Implementing compliance and practice standards through the development of written standards and procedures; • Designating a compliance officer or contact(s) to monitor compliance efforts and enforce practice standards; • Conducting appropriate training and education on practice standards and procedures; • Responding appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate Government entities; • Developing open lines of communication, such as (1) discussions at staff meetings regarding how to avoid erroneous or fraudulent conduct, and (2) community bulletin boards, to keep practice employees updated regarding compliance activities; and • Enforcing disciplinary standards through well-publicized guidelines. These seven components provide a solid basis upon which a provider practice can create a compliance program.
Question 4_4 out of 4 points
EHR stands for:
Selected Answer:
a. Electronic health record
Correct Answer: a. Electronic health record
Response Feedback:Rationale: EHR stands for electronic health record
Question 5_4 out of 4 points
The minimum necessary rule is based on sound current practice that protected health information should NOT be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function. What does this mean?
Selected Answer: b. Providers should develop safeguards to prevent unauthorized access to protected health information.
Correct Answer:
b. Providers should develop safeguards to prevent unauthorized access to protected health information.
Response Feedback: Rationale: The minimum necessary standard requires covered entities to evaluate their practices and enhance safeguards as needed to limit unnecessary or inappropriate access to and disclosure of protected health information. Only those individuals whose job requires it may have access to PHI. Only the minimum protected information required to do the job should
be shared.
Question 6_4 out of 4 points
Professionals who specialize in coding are called:
Selected Answer:
c. Coding specialists
Correct Answer: c. Coding specialists
Response Rationale: Professionals who specialize in coding are called medical coders or coding Feedback: specialists.
Question 7_4 out of 4 points
In what year was HITECH enacted as part of the American Recovery and Reinvestment Act?
Selected Answer:
d.
2009
Correct Answer: d.
2009
Response Feedback: Rationale: The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. Question 8_4 out of 4 points
What is PHI?
Selected Answer:
c. Protected health information
Correct Answer: c. Protected health information
Response Feedback: Rationale: Protected health information under the Health Information Portability and Accountability Act (HIPAA) is any information, whether oral or recorded, in any form or medium that is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university or health care clearinghouse relating to the past, present or future physical or mental health or condition of an individual, the provision of health services to that individual or payment around those services. Only health information at the individual level is covered; health information of groups is not.
Question 9_4 out of 4 points
Which of the following is a BENEFIT of electronic transactions?
Selected Answer:
c. Timely submission of claims
Correct Answer: c. Timely submission of claims
Response Feedback: Rationale: Electronic claims benefit the provider office by allowing timely submissions to the
insurance carrier and proof of transmission of the claims.
Question 10_4 out of 4 points
HIPAA stands for Selected Answer:
c. Health Insurance Portability and Accountability Act
Correct Answer: c. Health Insurance Portability and Accountability Act
Response Feedback:Rationale: Health Insurance Portability and Accountability Act (HIPAA)
Question 11_4 out of 4 points
Which option below is NOT a covered entity under HIPAA?
Selected Answer:
d. Workers’ Compensation
Correct Answer: d. Workers’ Compensation
Response Feedback: Rationale: The definition of health plan in the HIPAA regulations excludes any policy, plan or program that provides or pays for the cost of excepted benefits. Excepted benefits include:
• Coverage only for accident or disability income insurance, or any combination thereof;
• Coverage issued as a supplement to liability insurance;
• Liability insurance, including general liability insurance and automobile liability insurance;
• Workers’ compensation or similar insurance;
• Automobile medical payment insurance;
• Credit-only insurance;
• Coverage for on-site medical clinics; • Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
Question 12_4 out of 4 points
What is the definition of medical coding?
Selected Answer: c. Translating documentation into numerical/alphanumerical codes used to obtain reimbursement.
Correct Answer:
c. Translating documentation into numerical/alphanumerical codes used to obtain reimbursement.
Response Feedback: Rationale: Medical coding is the process of translating a healthcare provider's documentation of a patient encounter into a series of numeric or alphanumeric codes.
Question 13_4 out of 4 points
The OIG recommends that provider practices enforce disciplinary actions through well publicized compliance guidelines to ensure actions that are ______.
Selected Answer:
c.
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