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Ultimate Exam
Question 1. Which provider type is authorized to perform a limited scope of practice that includes prescribing controlled substances in most states? A) Medical Doctor (MD) B) Doctor of Osteopathic Medicine (DO) C) Nurse Practitioner (NP) D) Physician Assistant (PA) Answer: C Explanation: NPs have independent or collaborative prescriptive authority for controlled substances in many states, whereas PAs require physician supervision. Question 2. In a hospital‑owned practice, the governing body most directly responsible for clinical oversight is the: A) Board of Directors B) Medical Staff Committee C) Finance Committee D) Operations Committee Answer: B Explanation: The Medical Staff Committee provides clinical governance, ensuring quality and compliance with standards. Question 3. The most efficient step to reduce patient wait time during check‑in is to: A) Require insurance verification after the visit B) Implement electronic self‑check‑in kiosks C) Have patients fill paperwork in the waiting room
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D) Schedule appointments on a first‑come, first‑served basis Answer: B Explanation: Self‑check‑in kiosks capture demographics and insurance data before the encounter, streamlining workflow. Question 4. An effective leadership technique for improving physician‑staff communication is: A) Weekly written memos only B) Open‑door policy with regular huddles C) Strict hierarchical reporting D) Annual performance reviews only Answer: B Explanation: Regular huddles and an open‑door policy promote real‑time feedback and collaborative problem solving. Question 5. Which accounting method recognizes revenue when cash is actually received? A) Accrual accounting B) Modified cash basis C) Cash accounting D) Hybrid accounting Answer: C Explanation: Cash accounting records revenue at the point of cash receipt, unlike accrual which records when earned.
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Answer: D Explanation: Most accounting systems assign expense accounts to the 5000‑5999 range. Question 9. Which reimbursement model incentivizes providers to keep patients healthy by paying a fixed amount per member per month? A) Fee‑for‑Service B) Capitation C) Bundled Payments D) Pay‑for‑Performance Answer: B Explanation: Capitation provides a set per‑member payment regardless of services rendered, encouraging preventive care. Question 10. The CPT code set is primarily used for: A) Diagnoses documentation B) Procedure and service reporting C) Pharmaceutical billing D) Laboratory test identification Answer: B Explanation: CPT (Current Procedural Terminology) codes describe medical, surgical, and diagnostic services. Question 11. The first step of the revenue cycle, which verifies patient eligibility, occurs at the: A) Front‑end
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B) Middle‑office C) Back‑office D) Post‑payment Answer: A Explanation: Front‑end activities include eligibility verification and pre‑authorization before services are delivered. Question 12. An aging report that shows a high percentage of accounts >90 days old most likely indicates: A) Effective collections B) Billing errors or delayed payments C) Strong cash flow D) Low patient volume Answer: B Explanation: Older receivables suggest problems in billing accuracy, claim submission, or patient collection processes. Question 13. The most common root cause for claim denials related to “non‑covered services” is: A) Incorrect patient address B) Use of outdated CPT codes C) Missing provider NPI D) Service not medically necessary per payer policy Answer: D Explanation: Payers deny services not deemed medically necessary according to their coverage criteria.
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D) Implementing a new EMR system Answer: B Explanation: A CIA is a remedial agreement imposed by the OIG after significant compliance violations. Question 17. OSHA regulations most directly affect a practice’s: A) Billing procedures B) Clinical documentation standards C) Workplace safety and hazard communication D) Patient satisfaction surveys Answer: C Explanation: OSHA sets standards for employee safety, including exposure to bloodborne pathogens and ergonomics. Question 18. CLIA certification is required for a practice that performs: A) Radiology imaging B) Clinical laboratory testing on human specimens for diagnosis C) Prescription of medication D) Telehealth consultations Answer: B Explanation: The Clinical Laboratory Improvement Amendments (CLIA) regulate laboratories that test human samples for diagnostic purposes. Question 19. EMTALA obligates a hospital to:
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A) Provide free care to all patients B) Perform a medical screening exam and stabilize emergency conditions regardless of ability to pay C) Report all adverse events to the CDC D) Submit quarterly financial statements to CMS Answer: B Explanation: EMTALA requires emergency departments to screen and stabilize patients before discharge or transfer. Question 20. The first step in the staffing life cycle is: A) Conducting performance evaluations B) Recruiting and sourcing candidates C) Providing orientation D) Managing terminations Answer: B Explanation: Recruiting and sourcing precede all other HR activities in the staffing process. Question 21. Under the FLSA, a non‑exempt employee is entitled to: A) Salary regardless of hours worked B) Overtime pay for hours worked over 40 in a workweek C) Exemption from minimum wage requirements D) No overtime regardless of hours Answer: B
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C) Patient portal branding D) Inventory management module Answer: B Explanation: Clinical decision support can prompt appropriate CPT and ICD‑10 codes based on documented services. Question 25. Health Information Exchange (HIE) primarily enables: A. Direct mail communication between providers B. Secure electronic sharing of patient health data across organizations C. Billing reconciliation between insurers and providers D. Telehealth video conferencing Answer: B Explanation: HIEs facilitate interoperable exchange of health information across disparate health IT systems. Question 26. Telemedicine reimbursement under Medicare is considered: A. Covered only for rural patients B. Covered when the service is provided via real‑time interactive audio‑video communication and meets specific criteria C. Not covered under any circumstances D. Covered only for mental health services Answer: B Explanation: Medicare reimburses telehealth when services meet criteria such as originating site, technology, and provider qualifications.
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Question 27. A SWOT analysis helps a practice identify: A. Billing codes for new services B. Internal strengths and weaknesses as well as external opportunities and threats C. Employee salary scales D. The legal requirements for credentialing Answer: B Explanation: SWOT stands for Strengths, Weaknesses, Opportunities, Threats, providing a strategic overview. Question 28. The most effective metric to gauge patient satisfaction in a primary care practice is: A. Number of lab tests ordered B. Net Promoter Score (NPS) from post‑visit surveys C. Total revenue per provider D. Average length of stay in the waiting room Answer: B Explanation: NPS measures likelihood of patients recommending the practice, reflecting overall satisfaction. Question 29. When negotiating a vendor contract for medical supplies, the practice should include a clause for: A. Unlimited price increases B. Automatic renewal without notice C. Price escalation caps and performance guarantees
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A. Marketing strategy post‑disaster B. Data backup frequency and off‑site storage C. Employee vacation scheduling D. Redesigning the waiting area Answer: B Explanation: Protecting and restoring critical data is the primary focus of IT disaster recovery. Question 33. The HITECH Act primarily incentivized: A. Expansion of telehealth services B. Adoption and meaningful use of certified EHR technology C. Reduction of physician salaries D. Development of new pharmaceutical drugs Answer: B Explanation: HITECH provided financial incentives for meaningful use of EHRs to improve health care quality and safety. Question 34. Which of the following is considered a “designated health service” under Stark Law? A. Physical therapy B. Cosmetic surgery not covered by insurance C. Over‑the‑counter medication counseling D. Health education seminars Answer: A
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Explanation: Physical therapy is listed among the designated health services where self‑referral is prohibited. Question 35. A practice that uses the “bundled payment” model for a joint replacement surgery will: A. Bill each component separately B. Receive a single, comprehensive payment covering all services related to the episode of care C. Be reimbursed only for the surgical portion D. Not be able to bill for postoperative physical therapy Answer: B Explanation: Bundled payments combine all related services into one aggregate payment for the entire episode. Question 36. The CPT modifier “-25” is used to indicate: A. A bilateral procedure B. A significant, separately identifiable evaluation and management service on the same day as another procedure C. A reduced services fee D. A service performed by a trainee Answer: B Explanation: Modifier - 25 signals that the E/M service is distinct from other procedures performed on the same day. Question 37. Which of the following best describes “value‑based care”? A. Payment based solely on volume of services rendered
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Question 40. Under the EEOC, a practice must avoid discrimination based on all of the following EXCEPT: A. Age B. Marital status C. Disability D. National origin Answer: B Explanation: While many states prohibit marital status discrimination, the federal EEOC does not list it as a protected class. Question 41. The “right to audit” clause in a vendor contract primarily protects the practice by: A. Allowing the vendor to audit the practice’s financials B. Granting the practice access to the vendor’s records to verify pricing and compliance C. Preventing any audits from occurring D. Requiring the practice to audit all employee performance annually Answer: B Explanation: This clause enables the practice to review vendor records to ensure contractual terms are met. Question 42. In a cash‑based practice, which financial statement will most accurately reflect the practice’s liquidity? A. Income Statement B. Balance Sheet
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C. Statement of Cash Flows D. Owner’s Equity Statement Answer: C Explanation: The cash flow statement tracks inflows and outflows, directly showing liquidity. Question 43. A “hard stop” in an EMR workflow is used to: A. Prevent the provider from proceeding until a required field is completed B. Speed up data entry by skipping optional fields C. Automatically generate a claim D. Close the patient’s chart after discharge Answer: A Explanation: Hard stops enforce completion of critical documentation elements before advancing. Question 44. Which of the following is a key component of a practice’s Business Continuity Plan (BCP) for a pandemic? A. Redesigning the parking lot B. Implementing telehealth capabilities and remote work policies C. Expanding the cafeteria menu D. Purchasing new exam tables Answer: B Explanation: Telehealth and remote work ensure continuity of care when in‑person visits are limited. Question 45. The “35‑day rule” in Medicare billing refers to:
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Question 48. In the context of the ACA, the “Individual Shared Responsibility Payment” was eliminated in: A. 2015 B. 2017 C. 2019 D. 2021 Answer: B Explanation: The ACA penalty for not having health insurance was reduced to $0 starting in 2019, following the 2017 Tax Cuts and Jobs Act. Question 49. A practice’s “gross collection ratio” is calculated by dividing: A. Net collections by total expenses B. Gross charges by net collections C. Net collections by gross charges D. Total revenue by total assets Answer: C Explanation: The ratio measures the percentage of billed charges that are actually collected. Question 50. Which of the following best describes “incident reporting” in risk management? A. Documenting only financial losses B. Recording any event that could affect patient safety or staff well‑being C. Reporting only events that result in legal action
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D. Tracking marketing campaign outcomes Answer: B Explanation: Incident reporting captures all near‑misses, injuries, or adverse events to improve safety. Question 51. When a practice contracts with a “qualified health plan” (QHP) under the ACA, it must: A. Accept any patient regardless of insurance status B. Offer a minimum set of essential health benefits C. Provide free services to all members D. Submit quarterly financial statements to CMS Answer: B Explanation: QHPs must cover essential health benefits as defined by the ACA. Question 52. The “grouper” in a bundled payment model is used to: A. Separate individual services for separate billing B. Combine related services into a single billing entity based on diagnosis‑related groups (DRGs) or APCs C. Assign a random payment amount D. Determine provider salaries Answer: B Explanation: Grouper software classifies services into bundles for payment based on DRGs (inpatient) or APCs (outpatient). Question 53. Under the FMLA, an eligible employee is entitled to:
