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CPAR Exam 2019 WITH VERIFIED
SOLUTIONS
The amount of money set aside to cover an expense is called? B. An Accrual In a physician practice, Pre-service Revenue Cycle consists of: D. All the answers are correct Intentional misrepresentations that can result in criminal prosecution, civil liability and Administrative sanctions are known as? Abuse 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. Co-Insurance $341. Life Time Recovery Days $682. In following up on an unpaid claim, simply asking for a status of the claim: Will always result in honest responses __ 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 Which of the following are true statements? D. All of the answers are correct EMTALA stands for: Emergency Medical Treatment and Active Labor Act The automatic assignment of a person to a health insurance plan, typically under Medicaid plans is known as____
C. Auto-enrollment In a physician practice revenue cycle structure, point of service consists of: Coding and Charge Capture Patient access has a direct impact on several areas of the healthcare provider organization Including the following: D. All of the answers are correct Doctor services, outpatient care, and some home health care are services covered by _______. B. Medicare Part B All of the following codes EXCEPT ______ are frequently used when billing a claim to Medicare on the UB-04. D. All of the Above The CMS 838 is: B. The Medicare quarterly credit balance report Tricare for Life is: B. Sometimes the primary payer 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 Missing patient information can lead to incorrectly selecting the correct insurance plan code. A. True Disclosures made regarding a patient's protected health information without their Authorization are considered ______ A. A violation of the privacy rule (HIPPA) Physician Office staff should provide hospital schedulers with the following: D. All of the answers are correct Which statement below is NOT true? A. Medicare Part B does not cover self-administered drugs. The type of bill used to void or cancel a claim is ____
The practice of acquiring, analyzing, and protecting digital and traditional medical information is known as: HIM - Health Information Management The 2019 Medicare Part B Deductible is: A. 185 Patients with this coverage must have a DMA69 form completed and signed prior to sterilization procedures. A. Medicaid The timely filing limit for Medicare claims is: A. 1 year A complete medical record contains: C. All documentation related to the patient's care. A simply formal name for mechanisms that help people find their way is: B. Wayfinding The amount of money set aside to cover expenses is called _____. B. An accrual Early HMO's basic models included: D. All of the above (staff, group, network, direct contract, IRA) 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 The State Health Benefit Plan provides health insurance coverage to: D. State employees, teachers and retirees in Georgia The complete medical record components are defined by Medicare and Medicaid, the Department of Human Resources in the State, and: C. The Joint Commission 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 TCPA stands for:
Telephone Consumer Protection Act What percentage of denials are traced back to the front end? C. 0. ______ is a federal law enacted to address Administrative Simplification and Insurance Reform. C. HIPAA Additional information requests and medical record requests are examples of _________ denials. B. Soft 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 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 Patient responsibility on _____ accounts may be known as spend down. B. Medicaid ICD- 10 - PCS is the International Classification of Diseases and: A. Procedural Coding System _________ is responsible for auditing, investigating and imposing sanctions when necessary against health care providers. A. The Office of Inspector General The NPI (National Provider Identification) is a 10 digit number providing standard unique healthcare identifiers for the following: C. Providers, Health plans and Employers Proper follow-up on a claim includes: D: All of the answers are correct Best practices Post Service Processes to reduce and manage denial includes: D. All of the answers are correct
A. Patient balance follow-up and collections Each medical record must contain information that will: D. All of the answers are correct One of the effective methods used to pre-register patients is via: A. Face to Face Choose the correct statement(s) regarding TRICARE Coordination of Benefits (Double Coverage). D. All of the answers are correct 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 most apparent difference between a group plan and an individual health plan is: D. The source of payment premiums The _____ is designed to attempt to identify any other coverage the patient may have that could be primary to Medicare. MSP Questionnaire 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 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 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 When services might not be covered by Medicare, Medicare beneficiaries must be provided: A. An ABN
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 Which of the following is not true regarding lifetime reserve days? A. Lifetime reserve days are renewable CPT codes are organized into six major sections, including E&M, Anesthesiology, Surgery, Medicine, Pathology/Lab and: C. Radiology 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 The act that requires hospitals to provide emergency treatment to individuals, regardless of insurance status or ability to pay is ______. D. EMTALA 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 Patient overpayments should not be refunded to the patient until the following categories have been exhausted: D. All of the answers are correct 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
Which of the following is NOT a type of consent for treatment? D. Entitled Consent 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. Co-Insurance - $341. Lifetime Reserve Days - $682. There is "no one size fits all" approach to compliance. Organizations must _______ their compliance program based on their organizational needs. B. Customize 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 Which statement below is NOT true? D. An ABN must be given to the patient for self-administered drugs. Inpatient Medicaid stays that exceed the 90 day pre-certification will have to be re-certified within _____ prior to the 90th day. C. 3 days Tricare for Life is: C. Always the secondary payer. What is chapter 13 bankruptcy? B. Wage earners proceedings where debtor allowed to reorganize debt When a patient is determined to be eligible for retroactive Medicaid, a claim must be filed: A. Within 6 months of the month the retroactive eligibility is made. Which of the following is NOT true regarding a Rural Health Clinic (RHC)? D. It must provide preventative services Phrase used in the insurance industry to refer to the process of paying claims submitted.
C. Adjudication Best practice Time of Service Processes to reduce and manage denials includes: D. All of the answers are correct Validating patient identity is crucial to the continuity of patient care, patient safety through the reduction of patient record errors and minimizing fraud to the healthcare facility. A. TRUE CPT stands for: D. Current Procedural Terminology The _______ for Georgia is Palmetto GBA. B. Mac The critical validation points and factors that determine if a hospital will be paid for its services include(s): D. Insurance verification and precertification The Medicare rule that requires that all diagnostic services (regardless of the diagnosis) and any related therapeutic (same diagnosis) outpatient services provided to a beneficiary three days prior to an inpatient admission to the same hospital or a hospital owned, operated or managed by the same hospital be included on the inpatient claim and not billed separately on an outpatient claim is called: B. 72 hour rule Medical Necessity, untimely, and incorrect coding are examples of _______ denials. C. Hard ___________ are federally funded plans offered on the healthcare.gov marketplace. D. Exchange Plans Hospitals that are determined by the Department of Justice for violating the False Claim Act may be subject to entering a Corporate Integrity Agreement (CIA) and may be fined _____ times the amount of the violation. B. 3
A. Case Management/ Care Coordination The purpose of the HIPPA Notice of Privacy Practices is to inform patients of the privacy practices of their healthcare providers as well as their own privacy rights with respect to personal health information. A. TRUE _______ is a report that generally lists account numbers, patient and insurance balances, financial class, etc. B. Aged Trial Balance In Patient Access, ______ allow the opportunity to centralize and complete registration during scheduling and collect patient liability. A. Call Centers What form lets Medicare patients know that they may have to pay for a test or procedure their doctor has ordered if Medicare refuses to pay? D. ABN - Advanced Beneficiary Notice of Non-Coverage Medicare credit balance reports should be submitted: C. 30 days after the close of each quarter Hospitals can use the legal theory of _____ to fight refund demands by an insurer. C. Unjust enrichment A person who dies without a valid will is considered _______. B. Intestate Ambulatory payment classification is a method of reimbursement for _____. B. Outpatient Claims The ______ is the hospital inpatient notice given to all beneficiaries with Medicare or a Medicare Managed Care plan that explains their rights while in the hospital and how they may file an appeal if they feel they are being discharged too soon. A. IMM Ambulance billing requires: A. Pick up and destination modifiers Medical necessity is an analysis of the medical treatment ordered to determine if it is reasonable and necessary, and provided in the most appropriate setting to
meet the needs of the patient's illness or injury. Medicare has developed policies to determine if tests and procedures ordered are medically necessary. The policies are: D. A&B The benefits of the insurance plan of the parent whose birthday falls earlier in a year are determined before those of the insurance plan of the parent whose birthday falls later in that year; but if both parents have the same birthday, the benefits of the insurance plan which covered one parent longer are determined before those of the insurer which covered the other parent for a shorter period of time. This statement is known as: D. Birthday Rule Commercial insurance provides health care benefits to beneficiaries through a for-profit insurance company. Commercial carriers are charged-based carriers as opposed to cost-based payers. Two basic commercial insurance coverage's are individual or Direct Pay Health Care Plans and Group Healthcare Plans. A. TRUE In following up on an unpaid claim, simply asking for a status of the claim: B. is woefully insufficient (?) Missing patient information can lead to incorrectly selecting the correct insurance plan code. A. TRUE The following level II codes assigned by CMS are primarily used to identify products, supplies, and services not in the CPT codes: B. HCPCS Codes The hospital participation agreement requires the hospital to attempt to identify any other coverage the patient may have that could be primary to Medicare. Specific questions must be asked to determine if of the following could be primary over Medicare. Working Aged, Disabled, ESRD, Worker's compensation, Federal Black Lung, VA, Auto, No Fault, Medical and Liability, Law Enforcement and other government programs such as Research Grants. This is known as the _________ questionnaire.
Active duty and retired military sponsors, eligible family members and all other eligible beneficiaries must be entered into the Eligibility Reporting System to show eligibility for TRICARE benefits. The name of this system is: C. Defense Enrollment Eligibly Reporting System (DEERS) Determination by health plan that the recommended medical services, supply or drug meets the definition of medical necessity is called: A. Pre-certification ______ requires that individuals who receive care from a hospital facility be informed about financial assistance. B. 501r Which organization focuses on programs such as Pay for Performance (P4P), Provider Profiling, Quality Indicators and Report Cards? B. MCO's Charges for Physician services are billed on a: CMS 1500 Form All employers in the state of Georgia who have more than _____ employees, in the same line of business are required to have workers compensation insurance O.C.G.A 34- 9 - 2. C. 3 Which steps should you take when dealing with a bankrupt debtor? D. All of the answers are correct Sterilization procedures performed on Medicaid patients must occur between ______ days after the appropriate form is signed. B. 30- 180 What is chapter 7 bankruptcy? C. complete discharge of all debts In a physician practice, coding and charge capture are part of the: B. Point of Service Revenue Cycle Hospital and Nursing facilities are required to submit the DMA Form 710 ______. B. Quarterly Medicare has _____ parts:
D. 4
ABN stands for: Advanced Beneficiary Notice of Non-Coverage In the absence of statutes, regulations or national coverage policies, MAC's write ______ to address medical necessity policies. B. Local Coverage Determinations (LCD's) What type of bill would be used for an inpatient acute care hospital stay? A. 11X The ________ program was implemented by CMS in 2005 to identify and recover improper payments made by CMS. A. RAC What is chapter 12 bankruptcy? A. Bankruptcies for farmers What criteria must a debt meet to be considered an allowable Medicare bed debt? D. All of the answers are correct In a situation where the patient is unconscious and is taken to the emergency room, the law states that the hospital can treat the patient. This is known as: C. Implied consent - by law Tricare Prime is for: A. Beneficiaries who are not entitled to Medicare due to age (65) Intentional misrepresentations that can result in criminal prosecution, civil liability, and administrative sanctions are known as _______. C. Fraud Patient identity is typically initially validated via a government issued identification card such as: Driver's license
