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CPAR Exam Questions with Correct Solved Solutions
1. The amount of money set aside to cover an expense is called?: B. An Accrual
2. In a physician practice, Pre-service Revenue Cycle consists of:: D. All the answers are correct
3. Intentional misrepresentations that can result in criminal prosecution, civil liability and
Administrative sanctions are known as?: Abuse
4. 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. Life Time Recovery Days $682.
5. In following up on an unpaid claim, simply asking for a status of the claim:-
: Will always result in honest responses
6. are organizations that are hired by employers to process claims, admin-ister benefits
Per the employer's policies and pay claims as they determine them to be reasonable.: TPA's
7. Which of the following are true statements?: D. All of the answers are correct
8. EMTALA stands for:: Emergency Medical Treatment and Active Labor Act
9. The automatic assignment of a person to a
health insurance plan, typically under Medicaid plans is known as : C. Auto-enrollment
10. In a physician practice revenue cycle structure, point of service consists of:: Coding and
Charge Capture
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11. Patient access has a direct impact on several areas of the healthcare provider
organization Including the following:: D. All of the answers are correct
12. Doctor services, outpatient care, and some home health care are services
covered by .: B. Medicare Part B
13. All of the following codes EXCEPT are
frequently used when billing a claim to Medicare on the UB-04.: D. All of the Above
14. The CMS 838 is:: B. The Medicare quarterly credit balance report
15. Tricare for Life is:: B. Sometimes the primary payer
16. 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
17. Missing patient information can lead to incorrectly selecting the correct insurance
plan code.: A. True
18. Disclosures made regarding a patient's
protected health information with-out their Authorization are considered : A. A violation of the privacy rule (HIPPA)
19. Physician Office staff should provide hospital schedulers with the follow-ing:: D. All of the
answers are correct
20. Which statement below is NOT true?: A. Medicare Part B does not cover self-administered drugs.
21. The type of bill used to void or
cancel a claim is : D. xx
22. DRG stands for:: Diagnosis Related Group
23. An ABN (Advanced Beneficiary Notice) should be issued to the patient at the time of:: Pre-
4 / 17 sterilization procedures.: A. Medicaid
35. The timely filing limit for Medicare claims is:: A. 1 year
36. A complete medical record contains:: C. All documentation related to the patient's care.
37. A simply formal name for mechanisms that help people find their way is:: B. Wayfinding
38. The amount
of money set aside to cover expenses is called .: B. An accrual
39. Early HMO's basic models included:: D. All of the above (statt,
group, network, direct contract, IRA)
40. 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
41. The State Health Benefit Plan provides health insurance coverage to:: D. State employees, teachers
and retirees in Georgia
42. The complete medical record components are defined by Medicare and Medicaid, the
Department of Human Resources in the State, and:: C. The Joint Commission
43. The Center for Medicare and Medicaid Services (CMS) developed the Na-tional Correct
Coding Initiative (CCI) in 1996 to:: D. All of the answers are correct
44. TCPA stands for:: Telephone Consumer Protection Act
45. What percentage of denials are traced back to the front end?: C. 0.
46. is a federal law enacted to address Administrative Simplification and Insurance
Reform.: C. HIPAA
47. Additional information requests and medical record requests are examples of
denials.: B. Soft
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48. 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
49. 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
50. Patient responsibility on accounts may be known
as spend down.: B. Medicaid
51. ICD-10-PCS is the International Classification of Diseases and:: A. Procedural Coding
System
52. is responsible for auditing, investigating and imposing sanctions when necessary
against health care providers.: A. The Oflce of Inspector General
53. The NPI (National Provider Identification) is a 10 digit number providing standard
unique healthcare identifiers for the following:: C. Providers, Health plans and Employers
54. Proper follow-up on a claim includes:: D: All of the answers are correct
55. Best practices Post Service Processes to reduce and manage denial in-cludes:: D. All of
the answers are correct
56. DRG stands for:: C. Diagnosis Related Group
57. 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
58. Using the correct insurance plan code and assigning the primary and secondary
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68. The OIG guidance is specific
to state that " " is perhaps the single biggest risk area for hospitals.: C. Submission of accurate claims and information
69. The most apparent difference between a group plan and an individual health plan is::
D. The source of payment premiums
70. The is designed to attempt to identify any other coverage the patient may have
that could be primary to Medicare.: MSP Questionnaire
71. 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
72. 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
73. 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
74. When services might not be covered by Medicare, Medicare beneficiaries must be
provided:: A. An ABN
75. 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
76. Which of the following is not true regarding lifetime reserve days?: A. Lifetime reserve days are
renewable
77. CPT codes are organized into six major sections, including E&M, Anesthe-siology,
Surgery, Medicine, Pathology/Lab and:: C. Radiology
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78. 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
79. The act that requires hospitals to provide emergency treatment to individ-uals,
regardless of insurance status or ability to pay is .: D. EMTALA
80. in 1996 CMS developed the to reduce the
Medicare program's expenditures by detecting inappropriate codes submitted on claims, to pro- mote national coding methodologies, and to eliminate improper coding prac-tices.: B. The correct coding initiative
81. Information from a medical record is used to record the history of a pa-tient's health
care, to facilitate reimbursement from third parties, and ...: B. To assist attorneys seeking settlements in injury cases, other legal issues and research
82. Patient overpayments should not be refunded to the patient until the following
categories have been exhausted:: D. All of the answers are correct
83. 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
84. is a document signed by the patient in advance that authorizes a hospital to use
certain methods of treatment.: B. Advanced Directive
85. A physician order for a requested appointment must have the following:: C. ICD10 Code and
description
86. Who can give consent for treatment?: D. All of the answers are correct
87. 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
10 / 17 their compliance program based on their organizational needs.: B. Customize
98. Effective and aggressive
management of is essential to a robust revenue integrity program and in recent trends, it has moved from an "af-ter-the-fact" initiative to an effective prevention program.: A. Denials
99. Which statement below is NOT true?: D. An ABN must be given to the patient for self-admin-istered drugs.
100. 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
101. Tricare for Life is:: C. Always the secondary payer.
102. What is chapter 13 bankruptcy?: B. Wage earners proceedings where debtor allowed to reorganize debt
103. 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.
104. Which of the following is NOT true regarding a Rural Health Clinic (RHC)?: D. It must provide
preventative services
105. Phrase used in the insurance industry to refer to the process of paying claims
submitted.: C. Adjudication
106. Best practice Time of Service Processes to reduce and manage denials includes:: D. All of
the answers are correct
107. Validating patient identity is crucial to the continuity of patient care, pa-tient safety
through the reduction of patient record errors and minimizing fraud to the healthcare facility.: A. TRUE
108. CPT stands for:: D. Current Procedural Terminology
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109. The for Georgia is Palmetto GBA.: B. Mac
110. The critical validation points and factors that determine if a hospital will be paid for its
services include(s):: D. Insurance verification and precertification
111. 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
112. M
edical Necessity, untimely, and incorrect coding are examples of denials.: C. Hard
113. are federally funded plans offered on the healthcare.gov mar-ketplace.: D.
Exchange Plans
114. Hospitals that are determined by the Department of Justice for violating the False
Claim Act may be subject to entering a Corporate Integrity Agree-ment (CIA) and may be fined times the amount of the violation.: B. 3
115. Under the Affordable Care Act, plans that offer coverage to children on
their parents' plan must make the coverage available until the adult reaches the age of .: D. 26
116. Issues that are likely to cause a claim to fall "clean claim" testing are
often detected by .: C. Claim Scrubber
117. The basis for determining qualifications for indigent and/or charity care is the : D. Federal
Poverty Guidelines
118. A medical hospital lien must contain the following:: C. The amount of the hospital bill
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128. 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
129. Medicare credit balance reports should be submitted:: C. 30 days after the close of each quarter
130. Hospitals can use the legal theory of
to fight refund demands by an insurer.: C. Unjust enrichment
131. A person who dies
without a valid will is considered .: B. Intestate
132. Ambulatory payment classification is a method of reimbursement for
.: B. Outpatient Claims
133. 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
134. Ambulance billing requires:: A. Pick up and destination modifiers
135. Medical necessity is an analysis of the medical treatment ordered to deter-mine 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
136. 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
14 / 17 parent for a shorter period of time. This statement is known as:: D. Birthday Rule
137. Commercial insurance provides health care benefits to beneficia-
ries through a for-profit insurance company. Commercial carriers are charged-based carriers as opposed to cost-based payers. Two basic commer-cial insurance coverage's are individual or Direct Pay Health Care Plans and Group Healthcare Plans.: A. TRUE
138. In following up on an unpaid claim, simply asking for a status of the claim:: B. is
woefully insufficient (?)
139. Missing patient information can lead to incorrectly selecting the correct insurance
plan code.: A. TRUE
140. 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
141. 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.: A. Medicare Secondary Payer
142. With few exceptions, any Tricare beneficiary who lives within the zip code
catchment areas of a uniformed Services Hospital must obtain a before Tricare will cover the cost of non-emergency inpatient care received from a civilian hospital.: D. NAS (Non-Availability Statement)
143. The OIG (office of inspector general) established seven steps for an ef-fective compliance
program. Which of the following are included in these steps?: A. Standard of conduct, policies and procedures, ongoing
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154. Which organization focuses on programs such as Pay for Performance (P4P), Provider
Profiling, Quality Indicators and Report Cards?: B. MCO's
155. Charges for Physician services are billed on a:: CMS 1500 Form
156. 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
157. Which steps should you take when dealing with a bankrupt debtor?: D. All of the answers are
correct
158. Sterilization procedures performed on Medicaid patients must occur be-tween
days after the appropriate form is signed.: B. 30-
159. What is chapter 7 bankruptcy?: C. complete discharge of all debts
160. In a physician practice, coding and charge capture are part of the:: B. Point of Service Revenue
Cycle
161. Hospital and Nursing facilities are required to submit the DMA Form 710
.: B. Quarterly
162. Medicare has parts:: D. 4
163. ABN stands for:: Advanced Beneficiary Notice of Non-Coverage
164. In the absence of statutes, regulations or national coverage policies, MAC's write to
address medical necessity policies.: B. Local Coverage Determinations (LCD's)
165. What type of bill would be used for an inpatient acute care hospital stay?: A. 11X
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166. The program was implemented by CMS in 2005 to identify and recover
improper payments made by CMS.: A. RAC
167. What is chapter 12 bankruptcy?: A. Bankruptcies for farmers
168. What criteria must a debt meet to be considered an allowable Medicare bed debt?: D. All
of the answers are correct
169. In a situation where the patient is unconscious and is taken to the emer-gency room,
the law states that the hospital can treat the patient. This is known as:: C. Implied consent - by law
170. Tricare Prime is for:: A. Beneficiaries who are not entitled to Medicare due to age (65)
171. Intentional
misrepresentations that can result in criminal prosecution, civil liability, and administrative sanctions are known as .: C. Fraud
172. Patient identity is typically initially validated via a government issued iden-tification
card such as:: Driver's license
