Revenue Cycle Management in Healthcare, Exams of Nursing

Download Revenue Cycle Management in Healthcare and more Exams Nursing in PDF only on Docsity! CMAA Practice Test - ALL Ch.'s A CMAA is reviewing remittance advice to determine how claims have been paid and to see if any errors have been made by the third-party payer. This action occurs in which of the following phases of the revenue cycle? A. Receiving and posting reimbursement B. Payer adjudication C. Appeals and claims collections D. Health care encounter and documentation - correct answer ✔✔A. Receiving and posting reimbursement What stage is the revenue cycle considered to be completed? A. Registration and scheduling B. Payer adjudication C. Health care encounter and documentation D. Posting the payment - correct answer ✔✔D. Posting the payment A CMAA is checking with a patient's insurance payer to determine if a referral or preauthorization is needed prior to performing an MRI. This action occurs in which of the following phases of the revenue cycle? A. Payer adjudication B. Appeals and claims collection C. Charge capture and coding D. Utilization management review - correct answer ✔✔D. Utilization management review A CMAA is contacting the insurance payer to determine benefits coverage for a procedure and is requesting approval. Which of the following steps of the revenue cycle is being performed? A. Appeal B. Payer adjudication C. Eligibility and insurance preauthorization D. Encounter documentation - correct answer ✔✔C. Eligibility and insurance preauthorization Which of the following items is required in the encounter note? A. Provider signature B. Copay amount C. Provider's phone number D. Patient address - correct answer ✔✔A. Provider signature How often should a medical administrative assistant perform charge reconciliation? A. Yearly B. Monthly C. Daily D. Weekly - correct answer ✔✔C. Daily A CMAA notices a difference between the billed and allowed amount. Which of the following type of transaction must be posted in the patient account? A. Hardship write-off B. Contractual adjustment C. Payment posting D. Charge entry - correct answer ✔✔B. Contractual adjustment C. A patient who has an acute medical condition D. A patient diagnosed with end-stage renal disease - correct answer ✔✔D. A patient diagnosed with end-stage renal disease Which of the following is a function of a clearinghouse? A. Claims adjudication B. Submits claims to the third-party payer C. Files appeals D. Performs charge capture and coding - correct answer ✔✔B. Submits claims to the third-party payer Which of the following is the set amount established by an insurance payer for an office visit and should be collected at the time of the encounter? A. Premium B. Deductible C. Copay D. Coinsurance - correct answer ✔✔C. Copay A CMAA notices that no payments from a certain third party payer have been received in the past month. Which type of report should the assistant review to determine the status of the submitted claims? A. Patient aging report B. Insurance aging report C. Daily transaction report D. Patient statements - correct answer ✔✔B. Insurance aging report Which of the following programs will qualify a patient based on income? A. Medicare B. TRICARE C. Worker' compensation D. Medicaid - correct answer ✔✔D. Medicaid Which of the following is a program that is available to a patient who has no income or has a specific medical needs? A. Special needs plan (SNP) B. Sliding scale C. Hardship waiver D. TRICARE plan - correct answer ✔✔A. Special needs plan (SNP) A provider is paid a set amount for each member per month. This is an example of which of the following types of payment models? A. Value-based payment model B. Medicare Advantage Plan C. Fee-for-service D. Capitation - correct answer ✔✔D. Capitation Which of the following forms is used to report claims to a third-party payer from a provider's office? A. UB-04 B. CMS-1500 C. ABN Form D. Patient registration form - correct answer ✔✔B. CMS-1500 Which of the following codes are reported on the claim form to represent the conditions managed at the time of the visit and are required by the third-party payer for claims processing? A. HCPCS B. CPT C. DRG D. ICD-10-CM - correct answer ✔✔D. ICD-10-CM A third-party payer's policy for the length of time to submit claims is known as which of the following? A. Charge entry B. Timely filling C. Claims submission D. Payment posting - correct answer ✔✔B. Timely filling A Medicare beneficiary has enrolled in a health plan that offers inpatient, outpatient, vision, and dental coverage. In which of the following types of health plan is the beneficiary enrolled? A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D - correct answer ✔✔C. Medicare Part C Which of the following is a type of physical safeguard to protect patient medical records? A. Firewalls B. Automatic log off C. Software that logs access history D. Employee training - correct answer ✔✔C. Software that logs access history Which of the following paper filing systems can be helpful in a multiple-provider practice? Which of the following must be included in the inventory of equipment for the health care organization? A. Upgradeable options B. Brand comparisons C. Maintenance log D. Customer rating - correct answer ✔✔C. Maintenance log Which of the following should be verified when deliveries of supplies are received? A. The person who inventoried the prior delivery B. If the item goes to a specific person or department C. If the person who place the order researched for the best price D. Any discounts received for the supplies - correct answer ✔✔B. If the item goes to a specific person or department Which of the following can be used to make inventory software easier to use while maintaining accuracy? A. Linking the computer system to the vendors B. Only inventorying items greater than $500 in value C. Having two different employees verify D. Using barcodes for tracking - correct answer ✔✔D. Using barcodes for tracking Which of the following can be financial repercussion of not updating the inventory regularly? A. A person or department not receiving their item B. Having an excessive number of expired supplies C. Having the right number of supplies D. Preventing a shortage of items - correct answer ✔✔B. Having an excessive number of expired supplies Which of the following is a benefit of using inventory software? A. Eliminating downtime B. Determine trends of usage C. Having a surplus of supplies D. Limiting access to one person - correct answer ✔✔B. Determine trends of usage Which type of correspondence can be used to communicate a message to office staff with a date for a reference? A. Template B. Formal letter C. Standard form letter D. Memorandum - correct answer ✔✔D. Memorandum Which of the following should be used when answering the telephone in a health care facility? A. The name of the facility B. A loud voice C. A monotone voice D. The date and location of facility - correct answer ✔✔A. The name of the facility Which of the following actions should be taken when a second call comes in while speaking with a person on the first call? A. Put the first person on hold, and complete the second call B. Let the second call go to voicemail C. Put the first person on hold, and screen the second call D. Ask the first caller to call back later so the second can be answered. - correct answer ✔✔C. Put the first person on hold, and screen the second call D. Ask the first caller to call When the health care facility has downtime and paper messages are required, which of the following information must be documented? A. the name of the health care facility B. The facility's cell phone service company C. The facility's employer information D. The initials of the person who took the message - correct answer ✔✔D. The initials of the person who took the message Which of the following is a proper salutation? A. To Whom It May Concern B. Dear Sir or Madam C. Dear Nelson Fletcher D. Dear Mr. Nelson Fletcher - correct answer ✔✔C. Dear Nelson Fletcher Which of the following applies to written correspondence? A. Proofread correspondence before sending B. Write at a college level to patients C. Correspond when upset so that details are not forgotten D. Incorporate complex medical terms - correct answer ✔✔A. Proofread correspondence before sending Which of the following should be followed when writing to a specific person? A. Use generic greetings. B. Use nicknames. A. Provide the patient with the next available appointment. B. States, "Thursday will work," to see if the patient corrects the day. C. Make eye contact and asks the patient to repeat the information. D. Shake head to indicate confusion. - correct answer ✔✔C. Make eye contact and asks the patient to repeat the information. Which of the following actions should a medical administrative assistant take if a member of the health care team is not communicating effectively? A. Stop communicating with the team member. B. Have a private conversation with the team member. C. Contact the human resource department. D. Set up a meeting with the provider. - correct answer ✔✔B. Have a private conversation with the team member. Which of the following actions should a medical administrative assistant take when communicating with a patient about an upcoming procedure? A. Present the information in an envelope as the patient walks out so they can read it at home. B. Inform the patient that they can research the procedure online for more information. C. Give detailed information about possible complications. D. Avoid complex medical terminology - correct answer ✔✔D. Avoid complex medical terminology Why is it important to provide clear verbal and written instructions to a patient who is preparing for a procedure? A. It helps inform the patient's family about the procedure. B. It ensures insurance is able to be billed. C. It helps to prevent procedure cancelations. D. It prevent the patient from calling the office back to ask questions. - correct answer ✔✔C. It helps to prevent procedure cancelations. Which of the following is an example of educational or community resources that a medical administrative assistant can provide to a patient when they inquire about further information? A. Smoking cessation B. Wikipedia link C. Fundraising platforms D. List of staff at the facility - correct answer ✔✔A. Smoking cessation A medical administrative assistant notices the office has been receiving incentives from a medical equipment supplier for prescribing their devices to patients who have Medicare. Which of the following describes this action? A. Medicare fraud B. Medicare abuse C. Providing medical services in accordance with Medicare regulations D. General medical standard of care - correct answer ✔✔A. Medicare fraud A medical administrative assistant should identify that which of the following is an example of a HIPAA violation? A. Discussing the condition of a fellow employee's family member who requires preauthorization for treatment of their gastrointestinal infection. B. Releasing medical information to the CDC for a patient who has measles. C. An employee posts a picture to social media of the waiting room to show how busy the night shift is. D. Discussing the care of a minor child with the custodial parent. - correct answer ✔✔C. An employee posts a picture to social media of the waiting room to show how busy the night shift is. A patient is concerned about their protected health information (PHI). Which of the following is an example of PHI? A. Name of the patient's treating provider B. Diagnosis codes used for billing C. The medical office's address D. The patient's license plate number - correct answer ✔✔D. The patient's license plate number Which of the following is a requirement when disclosing patient medical records containing PHI from one medical provider to another medical provider? A. A release authorization signed by the patient when it is related to treatment, payment, or health care operations B. Inclusion of the patient's complete medical records C. The reason for releasing the medical records D. A bill submitted by the primary medical provider for the medical record release process - correct answer ✔✔C. The reason for releasing the medical records Which of the following actions should a medical administrative assistant take to safeguard patient data? A. Turn off the computer screen when going to lunch. B. Use a screen visor to cover patient information. C. Share passwords only on a need-to-know basis. D. Enter information on their personal cell phone to prevent repeated access of the medical record. - correct answer ✔✔B. Use a screen visor to cover patient information. A medical organization receives a court order for the medical record of a patient who has private insurance, but it does not include a signed release from the patient. Which of the following actions should the medical administrative assistant take? A. Fulfill the medical record request. B. Contact the patient to have them sign a release C. Contact the patient's insurance company for authorization D. Protect and respect the dignity and privacy of all patients - correct answer ✔✔C. Continuously act in the best interest of the general public. A medical administrative assistant is reviewing the fraud and abuse section in the policies and procedures manual. Which of the following responsibilities from the National Health Career Association Code of Ethics is the assistant fulfilling? A. Support the standards of professionalism and be honest in all professional interactions B. Protect and respect the dignity and privacy of all patients C. Participate in activities contributing to the improvement of personal health, our society, and the betterment of the allied health industry D. Continue to learn, apply, and advance scientific and practical knowledge and skills, stay up to date on the latest research and its practical application. - correct answer ✔✔A. Support the standards of professionalism and be honest in all professional interactions The staff in a provider's office routinely provides their patient medical records to the local university for a diabetes research project. Which of the following types of HIPAA violations does this disclosure represent? A. Unknowingly disclosing information B. Reasonable cause C. Corrected willful neglect D. Uncorrected willful neglect - correct answer ✔✔D. Uncorrected willful neglect Which of the following types of patient information requires authorization to be released? A. Child abuse documentation for the Child Protective Services B. Bone scan results for a consultation C. Stab wound repair notes for the police D. Sexually transmitted infection test results for state agencies - correct answer ✔✔B. Bone scan results for a consultation Which of the following is a pre-determined service type for optional scheduling within the same medical organization? A. Same provider service within the past 3 years B. Service provided out-of-network C. Service provided with a different provider in the same medical organization D. Service provided via telehealth due to different geographic location - correct answer ✔✔A. Same provider service within the past 3 years A CMAA answers a call from a parent who states their 7-year-old child has a sore throat , runny nose, and earache. The child was last seen 1 month ago for a camp physical. The assistant should schedule the appointment for which of the following durations? A. 15 minutes B. 20 minutes C. 30 minutes D. 60 minutes - correct answer ✔✔B. 20 minutes A CMAA takes a call from a patient who says they just spoke with their provider and was advised to schedule to schedule an appointment for tomorrow for high blood pressure, diabetes, and gout. For which of the following time frames should the assistant schedule? A. 15 minutes B. 20 minutes C. 30 minutes D. 60 minutes - correct answer ✔✔D. 60 minutes A patient is scheduled for a recurring therapy session next week and wants to know if they can change the appointment to telehealth. Which of the following actions are required prior to the telehealth appointment? A. The patient will need to sign a medical records release form B. The patient will need to consent to telehealth C. The provider will need to notify the patient that telehealth is not available for therapy D. The medical assistant must obtain preauthorization for the use of telehealth - correct answer ✔✔B. The patient will need to consent to telehealth Which of the following information can be located on the patient registration form? A. Allergies B. Telehealth platform C. Health history D. Religious affiliation - correct answer ✔✔A. Allergies Which of the following is a difference between electronic and manual scheduling? A. Appointment type B. Schedule logs C. Acceptable forms of payment D. Templates - correct answer ✔✔D. Templates Whether scheduling electronically or manually, a scheduled preparedness training is which of the following types of scheduling consideration? A. Equipment consideration B. other entities C. Urgent D. Provider's chosen working hours, days, and specified times - correct answer ✔✔D. Provider's chosen working hours, days, and specified times Which of the following is the appropriate time to remind the patient of copayment expectations? B. Patient income level C. Patient coinsurance D. Patient copayment - correct answer ✔✔C. Patient coinsurance Which of the following payment is the patient's financial responsibility expressed as a percentage of the services rendered? A. Deductible B. Coinsurance C. Copayment D. Premium - correct answer ✔✔B. Coinsurance A medical administrative assistant is performing the check-in process for a new patient. They provide the patient with a form that gives the medical provider permission to bill the third-party payer and receive reimbursement directly. Which of the following types of forms is this? A. Assignment of benefits B. Notice of privacy practice C. Encounter form D. Consultation referral form - correct answer ✔✔A. Assignment of benefits Which of the following forms allows financial responsibility for a service to be transferred to the patient? A. Pre authorization B. Explanation of benefits (EOB) C. Assignment of benefits D. Advanced beneficiary Notice (ABN) - correct answer ✔✔D. Advanced beneficiary Notice (ABN) A medical administrative assistant is entering patient data into the electronic health record during the intake process. Which of the following information should be included in the patient earth record from the intake process? A. Primary spoken language B. Credit score C. Past employment history D. Driving record - correct answer ✔✔A. Primary spoken language Which of the following is considered an electronic health record necessity when entering information for an established patient? A. Patient satisfaction survey update B. Financial institution update C. Insurance information update D. Vehicle update - correct answer ✔✔C. Insurance information update Which of the following information is imported into the electronic health record from the intake forms? A. Social history B. Employment history C. Credit history D. Address history - correct answer ✔✔A. Social history A CMAA is helping a patient by providing patient education. Which part of the health experience is the patient going through? A. Check-in B. Check-out C. Exam room visit D. Scheduling - correct answer ✔✔B. Check-out A medical administrative assistant is entering information from the check-in process into the patient's electronic health record A. Provided publicly to any source who requests it B. To minimize continuity of care for the patient C. Proactive health of the patient and reimbursement for services D. Provide statistical research use of the information - correct answer ✔✔C. Proactive health of the patient and reimbursement for services