Question 1

If a patient has Medicare and the fee schedule amount is $450 after the surgeon’s charge of $1050, what is the patient’s co-pay?

 

80

 

110

 

90

 

45

4 points  

Question 2

You are the CFO at a community hospital where there has been a reduction in revenue reported over the last three months. With whom might you consult to determine the cause? (choose all that apply)

 

The former CFO.

 

The payroll manager

 

The controller

 

The human resources officer

4 points  

Question 3

When you meet with the controller, he tells you the volume report did not show any issues. Where else might he check?

 

A collections and accounts receivable analysis.

 

The payroll totals for the year.

 

The insurance payoffs.

 

An employee absence report analysis.

4 points  

Question 4

While ICD-10 is the most recent coding source, ICD-9 was still used prior to October 2015 for __________.

 

Patients born before 1960

 

Coding older diseases

 

Patient lists

 

Billing

4 points  

Question 5

________________ can best be described as weighing the probability of one disease versus another disease as the cause of the pateint’s symptoms.

 

Differential diagnosis

 

Treatment diagnosis

 

Disease causation

 

Supplemental diagnosis

4 points  

Question 6

Which factors could contribute to the difficulties of being a CFO?

 

Lower state and federal revenues.

 

  Reduced labor costs.

 

   Lower costs for regulatory compliance.

 

   Lower liability costs.

4 points  

Question 7

A self-pay patient with no insurance is billed:

 

22% of actual cost due to new state healthcare guidelines

 

Only after it is determined by a doctor that the patient is actually sick and in need of care

 

With a 56% deduction due to new healthcare guidelines

 

The full price

4 points  

Question 8

 When you ask the controller to look into federal reimbursements to see if he can find the cause of the reduction, how might he respond? (Select all that apply)

 

   Federal reimbursements are not part of the revenue cycle, the problem lies in revenue.

 

    Since federal reimbursements are part of the revenue cycle, we might find the problem there.

 

    The problem lies in revenue so it’s possible that charges are not being generated.

 

   The problem lies in revenue so there could be a problem in claims.

4 points  

Question 9

In 1922 interest grew in using classification to categorize not only causes of mortality, but also _____________.

 

Causes of immortality

 

Causes of morbidity

 

Causes of disease pathology

 

Causes of disease spread

4 points  

Question 10

The determination of medical _______ involves comparing the procedure being billed to the diagnosis submitted.

 

Similarity

 

Necessity

 

Symptoms

 

Urgency

4 points  

Question 11

A main cause for the spread and severity of the Black Death includes:

 

Poor sanitation

 

Large extended families living together

 

Lack of medical knowledge

 

Historical trend of resistance to medical treatment

4 points  

Question 12

Once a diagnosis has been made by the doctor, _________ can then be determined.

 

Life-expectancy

 

Disease pathology

 

Disease causation

 

The code

4 points  

Question 13

Florence Nightingale’s work to improve sanitation reduced the mortality rate in her hospital from __________ in one year.

 

43% to 5%

 

62% to 5%

 

33% to 2%

 

60% to 2%

4 points  

Question 14

The first step toward a diagnosis is:

 

Patient history

 

Family morbidity rate

 

Known genetic defects

 

Cause of disease

4 points  

Question 15

CPT is part of HCPCS, known as _____________

 

Level 3

 

Level 1

 

Level 4

 

Level 5

4 points  

Question 16

Procedure coding encompasses a wide variety of services to patients, including:

 

Gas expenses related to travel for care

 

Pathology and diagnostic testing

 

Reimbursement for time lost at work

 

Self treatment

4 points  

Question 17

This form has space for 12 diagnosis codes and 6 procedure codes:

 

CMS-1500

 

CSM-1500

 

CCM-1300

 

HMHC-1250

4 points  

Question 18

Diagnosis can best be classified as the identification of a disease from its ____________.

 

Location

 

Pathology

 

Symptoms

 

Point of origin

4 points  

Question 19

When you provide the results of your analysis about the reduction in revenue problem to the CEO, what might you report? (Select all that apply)

 

You were right about the bundling – the problem resides with the APC outpatient billing.

 

We found that the claims included an APC code, but not the specific procedure code.

 

   All of the Medicare payments were exactly correct.

 

   We looked just at drugs as a snapshot and they are billing for the drug itself, but not for its administration.

4 points  

Question 20

Dr. William Farr is best known for is contribution to:

 

Finding the cure for the Black Death

 

Streamlining scientific method

 

Refining the Cullen disease clarification

 

Refining the classification of disease pathology

4 points  

Question 21

In the 1960s and 1970s the expansion of the CPT led to:

 

Adoption of 5-digit codes in CPT-2

 

Adopton of 5-digit codes in CPT-3

 

Adoption of 3-digit codes in CPT-4

 

Adoption of 4-digit codes in CPT-2

4 points  

Question 22

Select the two types of claim forms used by different types of providers.

 

CMS-1500 and UB-04

 

CSM-110 and UR-42

 

C3P-0000 and R2-D2

 

CMS-1200 and RD-92

4 points  

Question 23

An amendment to the ____________ in 1974 made the National Committee on Vital and Health Statistics a statutory body and required that there be an annual report to Congress on the health of the American people.

 

Public Information Act

 

National Healthcare Act

 

Procedure Coding Act

 

Public Health Act

4 points  

Question 24

The purpose of the ICD-10 is:

 

To promote international comparability in the collection, classification, processing, and presentation of morbidity and mortality statistics

 

To promote the advancement of medical science

 

To promote international standards for the collection and dissemination of medical statistics

 

To provide a clear and concise method for documenting disease and illness

4 points  

Question 25

The doctors review system is intended to:

 

Make the patient aware of what is going on

 

Convert symptoms into code

 

Certify that the correct evaluations were made

 

Identify symptoms you may have forgotten to mention

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