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WorksheetsNHA CMAA Module 6 Billing and Revenue Cycle
Total questions: 25
Worksheet time: 13mins
A medical administrative assistant is reviewing remittance advice to determine how claims have been paid and to see if any errors have occurred 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
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
A medical administrative assistant 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
A medical administrative assistant 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 followed?
A. Appeal
B. Payer adjudication
C. Eligibility and insurance preauthorization
D. Encounter documentation
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
How often should a medical administrative assistant perform charge reconciliation?
A. Yearly
B. Monthly
C. Daily
D. Weekly
A medical administrative assistant 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
An electronic health record (EHR) system assists health care organizations with which of the following tasks?
A. Provider documentation
B. Interviewing and hiring new staff
C. Ordering of supplies
D. Attracting new patients
Which of the following payers is designed for military members and their family?
A. TRICARE
B. Medicare
C. Medicaid
D. Workers' compensation
A provider agrees to accept the payer's allowed amount. What is the provider's status?
Non-participating provider
Eligible
Participating provider
Value-based
A fee-for-service Medicare patient arrives at a provider's office for medical services related to otitis media. Which of the following parts of Medicare should be billed?
Part A
Part B
Part C
Part D
A Medicare patient presents to the office for medication refills but expresses a financial barrier. Which of the following Medicare plans might be able to assist the patient with paying for prescription medications?
Part A
Part B
Part C
Part D
A provider is reimbursed for services rendered using CPT and ICD-10-CM codes. This is an example of which of the following types of payment models?
Value-based payment model
Capitation
Pay-for-performance
Fee-for-service
A provider is rewarded via a bonus when quality and performance measures are met. This is an example of which of the following types of payment models?
PAR provider
Pay-for-performance
Fee-for-service
Capitation
Which of the following patients is considered Medicare eligible?
A patient who has any chronic disease
A patient who is under 65 years of age
A patient who has an acute medical condition
A patient diagnosed with end-stage renal disease
Which of the following is a function of a clearinghouse?
Claims adjudication
Submits claims to the third-party payer
Files appeals
Performs charge capture and coding
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?
Premium
Deductible
Copay
Coinsurance
A medical administrative assistant 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?
Patient aging report
Insurance aging report
Daily transaction report
Patient statements
Which of the following programs will qualify a patient based on income?
Medicare
TRICARE
Workers' compensation
Medicaid
Which of the following is a program that is available to a patient who has no income or has specific medical needs?
Special needs plan (SNP)
Sliding scale
Hardship waiver
TRICARE plan
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?
Value-based payment model
Medicare Advantage Plan
Fee-for-service
Capitation
Which of the following forms is used to report claims to a third-party payer from a provider's office?
UB-04
CMS-1500
ABN form
Patient registration form
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?
HCPCS
CPT
DRG
ICD-10-CM
A third-party payer's policy for the length of time to submit claims is known as which of the following?
Charge entry
Timely filing
Claims submission
Payment posting
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?
Medicare Part A
Medicare Part B
Medicare Part C
Medicare Part D
