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WorksheetsCBCS Midway Quiz
Total questions: 75
Worksheet time: 52mins
Medicare Part ____ would cover a member who is admitted to a hospital for observation due to pneumonia.
Part A
Part B
Part C
Part D
People living in the U.S. and U.S. Territories (except Puerto Rico) who are already getting Social Security are automatically signed up for Medicare _____
Part A
Part B
Part C
Part D
Shreya has paid 250 toward her 500 deductible. She has an 80/20 plan. She sees her primary care physician for hypertension. The total allowed charge is $150. What is her payment responsibility?
$120
$150
$30
$250
Clear and concise provider’s documentation helps in establishing____
Medical Necessity
Patient Satisfaction
Billing Errors
Insurance Premiums
Malik’s employer provides health insurance coverage to employees. The employer requires employees to pay a portion of the premium costs. Malik is responsible for $1,200 yearly, which is divided evenly by the number of pay periods in the year and automatically deducted from each of Malik’s paychecks. If Malik is paid twice a month, how much will be taken out of each paycheck?
$1200
$600
$50
$100
Medicare is run by ____.
DOD
CDC
HHS
CMS
A person who has no income or falls below a certain percentage of the federal poverty level is usually eligible for ____
Medicaid
Medicare
COBRA
Tricare
Amari is covered by two insurance plans. Which statement regarding the coordination of benefits is true?
The primary insurance plan must be billed first.
The secondary insurance plan must be billed first.
Following coordination of benefits, reimbursement may exceed the initial/actual cost of services billed for.
Both insurances must be billed at the same time.
When two or more insurance plans are responsible for payment, the primary plan pays first and must _____
provide the maximum benefits
pay a percentage of the charges
split the charges with the secondary plan
determine what the secondary plan is responsible for
The positive outcomes of verifying insurance eligibility include _____
faster reimbursement
decreased clean claims
increased coverage
increased collection costs
Which of the following describes Medicare Part C?
It is free for most people who are eligible for Medicare.
It is often referred to as Original Medicare.
It is offered by private companies as an alternative to Original Medicare.
It is offered only to Medicare eligible individuals under age 65 with certain disabilities.
Which of the following statements regarding copayments is NOT true?
Many insurance plans require the policyholder to pay a copayment for medical services rendered.
Most health insurance plans require a copayment for wellness exams.
Copayment amounts are typically disclosed to the policyholder before they select a plan.
A copayment is a fixed amount that an individual must pay for a specific medical service or medication.
Medicare Part ___, also known as Medicare Advantage, is offered by private companies as an alternative to Original Medicare.
C
A
B
D
Justine has a 90/10 coinsurance plan and has already met her deductible for the plan calendar year. She sees her physician for conjunctivitis, and the total allowable charge is $90. How much is Justine responsible for?
$9
$90
$10
$0
Which of the following is NOT a Medicare Part B ABN notifier?
Suppliers of Medical Products
Hospice
Independent Laboratories
Outpatient Facilities
A person who was diagnosed with amyotrophic lateral sclerosis (ALS) is eligible for this federally funded program.
CHAMPVA
TRICARE
Medicare
Medicaid
Third-party liability (TPL) is a federal regulation that requires states to take measures to _____
increase claim payments by the payer of last resort
identify other third-party liability before claims are paid
ensure HIPAA compliance in claims submission
increase clean claims submitted to third-party payers
Korbyn has a copayment of 25 for office visits. He sees his physician for a sprain, and the total allowable charge is 100. How much will his health insurance plan pay?
$25
$75
$0
$100
Which of the following types of information is NOT typically needed to verify insurance over the phone?
Insurance ID number and group number
Date of birth (DOB)
Employer address and phone number
Emergency contact
Which of the following statements regarding an ABN is false?
The ABN must be completed, delivered in advance, and reviewed with the Medicare beneficiary (patient).
Any questions from the patient or patient’s representative can be answered after the ABN is signed by the patient or their proxy.
Medicare requires providers to issue an ABN of noncoverage when a service or procedure most likely will not be covered by insurance.
If the patient is unable to make medical decisions on their own behalf, the form must be reviewed with the patient’s representative who has authority as the healthcare proxy (often a family member).
Josie has an individual out-of-pocket maximum of 3,000 and a family out−of−pocketmaximum of 7,000. She has paid 2,250 out−of−pocket for herself, and her husband has paid 1,500. How much more do they have to pay before the family meets the maximum out-of-pocket amount?
$5500
$1500
$3750
$3250
The _____ rule is used to determine which insurance plan is primary when a dependent has two healthcare plans.
Coordination of Benefits
Medicaid Eligibility
Third-Party Liability
Birthday
The amount paid to buy a health insurance policy is called a _____
Premium
Deductible
Coverage
Claim
To be eligible for TRICARE, an individual (and their dependents) must be registered in _____
A. DEERS
B. ACA
C. CHAMPVA
D. Medicare (Parts A and B)
Which statement best describes coverage if a dependent has insurance through their employer and their parents?
The birthday rule determines primary coverage.
The employee insurance is secondary.
The employer determines which insurance is primary.
Their employee insurance is primary.
A person who was diagnosed with ALS, or Lou Gehrig’s disease, is eligible for which federally funded program?
CHAMPVA
Medicaid
Medicare
TRICARE
Which of the following statements best describes a deductible?
It is paid monthly.
It is a set amount that must be paid for certain services.
It must be met before a health insurance plan will begin to pay.
It is supplemental health insurance.
Which of the following is often photocopied during patient registration? Select all that apply:
Insurance Card
CMS-1500 Form
Chargemaster
Remittance Advoce
Drivers License
A physician’s office develops a user-friendly process for staff members to report suspected billing fraud and abuse. Which recommended component of a compliance program does this example demonstrate?
Internal monitoring and auditing
corrective action
Open lines of Communication
Rick Assessment
A healthcare provider identifies several overpayments during the self-disclosure process outlined in the OIG provider self-disclosure protocol. What must the provider do? Select all that apply:
Review a random sample of 100 claims to estimate damages
Report the findings to the OIG Fraud Hotline
Review at least 10 claims per service to assess for other improper payments
Return all overpayments to the government
Audit at least five claim for each federal healthcare program
How does undercoding differ from upcoding?
Undercoding does not report the full extent of services, whereas upcoding bills for more expensive services than those provided.
Undercoding leads to increased reimbursement, whereas upcoding results in loss of revenue.
Undercoding bills for services that never occurred, whereas upcoding bills for more complex services than those provided.
Undercoding is compliant with all laws and regulations, whereas upcoding is an illegal practice.
Which task is a recommended follow-up activity after an audit by a regulatory agency or contractor? Select all that apply:
Select a sample of electronic health records (EHRs) for the audiot.
Identify weaknesses that contributed to problems uncovered by the audit.
Assign staff members to develop a corrective action plan.
Update the internal monitoring plan to track any issues identified in the audit report.
Designate a lead who will work with the auditor.
Which scenario is an example of a beneficiary inducement?
A pharmaceutical company offers a psychiatrist remuneration to prescribe certain medications to Medicare patients.
A physician refers Medicaid patients to an occupational therapy practice owned by a sibling.
A durable medical equipment supplier offers gift cards to physicians who order their wheelchairs for Medicare patients.
A physician waives copays to entice new Medicare patients to come to the practice.
Which of the following acts specifically prohibits harassment, misrepresentation, threats, and spread of false information?
Fair Debt Collection Practices Act
Health Insurance Portability and Accountability Act
Health Information Technology for Economic and Clinical Health Act
False Claims Act
What information is provided to the healthcare provider on an electronic remittance advice (ERA)? Select all that apply:
Date of Service
Amount paid for the Service
EDI Number
Amount charged by the Provider
Patients Name
If an external audit reveals overpayments from a federal healthcare program, the healthcare provider must return the funds within _____ of the date of identification to avoid serious penalties.
90 days
365 days
60 days
30 days
_____ is required when there is a risk of harm that may or may not be obvious.
Informed Consent
Implied Consent
Physician Consent
Verbal Consent
What does the clearinghouse scrub for when processing a medical claim? Select ALL that apply:
Incorrect insurance plan number
Terminated insurance plans
Healthcare provider information
Incorrect spelling of a patient's name
Incorrect diagnosis coding
Which action should a medical biller take when a claim has not been paid within 30 to 45 days?
Contact the patient
Resubmit the claim
Contact the insurance plan
Notify the healthcare provider
According to the HIPAA Privacy Rule, what principle requires a provider to make reasonable efforts to limit information only to the intended purpose?
Release of information
Implied consent
Implied release
Minimum necessary
What bone is B?
Tibia
Fibula
Femur
Humerus
What is K?
TIbia
Fibula
Patella
Femur
Label #6
Triceps Brachii
Brachioradialis
Biceps Brachii
Deltoid
Number 1 is the:
left atrium
right atrium
left ventricle
right ventricle
Number 4 is the:
left atrium
right atrium
left ventricle
right ventricle
Number 6 is the:
aorta
pulmonary trunk
vena cava
right atrium
The exchange of oxygen and carbon dioxide occurs in the:
arteries
veins
capillaries
What are the steps of the digetive process?
Digestion in the small intestine, chewing, in the stomach, absorption and waste elimination.
Chewing, digestion in the stomach, digestion in the small intestine, absorption and waste elimination.
Chewing, digestion in the stomach, waste elimination, absoption and digestion in the small intestine.
The "master gland" is known as the __________________.
thyroid gland.
adrenal gland.
pancreas.
pituitary gland.
The adrenal glands release adrenaline to help the body regulate _________________.
diseases
body temperature.
stress.
hormones.
Which of the following is a function of the parasympathetic nervous system?
Increases heart rate
Decreases heart rate
Dilates pupils
Inhibits digestion
Which system is primarily responsible for the "fight or flight" response?
Parasympathetic
Sympathetic
Central
Peripheral
What is the scientific term for the structure that is commonly known as your voicebox?
larynx
alveoli
brochi
bronchioles
Which of the following is NOT a Medicare Part B ABN notifier?
Hospice
Independent Laboratories
Outpatient Facilities
Suppliers of Medical Products
What is original Medicare?
Parts A and B
Part A only
Parts C and D
Part C only
A(n) _____ is an example of a service that would require an ABN.
experimental treatment
initial outpatient therapy
routine doctor office visit
preventative service
Which of the following statements best defines stop-loss maximums?
This is a set amount that is due each office visit.
Once this amount has been met, the health insurance plan will pay 100% of all future costs for life.
The amount a policyholder must meet before the health insurance plan begins to pay.
It is the same as an out-of-pocket maximum
Which of the following statements best describes a deductible?
It is a set amount that must be paid for certain services.
It is supplemental health insurance.
It must be met before a health insurance plan will begin to pay.
It is paid monthly.
Where are taste buds in the body? Select all that apply:
Throat
Tongue
Neck
Palate
Brain
Which term means away from the point of attachment?
medial
lateral
distal
proximal
Which of the following acts specifically prohibits harassment, misrepresentation, threats, and spread of false information?
Health Insurance Portability and Accountability Act (HIPAA)
Fair Debt Collections Practices Act
Health Information Technology for Economic and Clinical Health Act (HITECH)
False Claims Act
A physician’s office develops a user-friendly process for staff members to report suspected billing fraud and abuse. Which recommended component of a compliance program does this example demonstrate?
Open lines of communication
risk assessment
corrective action
internal monitoring
Which contractor calculates the Medicare Fee-for-Service (FFS) improper payment rate?
Recovery Audit Contractor (RAC)
Medicare Administrative Contractor (MAC)
Supplemental Medical Review Contractor (SMRC)
Comprehensive Error Rate Testing (CERT) Contractor
A physician invests in a clinical laboratory and refers Medicare patients to that laboratory for testing. In this scenario, a _____ has occurred.
kickback
beneficiary inducement
safe-harbor arrangement
self referral
Which of the following statements is true?
When registering patients, healthcare staff does not need to worry about entry errors because clearinghouses will catch errors when claims are scrubbed.
When filling out registration forms, patients who are covered on multiple health insurance plans only need to supply information about their primary health insurance.
Healthcare facilities should not collect any payment at registration or check-in.
When filling out registration forms, patients should write their name exactly how it appears on the patient’s health insurance card and include a suffix, if present.
Which form does a patient sign to acknowledge the healthcare facility’s policy regarding the protection of their personal health information?
financial policy form
notices of privacy practices form
consent for treatment form
demographic form
The _____ is an analytics technology that runs algorithms to detect potential fraud and abuse in Medicare Fee-for-Service claims before payment.
Fraud Prevention System (FPS)
National Practitioner Data Bank (NPDB)
Medicare Fraud Strike Force
Program Integrity Command Center
Which responsibility is a function of the Center for Program Integrity (CPI) of the Centers for Medicare and Medicaid Services (CMS)? Select all that apply:
Provide guidance for developing a compliance program that is tailored to each sector of the healthcare industry.
Coordinate medical reviews and audits to prevent and address improper payments.
Offer education and outreach to improve compliance with laws, regulations, and program requirements.
Reduce the burden on healthcare providers so they can focus on patient care.
Establish a process for physicians to self-disclose potential incidents of billing fraud and abuse.
