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QUESTION NO:8
A set of federal compliance regulations to ensure standardization of billing, privacy and
reporting as institutions convert to electronic systems is called:
A. Health Insurance standard Act
B. Reimbursement Insurance Act
C. Medicare Reporting Act
D. Health Insurance portability and Accountability Act
Answer: D
QUESTION NO:7
that providers have to pay insurers to cover the cost of defending against
the lawsuits and paying large jury awards.
A. Ambulatory payment classifications
B. Reimbursement Insurance cost plan
C. Health proactive Insurance standard act
D. Increased insurance premiums
Answer: D
QUESTION NO:10
In which act, federal legislation designed to tighten accounting standards in financial
reporting and that holds top executives personally liable as to the accuracy and fairness of
their financial statements?
A. Sarbanes-Oxley Act
B. Insurance accountability Act
C. Financial statement Act
D. Portability and Accountability Standardized Act
Answer: A
QUESTION NO:3
when providers try to get one payor to pay for costs that have not been covered by
another payor, this refers to:
A. Cost Capacity
B. Cost capitalization
C. Cost-shifting
D. Prospective cost
Answer: C
QUESTION NO:11
Stark law sates that:
A. Legislation enacted by HIPAA to guard against providers’ ordering self-referrals for
Medicare or Medicaid patients directly to any settings in which they have a vested
financial interest.
B. Legislation enacted by CMS to guard against providers’ ordering self-referrals for
Medicare or Medicaid patients directly to any settings in which they have a vested
financial interest.
C. Legislation enacted by CMS to guard against providers’ ordering self-referrals for
Medicare or Medicaid patients indirectly to any settings in which they have a vested
financial interest.
D. Legislation enacted by HIPAA to guard against providers’ ordering self-referrals for
Medicare or Medicaid patients indirectly to any settings in which they have a vested
financial interest.
Answer: B
QUESTION NO:14
Gatekeepers requiring a patient to obtain a referral from his or her primary care
physician, the gatekeeper, before assign a specialist.
A. True
B. False
Answer: A
QUESTION NO:13
Concurrent review states that:
A. Planning appropriateness and medical necessity of a hospital stay while the patient is
in the hospital and implementing discharge planning.
B. Monitoring appropriateness and medical necessity of a hospital stay while the patient
is not in the hospital and try to implement discharge planning.
C. Planning appropriateness and medical necessity of a hospital stay while the patient is
not in the hospital and try to implement preadmission planning.
D. Monitoring appropriateness and medical necessity of a hospital stay while the patient
is in the hospital and implementing discharge planning.
Answer: D
QUESTION NO:18
Risk pool is:
A. A generally small population of individuals who are all uninsured under the same
arrangement, regardless of working status
B. A generally large population of individuals who are all insured under the same
arrangement, regardless of working status
C. A generally large population of groups who are all uninsured under the different
arrangement, regardless of working status
D. A generally small population of individuals who are all insured under different
arrangement, regardless of working status
Answer: B
QUESTION NO:17
A system that pays providers a specific amount in advance to care for defined health care
needs of a population over a specific period is called:
A. Health care system
B. Prospective payments system
C. Global payment system
D. Capitation
Answer: D
QUESTION NO:2
What change the basis of payment for hospital outpatient services from a flat fee for
individual services to fixed reimbursement for bundled services?
A. Cost payment system
B. Ambulatory payment classifications
C. Cost compliance and litigation
D. None of the above
Answer: B
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