Post Test Flashcards
(100 cards)
1
Q
- The access model created by Mark Murray for scheduling patients is referred to as:
a. Same-Day scheduling
b. Advanced access
c. Open access
d. All of the above
A
d. all of the above
2
Q
- Keys to success in an open access scheduling model include all of the following, except:
a. Continuity
b. Large number of appointment types
c. Capacity
d. Reducing demand for unnecessary visits
A
b. Large number of appointment types
3
Q
- The Fair Labor Standards Act requires that employees be paid time and one half their regular rate for working overtime. However, some workers are considered “exempt” from overtime. Identify the worker that must be paid overtime.
a. Executive employee
b. Clerical employee
c. Administrative employee
d. Professional employee.
A
b. Clerical employee
4
Q
- The following is true when evaluating, disciplining or discharging a person with a disability.
a. The disabled employee should be held to the same standards of performance as other similarly situated employees.
b. The disabled employee should be evaluated on a lower standard.
c. The disabled employee may be evaluated without an accommodation which has been requested.
d. An employer may not require medical evaluation to discover whether a disability is causing poor performance.
A
a. The disabled employee should be held to the same standards of performance as other similarly situated employees.
5
Q
- Successfully dealing with a patient list includes all of the following, except:
a. Acknowledge the patient’s list of questions and concerns
b. Negotiate what to cover in the visit
c. Allow the physician to set the agenda
d. Surface any remaining concerns
A
c. Allow the physician to set the agenda
6
Q
- Select which of the following statements is true.
a. External cause codes (V01-Y99) can never be a first listed diagnosis
b. A “Z” code may not be the only diagnosis on the claim
c. If not stated in the documentation, the default diagnosis for diabetes is Type I
d. With etiology and manifestation codes, the manifestation code is always the first listed diagnosis code
A
d. With etiology and manifestation codes, the manifestation code is always the first listed diagnosis code
7
Q
- Which of the following sections of a CV is considered optional:
a. Objective
b. Scholarly activity
c. Education
d. Board certification
A
a. Objective
8
Q
- The Family and Medical Leave Act (FMLA) allows a worker to take up to twelve weeks of unpaid leave per year for all of the following reasons, except:
a. Upon the birth of a child or the placement of a child for adoption or foster care
b. To care for an employee’s spouse, child or parent who has a serious health condition
c. For the employee’s own serious health condition
d. For intermittent episodes of illness related to chronic illness such as asthma
A
d. For intermittent episodes of illness related to chronic illness such as asthma
9
Q
- To be eligible for FMLA leave, an employee must have worked for the employer:
a. For at least six months, full-time
b. For at least six months, part-time (minimum 1,250 hours or approximately 24 hours per week)
c. For at least one year, part-time (minimum 1,250 hours or approximately 24 hours per week)
d. For at least one year, full-time.
A
c. For at least one year, part-time (minimum 1,250 hours or approximately 24 hours per week)
10
Q
- FMLA applies to:
a. Employers with ten (10) or more employees
b. Employers with twenty (20) or more employees
c. Employers with fifty (50) or more employees
d. All employers regardless of number of employees
A
c. Employers with fifty (50) or more employees
11
Q
- The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 is a federal law, which allows certain individuals the right to continue health insurance coverage. This law applies to:
a. Employers with fifty (50) or more employees
b. Employers with twenty (20) or more employees
c. All employers
d. Large companies with more than two hundred fifty (250) workers
A
b. Employers with twenty (20) or more employees
12
Q
- Tail coverage is needed when the physician is covered by:
a. Occurrence coverage
b. Claims made insurance
c. Both A and B
d. None of the above
A
b. Claims made insurance
13
Q
- The generation often defined as having a very high level of comfort with technology is:
a. Traditionalists
b. Baby Boomers
c. Generation X
d. Millennials
A
d. Millennials
14
Q
- HCPCS (Healthcare Common Procedure Coding System):
a. Are established, maintained and updated annually by CMS (Center for Medicare and Medicaid Services)
b. Use a format consisting of five numerals
c. Are the codes used to describe lab tests
d. Are established, maintained and updated annually by AMA
A
a. Are established, maintained and updated annually by CMS (Center for Medicare and Medicaid Services)
15
Q
- The largest generation defined to date is:
a. Traditionalists
b. Baby Boomers
c. Generation X
d. Millennials
A
d. Millennials
16
Q
- The physician may select an Office Visit Level of Service based on their time spent with a patient when:
a. The patients has lots of questions
b. The patient is late for their appointment
c. When more that 50% of the physician’s time is spent in counseling, the length of the total time of the visit determines the code selected
d. A physician cannot charge for their time, it must always be assigned to a service.
A
c. When more that 50% of the physician’s time is spent in counseling, the length of the total time of the visit determines the code selected
17
Q
- On Day 1, a patient is placed in the hospital as an Observation patient. On Day 2, the patient is admitted as an inpatient. The correct coding for this scenario is:
a. Day 1: Initial Observation Care code. Day2: Subsequent Hospital Care code
b. Day 1: Initial Observation Care code. Day2: Not billable. A complete H&P was already done
c. Day 1: Initial Observation Care code. Day2: Initial Hospital Care (Admit) code
d. Day 1: Office or Other Outpatient Care code (You can only admit a patient once). Day2: Initial Hospital Care (Admit) code
A
c. Day 1: Initial Observation Care code. Day2: Initial Hospital Care (Admit) code
18
Q
- On Day 1, a patient is seen in the ER at 11:13 PM by the ED physician. On Day 2, the physician sees the patient in the hospital for the first time at 7:00 AM. The correct coding for this scenario is:
a. Day 1: Initial Hospital Care code. Day2: Subsequent Hospital Care code
b. Day 1: Nothing billable. Day2: Subsequent Hospital Care code
c. Day 1: Nothing billable. Day2: Initial Hospital Care code with date of service on Day 1
d. Day 1: Nothing billable. Day2: Initial Hospital Care code with date of service on Day 2
A
d. Day 1: Nothing billable. Day2: Initial Hospital Care code with date of service on Day 2
19
Q
- Subsequent hospital care services are:
a. Reimbursed very well
b. Based on the three key components. Time may not be used to determine the level of subsequent hospital care code.
c. Must meet the criteria for two of the three key components or the criteria for time plus meet the CPT definition of the three levels of codes described as improving, has developed a minor new problem or has developed a significant new problem
d. Are not to be used by consultants for follow-up visits after the initial consultation
A
c. Must meet the criteria for two of the three key components or the criteria for time plus meet the CPT definition of the three levels of codes described as improving, has developed a minor new problem or has developed a significant new problem
20
Q
- Hospital Discharge Services codes are based on:
a. The type of admission status that the patient was assigned
b. Three key components of care
c. Time
d. Face-to-face time with the patient
A
c. Time
21
Q
- Office and Inpatient Consultations:
a. Are reimbursed by Medicare using the CPT consultation codes 99241-99245 and 99251-99255
b. Are based on three key components or time
c. Require documentation of two of the three key components
d. Cannot be performed or charged for by a Family Practice Physician.
A
b. Are based on three key components or time
22
Q
- Critical Care Services:
a. Cannot be charged for by a Family Practice Physician
b. Are inclusive of certain services, e.g., interpretation of arterial blood gases (ABGs) or chest x-rays (CXR)
c. Are charged based on the three key components
d. Require that the patient be in the Critical Care unit.
A
b. Are inclusive of certain services, e.g., interpretation of arterial blood gases (ABGs) or chest x-rays (CXR)
23
Q
- The physician may charge for a patient’s admission to a Skilled Nursing Facility:
a. Based on the patient’s insurance plan
b. There is no charge for the patient’s admission because the physician already charged for the Discharge Services on the same date of service
c. Depending on the time required to complete the paperwork related to the transfer
d. Even if it occurs on the same day as discharge from the hospital and the discharge is billed also
A
d. Even if it occurs on the same day as discharge from the hospital and the discharge is billed also
24
Q
- Historically the highest returns but with the greatest risk have been earned on:
a. Cash or cash equivalents
b. Equities (stocks)
c. Fixed income assets
d. Bonds
A
d. Bonds
25
25. To diagnosis code an adverse effect the physician would:
a. Consult the Table of Drugs and Chemicals for a code for the causative agent
b. Code the effect such as gastritis, rash, tachycardia
c. First code the causative agent using an “T” code followed by a code for the effect
d. First code the effect, followed by an “T” code for the causative agent.
d. First code the effect, followed by an “T” code for the causative agent.
26
26. The codes for Transitional Care Management services:
a. Are based on three key components
b. Are based on time
c. Are based on timing of the face-to-face visit and the level of medical decision making
d. Are not reimbursed by Medicare.
c. Are based on timing of the face-to-face visit and the level of medical decision making
27
27. Home Visits:
a. May not be based on time
b. May be coded in the same manner as other services, based on the three key components of the assessment performed and documented
c. Should be charged based on the time including travel time
d. Are only reimbursed for terminally ill patients.
c. Should be charged based on the time including travel time
28
28. When a physician provides services involving direct (face-to-face) patient contact of more than thirty minutes duration that is beyond the usual service, the following should be billed:
a. The physician may document the total amount of time spent with the patient and the services provided and use the prolonged service codes
b. The physician should use the Level V Office Visit code
c. The physician should admit the patient to the hospital and account for the time spent as part of the Observation or Initial Hospital Care codes
d. The physician may document the total amount of time spent with the patient and the services provided and use the prolonged service codes, in addition to the appropriate Evaluation & Management codes or procedure and supply codes.
d. The physician may document the total amount of time spent with the patient and the services provided and use the prolonged service codes, in addition to the appropriate Evaluation & Management codes or procedure and supply codes.
29
29. A physician may bill for supervision of a patient under care of a home health agency for services such as revision of care plans, review of laboratory and other studies and communication with health care professionals:
a. Using the care plan oversight codes for recurrent supervision of thirty (30) minutes or more in one month
b. Only if the patient is seen in the office during the month
c. If the work involves low intensity and infrequent supervision
d. If a home visit is also performed within the same month.
a. Using the care plan oversight codes for recurrent supervision of thirty (30) minutes or more in one month
30
30. A physician may perform both a procedure (e.g., colposcopy) and an E&M service (e.g., a Level III Office Visit) on the same day:
a. Only if the doctor charges for the most expensive service provided
b. And charge for both services using modifier 25 on the E&M code
c. Should not perform both services on the same day since only one will be reimbursed
d. And charge for both services using modifier 25 on the procedure code
b. And charge for both services using modifier 25 on the E&M code
31
31. The 1995 detailed exam is defined as:
a. Examination of 5-7 body areas or organ systems
b. Examination of 2-7 organ systems only
c. Examination of 2-7 body areas or organ systems with at least four descriptors about the symptomatic organ system
d. Examination of 2-7 body areas or organ systems
c. Examination of 2-7 body areas or organ systems with at least four descriptors about the symptomatic organ system
32
32. Excision of lesions must be classified by the following criteria:
a. The type of lesion—benign, pre-malignant or malignant
b. The size of the repair
c. The measured size of the lesion
d. The size of the lesion including the smallest margin necessary to remove the lesion
a. The type of lesion—benign, pre-malignant or malignant
| d. The size of the lesion including the smallest margin necessary to remove the lesion
33
33. CPT differentiates between face-to-face time and floor time in its description of the time component of the evaluation and management codes. Floor time is defined as:
a. The time the physician reviews the chart, examines the patient, writes notes, and communicates with other professionals and the patient’s family
b. Only that time the physician spends with the patient
c. The time the physician spends with the patient and/or family
d. The time spent on the patient’s unit as well as time spent off the floor reviewing findings in pathology or radiology.
a. The time the physician reviews the chart, examines the patient, writes notes, and communicates with other professionals and the patient’s family
34
34. The 1995 and 1997 Evaluation and Management Guidelines differ significantly in what two areas:
a. ROS and medical decision making
b. Past medical history and the physical exam
c. The physical exam and medical decision making
d. History of the present illness and the physical exam
d. History of the present illness and the physical exam
35
35. The practice of spreading money over different investments to reduce risk is called:
a. Diversification
b. Asset allocation
c. Capitalization
d. Risk tolerance
a. Diversification
36
36. Both a preventive visit code and a problem-focused code may be billed on the same day when the following is true:
a. When both visits are appropriately documented, the problem is identified as significant and modifier 25 is added to the problem-focused code
b. When both visits are appropriately documented, the problem is identified as significant and modifier 25 is added to the preventive code
c. When the same diagnosis code is used for both services
d. When the two visits are each separately documented in the record
a. When both visits are appropriately documented, the problem is identified as significant and modifier 25 is added to the problem-focused code
37
37. The following information must be considered when selecting a code related to the repair of a laceration:
a. The sum of all wounds in the same classification (location) and the type of closure (simple, intermediate or complex)
b. The sum of all wounds regardless of location
c. Each laceration repair is billed separately with modifier 51
d. The sum of all wounds of the same location, regardless of the repair classification
a. The sum of all wounds in the same classification (location) and the type of closure (simple, intermediate or complex)
38
38. Codes for transitional care management services are based on:
a. Time the patient was discharged from the hospital
b. Time that the medication reconciliation takes place
c. Time that the patient first contacts the office after discharge
d. Time of the first face-to-face visit and the level of medical decision making
d. Time of the first face-to-face visit and the level of medical decision making
39
39. Correct charging for routine childhood immunizations is based on:
a. Combining the charges for the administration and the vaccine/toxoid
b. Billing a nurse visit (99211) in addition to the Preventive Service code
c. Immunization fees are included in the Preventive Service codes for children
d. Charges for the vaccine/toxoid plus an administration fee based on the number of components of each vaccine/toxoid administered.
d. Charges for the vaccine/toxoid plus an administration fee based on the number of components of each vaccine/toxoid administered.
40
40. The CPT book is:
a. Copyrighted, maintained and published by AMA with an effective date of January 1 of each year
b. In the public domain just like ICD-10-CM
c. Published and maintained by the World Health Organization (WHO)
d. Maintained and published annually by the Center for Medicare and Medicaid Services (CMS)
a. Copyrighted, maintained and published by AMA with an effective date of January 1 of each year
41
41. When selecting an ICD-10-CM code:
a. The alphabetical index provides sufficient detail for each diagnosis so it is not necessary to use the tabular index
b. It is easy to locate a code in the tabular index so there is no need to use the alphabetical index to locate the correct selection
c. There are no valid three digit diagnosis codes
d. Each diagnosis should be looked up in the alphabetical index and verified in the tabular
d. Each diagnosis should be looked up in the alphabetical index and verified in the tabular
42
42. Initial Hospital Care codes require which modifier to identify the admitting physician of record?
a. Modifier 25
b. Modifier AI
c. Modifier AE
d. Modifier 59
b. Modifier AI
43
43. Diagnosis codes S00-Y99 report External Causes of Injury or Morbidity and should be used by the Family Practice physician for several reasons. Identify which of the following responses is correct:
a. The use of an external cause code allows the claims examiner to determine liability, when appropriate, and facilitates claims processing
b. Use of multiple external cause codes is not appropriate
c. An external cause code should always be the first listed diagnosis code
d. Using an external cause code will cause the claim to be “tied-up” by the insurance company and affect the physician’s Accounts Receivables balance.
a. The use of an external cause code allows the claims examiner to determine liability, when appropriate, and facilitates claims processing
44
44. It is not necessary to record information about the Past, Family and Social History (PFSH) for certain categories of Evaluation and Management services. This is called an interval history. Select the codes that require only an interval history.
a. Subsequent Hospital Care codes, Subsequent Observation Care codes, Established Patient Office Visit codes
b. Established Patient Home Visit codes and Established Patient Domiciliary Care codes, Outpatient Consultation codes
c. Emergency Care codes, Subsequent Hospital Care codes
d. Subsequent Nursing Facility Care, Subsequent Hospital Care codes, Established Patient Home Visit codes, Established Patient Domiciliary Care codes, Subsequent Observation Care codes
d. Subsequent Nursing Facility Care, Subsequent Hospital Care codes, Established Patient Home Visit codes, Established Patient Domiciliary Care codes, Subsequent Observation Care codes
45
45. The History portion of the Evaluation & Management codes consists of four sections. Documentation of the Chief Complaint is required for every visit. The remaining sections are History of Present Illness (HPI), Review of Systems (ROS) and Past, Family and Social History (PFSH). The code selected for this portion of the encounter is determined by:
a. The highest level of the three (HPI, ROS, PFSH)
b. The lowest level of the three (HPI, ROS, PFSH)
c. Two of the three at the same level
d. The number of systems reviewed.
c. Two of the three at the same level
46
46. The definition of pay-for-performance (P4P) is:
a. The use of negative reinforcers to drive physician change
b. A program whose central purpose is to improve the quality of patient care and clinical outcomes
c. The highest quality medicine, in the most appropriate setting, at the lowest possible cost
d. The use of incentives to encourage and reinforce the delivery of evidence-based practices and healthcare system transformation that promotes better outcomes as efficiently as possible
d. The use of incentives to encourage and reinforce the delivery of evidence-based practices and healthcare system transformation that promotes better outcomes as efficiently as possible
47
47. The Medical Decision Making portion of the Evaluation & Management codes consists of three sections. They are amount of data, diagnoses and management options, and risk of morbidity and/or mortality. The code selected for this portion of the encounter is determined by:
a. The highest level of the three
b. The lowest level of the three
c. Two of the three at the same or a higher level
d. None of the above.
c. Two of the three at the same or a higher level
48
48. The NCQA (National Committee for Quality Assurance):
a. Tracks the quality of care delivered by health plans
b. Develops performance measures for hospitals
c. Tracks the quality of care delivered by physician groups
d. Tracks the quality of care delivered by employers
a. Tracks the quality of care delivered by health plans
49
49. HEDIS is:
a. The Healthcare Effectiveness Data and Information Set which measures specific criteria for healthplans
b. The Healthplan Employer Data Information Set which measures specific criteria for employer groups
c. The Healthy Employees Data Information System which establishes goals for employee wellness programs
d. The Healthy Employees Defined Incentive Set establishes healthcare goals for employees to achieve and receive insurance benefits in return for maintaining the standards.
a. The Healthcare Effectiveness Data and Information Set which measures specific criteria for healthplans
50
50. All of the following are true of Physician Quality Reporting System (PQRS), except:
a. Is administered by the Centers for Medicare and Medicaid Services (CMS)
b. There is a penalty of up to 2% for non-participation starting in 2015
c. The program is available only to primary care providers
d. Measures data can be submitted through claims, registries, EHRs
c. The program is available only to primary care providers
51
51. If you are in the highest federal income tax bracket, you pay that highest percent on:
a. Every dollar of income
b. Only on the amount over a designated amount listed in a tax table
c. Unknown since the amount changes every year based on inflation
d. On 50% of your adjusted gross income (AGI)
b. Only on the amount over a designated amount listed in a tax table
52
52. Medicare is a federal insurance program designed to cover health care services for person 65 years and older. Medicare has four parts. Which part is responsible for Medicare Advantage plans?
a. Part A
b. Part B
c. Part C
d. Part D
c. Part C
53
53. All of the following are true about the Medicare Conversion Factor, except:
a. A new Conversion Factor is calculated annually
b. All specialties use the same Conversion Factor
c. All CPT codes are paid based on an RVU multiplied by the Conversion Factor
d. The Conversion Factor is a method for converting an RVU to a dollar amount for payment
b. All specialties use the same Conversion Factor
54
54. If you are contracted with a commercial insurance plan and are designated as a participating physician, your payment will be based on:
a. Your charge
b. The insurer’s allowed amount
c. The resource based relative value system
d. Your charge less 20 percent
b. The insurer’s allowed amount
55
55. The Medicare Physician Fee Schedule Database contains all the following, except:
a. Reimbursement by CPT code
b. RVUs
c. Conversion Factor
d. Procedures for which an assistant surgeon is allowed are indicated
a. Reimbursement by CPT code
56
56. Medicare patients must pay coinsurance of:
a. 10%
b. 20%
c. 30%
d. 50%
b. 20%
57
57. Accounts Receivable is defined as:
a. The amount the insurer allows for a service
b. Amount that is uncollectible after the insurance and patient have paid
c. Monies owed to the practice
d. Amount that the practice must collect from self-pay patients
c. Monies owed to the practice
58
58. All of the following payments may be collected from the patient by a contracted and participating plan provider, except:
a. Copayment
b. Coinsurance
c. Deductible
d. Difference between the allowed amount and the provider’s charge
d. Difference between the allowed amount and the provider’s charge
59
59. The total RVU for a CPT code for a local provider is calculated as:
a. Sum of the work, practice expense and malpractice RVUs
b. Sum of the work, practice expense and malpractice RVUs, multiplied by a conversion factor
c. Sum of the work, practice expense and malpractice RVUs, with each RVU geographically adjusted by a GPCI
d. Sum of the work, facility/non-facility practice expense and malpractice RVUs, with each RVU geographically adjusted by a GPCI
a. Sum of the work, practice expense and malpractice RVUs
60
60. A dangerous type of clause often included in managed care contracts that could leave a physician completely and personally responsible for any costs the managed care organization incurs as a result of a claim is called a(n):
a. Offset clause
b. Subrogation clause
c. Hold harmless clause
d. Non-interference with members clause
c. Hold harmless clause
61
61. One of the most critical elements of a managed care agreement is:
a. Credentialing
b. Grievance resolution
c. Definitions
d. Assignment.
c. Definitions
62
62. A managed care contract should specify all the following, except:
a. Timely filing deadline
b. Separate payment terms and schedules for each plan or product
c. Term of the contract, how it can be terminated, renewal
d. A complete list of the company’s officers and board members.
d. A complete list of the company’s officers and board members.
63
63. Three basic financial statements provide an accounting picture of the firm’s operation and its financial position. These three documents are:
a. The annual report, the income statement and operating expenses
b. The income statement, the balance sheet and the statement of cash flows
c. The income statement, the balance sheet and operating expenses
d. The annual report, assets and liabilities.
b. The income statement, the balance sheet and the statement of cash flows
64
64. The Income Statement reports:
a. Transactions over a period of time, e.g., January 1, 1998 through December 31, 1998
b. Transactions at a point in time, e.g., On December 31, 1998
c. A “plain-English” narrative of the organization’s revenue sources
d. Cash on hand.
a. Transactions over a period of time, e.g., January 1, 1998 through December 31, 1998
65
65. The Balance Sheet reports:
a. Transactions over a period of time, e.g., January 1, 1998 through December 31, 1998
b. Transactions at a point in time, e.g., On December 31, 1998
c. Revenues compared to expenses during the fiscal year
d. The balance remaining in the checking account at the end of the month.
b. Transactions at a point in time, e.g., On December 31, 1998
66
66. The Balance Sheet consists of three primary sections. Which is the correct list?
a. Net income, net expenses and net profit
b. Cash, expenses and profit
c. Cash flows, expenses and Fund Capital
d. Total assets, Total liabilities and Total equities.
d. Total assets, Total liabilities and Total equities.
67
67. On the Balance Sheet, all of the following may be considered assets, except:
a. Cash and securities
b. Accounts receivable
c. Accounts payable
d. Inventories.
c. Accounts payable
68
68. On the Balance Sheet, all of the following may be considered liabilities, except:
a. Accounts payable
b. Accounts receivable
c. Accrued expenses
d. Notes payable.
b. Accounts receivable
69
69. The primary sections of the Income Statement are:
a. Net Medical revenue, Total operating expenses and Net income
b. Revenues received and other income
c. Cash received and investment income
d. Investment income and charitable contributions.
a. Net Medical revenue, Total operating expenses and Net income
70
70. Retained earnings are:
a. Earnings generated in the course of doing business
b. Earnings accumulated over time
c. An income statement item
d. Equal to assets minus liabilities
a. Earnings generated in the course of doing business
71
71. Net worth is:
a. Earnings generated in the course of doing business
b. Earnings accumulated over time
c. An income statement item
d. Equal to assets minus liabilities
d. Equal to assets minus liabilities
72
72. FICA (Social Security) and Medicare taxes are withheld from employees’ payroll checks. This same amount is matched by the employer. The amount of these taxes is:
a. FICA 1.9% and Medicare 1%
b. FICA 9.2% and Medicare 2%
c. FICA 6.2% and Medicare 1.45%
d. FICA 4.45% and Medicare 1.2%
c. FICA 6.2% and Medicare 1.45%
73
73. The difference between cash accounting and accrual accounting is:
a. Cash accounting records revenues and expenses in the period incurred
b. Cash accounting reflects revenues when received and expenses when paid
c. Expenses are recorded based on the date services were incurred or goods were received
d. All of the above
b. Cash accounting reflects revenues when received and expenses when paid
74
74. There are many methods that physicians may use to set their fee schedule. All of the following sources may be used to assist the doctor, except:
a. Fee schedules obtained from fee-for-service insurers
b. Other physician practices
c. The Resource Based Relative Value Scale (RBRVS)
d. “Allowable” fees received from third-party payors.
b. Other physician practices
75
75. Services of a nurse practitioner (NP) or physician assistant (PA) may be billed “incident to” a physician’s service in the following place of service:
a. Hospital
b. Office
c. SNF
d. Patient’s home
b. Office
76
76. The level of supervision required for an NP or PA seeing patients in the office is:
a. General
b. Direct
c. Personal
d. By phone
b. Direct
77
77. Appropriate Accounts Receivable management requires that unpaid patient accounts be periodically reviewed to collect unpaid balances. Accounts may be turned over to a collection agency in an effort to receive payment. Collection activity is generally initiated at:
a. 60 days past due
b. 90 days past due
c. 150 days past due
d. 180 days past due.
b. 90 days past due
78
78. An emergency medical condition may be defined using:
a. The prudent layperson standard
b. The prudent physician standard
c. Either a or b
d. None of the above
c. Either a or b
79
79. Bonus payments to the physician by a managed care plan may be based on all the following, except:
a. Hospital utilization measured in hospital days per 1,000 members
b. Referral management utilization measured by referrals per 1,000 members
c. Member satisfaction surveys
d. The number of physicians in the group
d. The number of physicians in the group
80
80. The gross collection percent is calculated by:
a. Payments / charges
b. Payments / charges – adjustments
c. Charges / payments
d. Charges – adjustments / payments
a. Payments / charges
81
81. The net collection percent is calculated by:
a. Payments / charges
b. Payments / charges – adjustments
c. Charges / payments
d. Charges – adjustments / payments
b. Payments / charges – adjustments
82
82. If a claim is denied as not medically necessary, the physician should:
a. Appeal the claim and write off the charges if the appeal is lost
b. Bill the patient
c. Sue the insurance company
d. Resubmit the claim
a. Appeal the claim and write off the charges if the appeal is lost
83
83. Days in accounts receivable is calculated by:
a. Total accounts receivable / 365 days
b. Total accounts receivable / average daily charges
c. Total accounts receivable / average monthly charges
d. Total accounts receivable / 260 days
a. Total accounts receivable / 365 days
84
84. An adjustment is:
a. An amount the practice has agreed by contract to write off
b. The difference between the amount charged and the allowed amount
c. An amount that cannot be collected from the patient
d. All of the above
d. All of the above
85
85. The allowed amount is:
a. The amount the practice charges for a service
b. The amount the practice has agreed to write off
c. An amount that is collected from the patient
d. The amount an insurer has contractually agreed to pay for a service
d. The amount an insurer has contractually agreed to pay for a service
86
86. Accounts receivable appears on the following financial statement(s):
a. Income statement
b. Balance sheet
c. Cash flow statement
d. All of the above
b. Balance sheet
87
87. The medical industry standard in benchmarking data for physician practices is provided by:
a. MGMA
b. AAFP
c. AMA
d. None of the above
a. MGMA
88
88. All of the following are taxable events to the physician on Form 1099, except:
a. Moving expenses
b. Student loan repayment
c. Loan forgiveness
d. Health care insurance premiums
d. Health care insurance premiums
89
89. The physician employment agreement should specify all the following, except:
a. Who pays for tail coverage
b. Remuneration for outside activities
c. Credentialing requirements
d. Term, termination and renewal of the agreement
c. Credentialing requirements
90
90. A business plan is a tool about which all the following are true, except:
a. Identify goals and develop a strategy to achieve them
b. Ensure that a lender understands your business so he can make a prudent assessment of risks
c. Has no single correct format
d. Has a single correct format.
c. Has no single correct format
91
91. The following is an essential element of a business plan:
a. Marketing plan
b. Management plan
c. Financial plan
d. All of the above
d. All of the above
92
92. All the following are often incorporated into the physician employment agreement in the form of an attachment, addendum or exhibit, except:
a. Signing bonus
b. Promissory note
c. Physician compensation formula
d. Dispute resolution
d. Dispute resolution
93
93. A non-compete clause in a physician contract is an example of a:
a. Hold harmless clause
b. Restrictive covenant
c. Assignment clause
d. Termination clause
b. Restrictive covenant
94
94. If a claims made policy is discontinued, tail coverage may cost 100-200% of the annual premium. An alternative to tail coverage would be:
a. Term coverage
b. Liability coverage
c. Incident coverage
d. Retrospective (nose) coverage
d. Retrospective (nose) coverage
95
95. Physician compensation may be based on all the following, except:
a. A salary
b. A percent of the physician’s production
c. Referrals
d. RVUs
c. Referrals
96
96. Under this compensation arrangement the employee assumes the risk of collections:
a. A percent of collections
b. RVUs
c. Salary
d. A percent of charges
a. A percent of collections
97
97. All of the following are reasons for termination “with cause”, except:
a. Loss of medical license
b. Conviction of a criminal offense
c. Failure to pay student loans timely
d. Inability to secure professional liability insurance
c. Failure to pay student loans timely
98
98. Professional liability insurance that pays only for claims made during the period in which the policy is in force is called:
a. Claims made coverage
b. Occurrence coverage
c. Claims paid coverage
d. Tail coverage
a. Claims made coverage
99
99. Capitation is paid based on a fixed monthly amount based on age and sex of the covered individual and paid to the practice each month in what is designated as:
a. Allowed amount
b. Fee-for-service
c. Per member, per month (PMPM)
d. Capitated amount
c. Per member, per month (PMPM)
100
100. ICD-10-CM has two types of diagnosis codes for some preventive visits defined as:
a. With immunizations/without immunizations
b. With abnormal findings/without abnormal findings
c. With physical exam/without physical exam
d. With other services provided at the same visit/without other services provided at the same visit
b. With abnormal findings/without abnormal findings
