• Balanced Budget Act of 1996
• False Claims Act
• HIPAA
• Medicare Integrity Program
• Section 101 of MMA
• Section 1128 of Social Security Act

Under HIPAA, individually identifiable patient information is called PHI for Private Health Information

1. True
2. False

PHI cannot be shared with law enforcement agencies without consent, except under court order.

1. True
2. False

^{When are patients required to sign a confirmation that they have received a NOP?}

1. ^{Each time they receive service}
2. ^{Each time the NOP is revised}
3. ^{Once in their lifetime}
4. ^{Never, no signature is required}

Under EMTALA, a patient can request transfer only at the suggestion of the hospital

1. True
2. False

Under the Patient Self Determination Act, hospitals and other healthcare providers who receive federal funds must inquire and then doccument when the patient has an advanced directive.

1. True
2. False

EMTALA regulations apply only to EDs

1. True
2. False

"Abuse" describes a deception or misrepresentation known to potentially result in some unauthorized benefit.

1. True
2. False

Stark I, II, and III are common names for the Anti-Kickback Statute

1. True
2. False

Under TCPA, contact with a debtor on a cell phone using automated dialing equiptment is prohibited.

1. True
2. False

Under FDCPA, no collection action may be taken while the account is being disputed.

1. True
2. False

Under FDCPA, the collector must notify the debtor that the communication is an attempt to collect a debt.

1. True
2. False

Regulation Z governs maximum charges for consumer credit.

1. True
2. False

Under the Fair Credit Reporting Act, obsolete information about accounts in collection must be removed from a credit file in five years.

1. True
2. False

CMS requires all hospital to be accredited by TJC.

1. True
2. False

Medicare limits observation, except in very rare instances, to what legnth of time?

1. 23 Hours
2. 24 Hours
3. 48 Hours
4. 72 Hours

To qualify for SNF coverage, Medicare requires a person to have been a hospital patient for at least three consecutive days (not including the day of discharge).

1. True
2. False

A single Informed Consent document is signed to cover all procedures and services being performed in any 24-hour period.

1. True
2. False

In the ER, failure of a patient, who is aware of what is happening, to object to treatment is implied consent.

1. True
2. False

Psychiatric Treatment, AIDS testing, and blood transfusion are consented to with a genral consent form.

1. True
2. False

An emancipated minor is able to give his or her own consent to receive treatment.

1. True
2. False

The purpose of a medical record is to:

1. Serve as a legal doccument and a statistical tracking tool
2. Support charges and coding
3. Facilitate appropriate utilization review and quality of care evaluations
4. Serve as communication and continuity of care tool
5. All of the above

National Coverage Determinations (NCDs) and Local Coverae Determinations (LCDs) are:

1. Guidelines that employers use to determine eligibility under group health plans
2. Policies that CMS and fiscal intermediaries use to pay or deny claims based on medical necessity
3. Laws that dictate how PHI can be used by law enforcement agencies
4. Standards that healthcare providers must meet to facilitate reimbursement by Medicare and Medicaid

Verbal telephone orders from the referring physician can be accepted by which of the following (Select all that apply)

1. A physician extender
2. A registered nurse
3. A case manager
4. All of the above

1. A physician extender
2. A registered nurse

Which of the following is not a true statement about the ABN?

1. The ABN must contain a brief description of the service, the fees, and the reason the service os not expected to be covered
2. Patients sign and date the ABN after indicating their decision to proceed or forego the service
3. Patient access staff can witness the signature if the form is signed in that department
4. ABNs are not required for statutorily excluded items such as screening mamograms and routine physicals
5. An ABN is required for an applicable service even if the patient previously signed an ABN for the same service

Which of the following is not a true statement about MSP laws and the MSP questionnaire?

1. During the 30-month COB period, Medicare becomes the primary payer for ESRD patient if they become Medicare eligible based on age.
2. For recurring patients, the MSP questionnaire needs to be redone every 90 days
3. For non-recurring patients, the MSP questionnaire is needed for every patient visit - even if the patient was seen on the previous day
4. Completed MSP questionnaire must be kept for 10 years

What is the formula for the Average Legnth of Stay?

Which payer has a deductible charged once per spell of illness?

Which payer covers medications subject to deductible and "donut hole?"

Which payer is available to the sponser on the first day of active orders, while the other dependents are not eligible until after 30 days?

Which payer covers the vulnerable, with funding shared by federal and state governments?

Medicare is primary in each of the following situations except for:

1. Services covered by a workers' compensation, including the Black Lung Benefits Act
2. Care related to an accident for which the third party liability or no-fault coverage exists
3. Patients 65 or older with group coverage from their own or spouses' employment with an employer who has 20 or more employees.
4. Patints with ESRD who have completed their 30-month coordination period

Which of the following is not a true statement about coordination of benefits?

1. GHPs are always secondary to Medicare
2. Medicaid is alyays the payer of last resort
3. TRICARE is also the payer of last resort unless the subscriber has purchased a TRICARE supplement to pay deductibles and coinsurance
4. Almost all payers are secondary to any liability or property and casualty insurance

Which type of ICD supplemental code describes encounters with a provider in circumstances other than disease or injury?

1. E code
2. H code
3. J code
4. V code

Which of the following is not a true statement about HCPCS and CPT codes?

1. The HCPCS is divided into two levels
2. Level I of HCPCS is the CPT, a five-digit alpha-numeric code that identifies medical services and procedures furnished by physiciand and other healthcare professionals
3. Level II of the HCPCS is a five-digit alpha-numeric code that identifies products, supplies, and services not included in the CPT codes when used outside a physiciand office
4. CPT codes are copyrighted and maintained annually by CMS

Which of the following are the three primary components of the seven components used in selecting a level of E&M serivce?

1. History, examination, and counseling
2. Examination, medical decision-making, and counseling
3. History, examination, and medical-decision making
4. Examination, medical decision-making, and coordination of care

Which of the following is not a true statement about HCPCS and CPT modifiers?

1. Modifiers are two-digit codes that can indicate that a service or procedure was altered by some circumstance that increases or decreases its value
2. Modifiers can clarify the anatomic site of a procedure or can avoid the appearance of duplicate billing if a procedure is performed multiple times in the same day
3. Modifier 25 indicated a bilateral procedure (required when applicable, unless the CPT code description itself includes the word "bilateral")
4. Modifier 77 indicates the same procedure performed more than once on the same date of service, but at different encounters by different physicians

A DRG payment is the total payment for a case, regardless of actual charges (unless an outlier is paid in certain cases)

1. True
2. False

DRGs are the outpaitent equivalent of APCs.

1. True
2. False

The RBRVS is used by Medicare to determine the calue of practitioner services.

1. True
2. False

Which of the following is not a common method to determine appropriate value for UCR charges?

1. Global standard
2. Community standard
3. Physician-charge data
4. Relative value system

For most skilled nursing care, Medicare uses the OASIS to determine the payment rate.

1. True
2. False

CAHs are not subject to Medicare DRGs or APCs, but instead are paid 110% of allowable Medicare costs.

1. True
2. False

CMS approval is required for a small rural hospital to swing beds between acute and SNF care.

1. True
2. False

An IRF provides services to patients that need intensive rehabilitation services to improve the individual's overall physical condition.

1. True
2. False

Capitation shifts a great deal of the risk to the payer because costs fluctuate dramatically based on services provided by contracted providers.

1. True
2. False

Under locum Tenens and Reciprocal Agreements, a substitute physician can be paid for services provided to a Medicare patient as long as the substitute and regular physicians have an agreement on file with CMS.

1. True
2. False

Which of the following is not a true statement about DME billing?

1. The provider's address determines which DMERC should be billed
2. A National Supplier Number (different than a regular Medicare provider number) is required
3. Medicare Certification is required
4. A Certificate of Medical Necessity or a physician prescription is required

Which of the following is the HIPAA standard transaction used by hospitals to submit claims electronically?

1. UB-04
2. NUBC
3. 837I
4. 837P

Acording to the 72-Hour Rule, which of the following must be included with an inpatient admission claim (Select all that apply.)

1. Outpatient services received on the day before an admission
2. Diagnostic services received in the three days prior to admission
3. Theraputic services received on the admission date of service with a different primary diagnosis code
4. Theraputic services received within three days of an admission with the same primary diagnosis code 
5. All of the above

In a typical Chapter 7 bankruptcy, the unsecured creditors (such as healthcare providers) receive 50-75% of the money they are owed.

1. True
2. False

In the case of injuries caused by the negligence of another party, the responsible party is the negligent party.

1. True
2. False

if divorced, the responsible party for a minor patient is the custodial parent as named in the divorce decree.

1. True
2. False

A judgement is a liability for an injury or wrongdoing by one person to another resulting from a breach of legal duty.

1. True
2. False

Which of the following is not a provision of Medicare's bad debt policies?

1. Onlyhospital services are reimbursable as Medicare bad debt
2. The hospitals must attempt to collect the account for a minimum of 60 days, with no payment from the patient during that time, before claiming it as a bad debt
3. Sund business judgement must establish that there is no likelihood of recovery at any time in the future
4. Proof of collection efforts must be available in the event of an audit

What is the formula for Net Recovery Rate?

• Bad Debt - Bad Debt Recovery = Net Bad Debt
• Gross Revenue - Allowances/Discounts - Charity - Bad Debt - Other Non-Cash Deductions = Net Revenue
• Net Bad Debt / Net Revenue = Net Bad Debt Percentage

• Personnel + Systems + Statements = Total Costs to Collect
• Medicare + Medicaid + Insurance + Patients = Total Received
• Total Costs to Collect / Total Received = Cost to Collect

Most Patient Account managers do not play a role in developing their organization's mission and vision, but they are responsible for motivation staff to work toward that mission and vision.

1. True
2. False

What is used to evaluate the ability to pay debts and to earn income?

What is a collection agency's commission an example of?

• Total Daily Revenue / Number of Days = Average Daily Revenue
• Total AR / Average Daily Revenue = Gross AR Days

What is the formula for Net AR Days?

• Total Daily Revenue - Total Charity - Bad Debt - Total Contractual Allowances = Total Net Daily Revenue
• Total Net Daily Revenue / Number of Days = Average Net Daily Revenue
• Total AR / Average Net Daily Revenue = Net AR Days

What is the formula for Days Cash on Hand?

Which of the following is not a common asset control requirement?

1. Specific people are responsible for cash and they are bonded
2. Cashiers have drawer limits and balance them weekly
3. There are functionality limits
4. Cash payments are recorded on numbered receipts and deposited daily
5. A manager performs spot audits

CMS and the OIG have the right to exclude a provider from the Medicare program for any activity that could result in a "civil monetary penalty," regardless of investigations performed or not performed.

1. True
2. False

Job interviews, evaluations, promotions, discipline, terminations, and the like should be done carefully and objectively to avoid any appearrance of this...