Question 1

Which of the following organizations is the umbrella under which all regulatory agencies eventually fall because the health and welfare of the citizens of the nation are ultimately deemed to be federal responsibility?

Accepted Answer

A)  Centers for Disease Control (CD
C)  
B)  The U.S.Department of Health and Human Services (USDHHS) 
C)  Health and Human Services (HHS) 
D)  The Federal Employees Health Benefits Program (FEHBP) E) A) and B)
F) None of the above

Question 2

The effects of the new regulatory and reimbursement laws instigated subtle changes which will have an impact on the physician office as well as outpatient facilities, ancillary services, and hospitals. In order to become, or perhaps soon remain, a Medicare/Medicaid provider, a medical compliance program must be in place. According to the Fox Group's website that includes which of the following measures?

Accepted Answer

A)  Compliance with health and safety laws and regulations
B)  Compliance with fraud complaints
C)  Compliance with environmental laws and regulations
D)  Compliance with human resources laws and regulations
E)  Compliance with HIPAA laws and regulationsF) A) and C)
G) All of the above A,C,D,E

Question 3

The __________________________ was developed by Medicare in an effort to control quality and cost and minimize preventable complications.

Accepted Answer

Do Not Pay list
Rationale : I...

Question 4

Which of the following statements is true about the projected results of the increase in federal and state mandated health care cost reform legislation?

Accepted Answer

A)  The increase in governmental regulations provides for a higher quality of care.
B)  Governmental oversight is something that has been lacking in health care over the past several years.
C)  The burden of proof is placed on the health care community.
D)  The increase in governmental oversight allows for improved outcomes with decreased FTEs.E) B) and D)
F) B) and C)

Question 5

On October 1, 2013, the federal government will implement the mandatory transition to the International Classification of Diseases, Tenth Revision (ICD-10) . Of the following responses, which is the most reasonable rationale for the upgrade?

Accepted Answer

A)  The ICD-10 is an easier method of coding to use in a complicated health care delivery system.
B)  The ICD-10 transition is to better manage the quality of health care data through more precise and accurate diagnostic coding.
C)  The ICD-10 initiative is to ensure improved patient outcomes.
D)  The ICD-10 has been designed to improve the collection of data at the point of care.E) A) and B)
F) C) and D)

Question 6

Which type of billing codes is used by Medicare to determine the level of severity and per diem rate?

Accepted Answer

A)  POA
B)  MS-DRG
C)  ICD
D)  PPACE) A) and D)
F) None of the above

Question 7

Which of the following responses is not a benefit of Pay for Performance (P4P)  legislation?

Accepted Answer

A)  The system rewards health care providers upon good service to consumers.
B)  The system rewards physicians and other health care professionals when patients receive good results from that care.
C)  Reimbursement is related to quality and efficiency of care provided.
D)  Patients will play a more active role in the determination of performance-based payment.E) B) and C)
F) A) and C) B

Question 8

The importance of billing codes and reimbursement for services cannot be overstated. Which of the following responses are true regarding accurate code input and claims processing?

Accepted Answer

A)  CPT codes were grouped into services by the first digit followed by four more digits that further described the procedure.
B)  The number 9 is reserved for visits related to evaluation and management procedures.
C)  The CPT code 99211 is an office visit and used for injections.
D)  Two digit modifiers are used to further distinguish services and procedures altering the billing process.
E)  Inaccurate code input will delay claims processing.F) None of the above.G) E) and F)
H) A) and C)

Question 9

Electronic data interchange (EDI)  has been instrumental in facilitating the health care process. Which of the following responses best describes the impact of the EDI?

Accepted Answer

A)  EDI has the potential to eliminate second opinions.
B)  EDI interacts with multiple databases.
C)  EDI supplies proof of recovery.
D)  EDI facilitates the approval of patient claims.E) A) and C)
F) None of the above

Question 10

Which of the following statements is true about the do-not-pay list?

Accepted Answer

A)  If a patient develops a complication, Medicare will reimburse for all services.
B)  If a patient develops complications, Medicaid will reimburse for all services.
C)  If a patient has certain complications during the hospital stay, Medicare will not reimburse the hospital at the higher rate for the treatment.
D)  If a patient develops a preventable complication, Medicare will demand the immediate transfer of the patient to a different health care setting.E) All of the above
F) A) and B)

Question 11

President Obama signed into law on March 23, 2010, The Health Care and Education Reconciliation Act of 2010 (Pub.L.111-152, 124Stat.1029) , which amended the Patient Protection and Affordable Care Act (PPAC)  and further strengthened the federal grip on health care regulation in the United States. Which of the following statements best reflects the intentions of the act?

Accepted Answer

A)  The health care of children under the age of 15 will be covered by local government funds.
B)  Veterans from the Iraq War will have all health insurance benefits excluding dental.
C)  The act guarantees health insurance for every citizen.
D)  The act moves regulation of federal health insurance to the state levels.E) A) and C)
F) A) and D)

Question 12

The Patient Protection and Affordable Care Act of March 2010 (PPACA)  Section 1561 will, when fully activated by 2014, extend affordable health care to an estimated 32 million more people. Which of the following is not a financial impact of the Act?

Accepted Answer

A)  A need for increased supplies
B)  The need to hire more staff
C)  The need to monitor patient outcomes
D)  The need to hire additional health information technology (HIT)  coordinatorsE) A) and B)
F) None of the above

Question 13

Implementing an electronic health record in a small primary care practice can be cost prohibitive. To assist in the cost of the endeavor, the government has done which of the following?

Accepted Answer

A)  Provided loans to physicians to purchase technology
B)  Offered physicians stipends if they use the equipment correctly
C)  Has given financial aid to larger practices to purchase equipment
D)  Has given physicians the equipment to convert to electronic health recordsE) A) and B)
F) All of the above

Question 14

Which of the following statements about Medicare Part A are correct?

Accepted Answer

A)  Medicare Part A has an annual deductible.
B)  Medicare Part A covers immunizations.
C)  Medicare Part A covers facility related expenses.
D)  Medicare Part A covers medical supplies.
E)  Medicare Part A is also called the Advantage Plan.F) B) and D)
G) C) and E)

Question 15

The role of the informatics nurse is important to the success of the implementation of the EHR. Which of the following statements is true about the expanded role of the informatics nurse?

Accepted Answer

A)  The informatics nurse has the responsibility of maintaining the compliance procedures of the health care setting.
B)  The informatics nurse has the responsibility of analyzing the coding system.
C)  The informatics nurse has the responsibility to serve as the liaison between physician and patient and physician and agency.
D)  The informatics nurse has the responsibility of creating meaningful use policies.E) C) and D)
F) A) and B)

Question 16

Electronic data interchange (EDI)  is an effort to help phase out paper claims except under extensive appeal circumstances. The result of this initiative is which of the following?

Accepted Answer

A)  Health care providers were forced to install EDI transmission programs in their billing and medical record systems.
B)  A large savings on paper supplies
C)  An increased need for assistive software
D)  A decrease in the denial of claimsE) A) and B)
F) A) and C)

Question 17

The system called Pay for Performance (P4P)  is also known as which of the following?

Accepted Answer

A)  Value-based purchasing (VBP) 
B)  Diagnostic related groups
C)  Children's Health Initiative Program
D)  MedicaidE) C) and D)
F) A) and B)

Question 18

One of the biggest pitfalls and concerns to health care providers to the transition to the ICD-10 by 2013 is which of the following?

Accepted Answer

A)  Training staff to use the new system efficiently
B)  Having enough qualified personnel available to troubleshoot impending issues
C)  The need to overcome resistance to change in the health care setting
D)  The cost to convert the current systems to accommodate the changesE) All of the above
F) None of the above

Question 19

The Centers for Medicare and Medicaid Services (CMS) mandated all providers, insurers and any middlemen involved in the health care industry submission of claims for reimbursement or registering of care, the verifying of eligibility, the precertification of services, or any other client- related information to adhere to a uniform format by October 200
2.This action forced all providers to install_______________________ transmission programs in their billing and medical record systems.Standard Text:

Accepted Answer

Electronic Data Interchange (EDI) 
Rationale : The Centers for Medicare and Medicaid Services (CMS) mandated all providers, insurers and any middlemen involved in the health care industry submission of claims for reimbursement or registering of care, the verifying of eligibility, the precertification of services, or any other client- related information to adhere to a uniform format by October 2002. This action forced all providers to install Electronic Data Interchange (EDI) transmission programs in their billing and medical record systems and has altered the methods of communication for all health care professionals.

Question 20

There has been an impact of the Health Insurance Reform Act, also known as The Patient Protection and Affordable Care Act, on system use and design. Which of the following actions was enacted upon the president's signature?

Accepted Answer

A)  Young people can remain on their parents insurance until 24 years old.
B)  Children with preexisting conditions are no longer covered.
C)  New plans must offer free preventive care.
D)  There are lifetime limits on benefits.E) A) and B)
F) B) and C)

Exam 20: Regulatory and Reimbursement Issues

Which of the following organizations is the umbrella under which all regulatory agencies eventually fall because the health and welfare of the citizens of the nation are ultimately deemed to be federal responsibility?

Correct Answer
verified

Correct Answer
verified
A,C,D,E

The __________________________ was developed by Medicare in an effort to control quality and cost and minimize preventable complications.

Correct Answer
verified
Do Not Pay list
Rationale : I...
View Answer

Which of the following statements is true about the projected results of the increase in federal and state mandated health care cost reform legislation?

Correct Answer
verified

On October 1, 2013, the federal government will implement the mandatory transition to the International Classification of Diseases, Tenth Revision (ICD-10) . Of the following responses, which is the most reasonable rationale for the upgrade?

Correct Answer
verified

Which type of billing codes is used by Medicare to determine the level of severity and per diem rate?

Correct Answer
verified

Which of the following responses is not a benefit of Pay for Performance (P4P) legislation?

Correct Answer
verified
B

The importance of billing codes and reimbursement for services cannot be overstated. Which of the following responses are true regarding accurate code input and claims processing?

Correct Answer
verified

Electronic data interchange (EDI) has been instrumental in facilitating the health care process. Which of the following responses best describes the impact of the EDI?

Correct Answer
verified

Which of the following statements is true about the do-not-pay list?

Correct Answer
verified

Correct Answer
verified

The Patient Protection and Affordable Care Act of March 2010 (PPACA) Section 1561 will, when fully activated by 2014, extend affordable health care to an estimated 32 million more people. Which of the following is not a financial impact of the Act?

Correct Answer
verified

Implementing an electronic health record in a small primary care practice can be cost prohibitive. To assist in the cost of the endeavor, the government has done which of the following?

Correct Answer
verified

Which of the following statements about Medicare Part A are correct?

Correct Answer
verified

The role of the informatics nurse is important to the success of the implementation of the EHR. Which of the following statements is true about the expanded role of the informatics nurse?

Correct Answer
verified

Electronic data interchange (EDI) is an effort to help phase out paper claims except under extensive appeal circumstances. The result of this initiative is which of the following?

Correct Answer
verified

The system called Pay for Performance (P4P) is also known as which of the following?

Correct Answer
verified

One of the biggest pitfalls and concerns to health care providers to the transition to the ICD-10 by 2013 is which of the following?

Correct Answer
verified

There has been an impact of the Health Insurance Reform Act, also known as The Patient Protection and Affordable Care Act, on system use and design. Which of the following actions was enacted upon the president's signature?

Correct Answer
verified

Exam 20: Regulatory and Reimbursement Issues

Which of the following organizations is the umbrella under which all regulatory agencies eventually fall because the health and welfare of the citizens of the nation are ultimately deemed to be federal responsibility?

Correct AnswerverifiedShow Answer

Correct AnswerverifiedA,C,D,E

The __________________________ was developed by Medicare in an effort to control quality and cost and minimize preventable complications.

Correct AnswerverifiedDo Not Pay list Rationale : I...View AnswerShow Answer

Which of the following statements is true about the projected results of the increase in federal and state mandated health care cost reform legislation?

Correct AnswerverifiedShow Answer

On October 1, 2013, the federal government will implement the mandatory transition to the International Classification of Diseases, Tenth Revision (ICD-10) . Of the following responses, which is the most reasonable rationale for the upgrade?

Correct AnswerverifiedShow Answer

Which type of billing codes is used by Medicare to determine the level of severity and per diem rate?

Correct AnswerverifiedShow Answer

Which of the following responses is not a benefit of Pay for Performance (P4P) legislation?

Correct AnswerverifiedB

The importance of billing codes and reimbursement for services cannot be overstated. Which of the following responses are true regarding accurate code input and claims processing?

Correct AnswerverifiedShow Answer

Electronic data interchange (EDI) has been instrumental in facilitating the health care process. Which of the following responses best describes the impact of the EDI?

Correct AnswerverifiedShow Answer

Which of the following statements is true about the do-not-pay list?

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

The Patient Protection and Affordable Care Act of March 2010 (PPACA) Section 1561 will, when fully activated by 2014, extend affordable health care to an estimated 32 million more people. Which of the following is not a financial impact of the Act?

Correct AnswerverifiedShow Answer

Implementing an electronic health record in a small primary care practice can be cost prohibitive. To assist in the cost of the endeavor, the government has done which of the following?

Correct AnswerverifiedShow Answer

Which of the following statements about Medicare Part A are correct?

Correct AnswerverifiedShow Answer

The role of the informatics nurse is important to the success of the implementation of the EHR. Which of the following statements is true about the expanded role of the informatics nurse?

Correct AnswerverifiedShow Answer

Electronic data interchange (EDI) is an effort to help phase out paper claims except under extensive appeal circumstances. The result of this initiative is which of the following?

Correct AnswerverifiedShow Answer

The system called Pay for Performance (P4P) is also known as which of the following?

Correct AnswerverifiedShow Answer

One of the biggest pitfalls and concerns to health care providers to the transition to the ICD-10 by 2013 is which of the following?

Correct AnswerverifiedShow Answer

There has been an impact of the Health Insurance Reform Act, also known as The Patient Protection and Affordable Care Act, on system use and design. Which of the following actions was enacted upon the president's signature?

Correct AnswerverifiedShow Answer

Correct Answer
verified

Correct Answer
verified
A,C,D,E

Correct Answer
verified
Do Not Pay list
Rationale : I...
View Answer

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified
B

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified