Part 1 Flashcards
Value based purchasing and pay for performance and systems typically link all of the following components EXCEPT:
A. Setting of care
B. Quality
C. Performance
D. Payment
Setting of care
A one page codified format for inpatient claim submission that contains all the information required by the payer to process the bill.
A. CMS 1500
B. UB 04
UB 04
Which is the insurance plan responsible for paying healthcare insurance claims first?
A. Secondary insurance
B. Primary insurance
Primary insurance
Which is the former name for Tricare Standard?
A. Triwest
B. CHAMPVA
C. CHAMPUS
CHAMPUS
Which are preprinted on a facility’s chargemaster to indicate the location or type of service provided to an inpatient?
A. HCPCS level II codes
B. Revenue codes
C. ICD10CM/PCS codes
D. CPT codes
Revenue codes
Medicare benefit period begins with the first day of hospitalization and ends when the patient has been out of the hospital for ________ consecutive days.
A. 30
B. 90
C. 10
D. 60
60
The primary care provider (PCP) his responsible for ________?
A. Denying all referrals to specialists and impatient hospital admissions
B. Providing nonessential health care services to all patients
C. Supervising and coordinating health care services for enrollees
D. Being a gatekeeper to provide services at the highest possible cost
Supervising and coordinating health care services for enrollees
What is the payment reduction for hospital and facilities that fail to successfully meet the requirements of Medicare’s Quality Reporting programs?
A. 4% reduction
B. 2% reduction
C. 1% reduction
D. 3% reduction
2% reduction
Which is a health care program for active duty members oof the military and their qualified family members?
A. Tricare
B. CHAMPVA
C. Medicare
D. CHAMPUS
Tricare
The patient must pay $500 out of her own pocket before her insurance company will begin to reimburse for medical expenses. She is also responsible for 20% of the bill for medical services. The $500 is a
A. Coinsurance
B. Co-pay
C. Premium
D. Deductible
Deductible
