Exam 3 Review

1. Exam 3 Review MIS 4243

2. Question 1 Which Medicare plan pays for hospital services? • Part A • Part B • Part C • Part D

3. Question 2 What does comorbidity mean? • The patient died • The patient developed an infection after being admitted • The patient developed a complication • The patient had more than one condition when admitted

4. Question 3 A participating provider charges $80, but the Medicare allowed amount is $70. What is the write-down amount? • 10 percent • 80 percent • $10 • $80

5. Question 4 Diagnosis codes assigned to represent disease or medical condition treated are: • HCPCS • CPT-4 • ICD-9-CM • All of the above

6. Question 5 A prospective payment system (PPS) is being used by a hospital. Which of the following is NOT true? • There will be a maximum limit per discharge. • It will be based on reasonable costs given the diagnosis. • The hospital can be any type (general, children’s, cancer, and so forth). • Patients who stay one night versus two nights will be charged the same amount if their diagnosis is the same.

7. Question 6 Which paper form was designed for institutional claims? • Part A • UB-04 • CMS-1500 • W-4

8. Question 7 A(n) _________ statement shows all unpaid items with payment, adjustments, and balance for each item. • Balance forward • Open item • Either balance forward or open item • Neither balance forward or open item

9. Question 8 Which of the following EDI transactions is currently NOT required by HIPAA? • Claim attachment • Enrollment and de-enrollment in a health plan • Health plan premium payments • Referral certification and authorization

10. Question 9 Provider payment delays can be caused by: • A bill-hold period • Payment floor • Secondary insurance plan billing • All of the above

11. Question 10 Special software that examines claim data before it is sent to eliminate preventable billing errors is called: • Claim edit • Claim scrubber • Clearinghouse • EMC

12. Question 11 What type of statistic can be used to compare patients who receive a therapy versus those who did not? • Mean • Mode • Ratio • Standard deviation

13. Question 12 Eighteen patients were counseled against smoking and twelve were not. What is the proportion of patients who were counseled? • .40 • .60 • .66 • 1.5

14. Question 13 A ___________ usually has a separate database created to track specific data types such as childhood immunizations. • HEDIS • Index • ORYX • Registry

15. Question 14 The data mining technique called __________ could be used to predict length of stay of a patient in a hospital with a particular medical condition. • Association • Clustering • Classification • Estimation

16. Question 15 CMS developed the _______ program to encourage improvements in quality of care coordination for patients with chronic illnesses. It also gives bonus payments to doctors who meet or exceed performance standards. • Data mining • NHQM • P4P • Sampling

17. Question 16 Software systems that share a common database are: • Interfaced • Integrated • Indexed • Regulated

18. Question 17 What department abstracts and reports National Hospital Quality Measures (NHQM)? • Billing • Utilization management • Quality management • Utility

19. Question 18 Which of the following systems would be used track employee health? • Financial • Human resource • Scheduling • Quality management

20. Question 19 An employee scheduling system is used for all of the following except: • Processing doctors’ orders • Managing employee sick days • Scheduling pre-op cleaning • Maintaining an on-call schedule

21. Question 20 Which of the following is true regarding the Recovery Audit Contractor (RAC) program? • It increases the risk of financial loss to the hospital/physician. • It was created by CMS in 2013. • It utilizes a public company as its contractor. • All of the above are true.