Part 1 Flashcards Preview

HIM 345 FINAL > Part 1 > Flashcards

Flashcards in Part 1 Deck (10)
Loading flashcards...
1

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

2

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

3

Which is the insurance plan responsible for paying healthcare insurance claims first?

A. Secondary insurance
B. Primary insurance

Primary insurance

4

Which is the former name for Tricare Standard?

A. Triwest
B. CHAMPVA
C. CHAMPUS

CHAMPUS

5

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

6

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

7

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

8

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

9

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

10

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