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- What is the first step of the life cycle of a payment claim? a. The patient checks in at the front desk. b. Denials and appeals have been closed. c. Coinsurance payments are met. d. Treatment plans have been identified.
ANSWER: a
FEEDBACK: a. Correct. The revenue cycle is the life cycle of a payment claim that begins
when the patient checks in at the front desk and ends after all payments or denials and appeals have been made. b. Incorrect.^ The^ revenue^ cycle^ ends^ when^ all^ payments^ or^ denials^ and appeals (^) have been made. c. Incorrect.^ Coinsurance^ is^ the^ percentage^ the^ patient^ pays^ for^ covered services (^) after the deductible has been met and the copay has been paid. d. Incorrect.^ Bills^ must^ accurately^ describe^ the^ treatment^ or^ service^ so^ that the (^) claim can be paid appropriately.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Introduction
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.1 - Identify the steps in the revenue cycle.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 1:17 AM
DATEMODIFIED: 6/2/2023 1:20 AM
- Why is it important that the process of managing billing cycles be performed accurately and on a timely basis? a. to maintain cash flows b. to ensure deductibles have been met c. to enable the organization to become a covered entity d. to prevent Medicare abuse
ANSWER: a
FEEDBACK: a. Correct. Throughout the process of managing billing cycles, cash flow must be
maintained to enable health care facilities to deliver quality care to their patients and stay in business. b. Incorrect.^ The^ insurance^ provider,^ not^ the^ provider^ of^ the^ service,^ will ensure (^) that deductibles have been met. c. Incorrect. Health care organizations that are required to comply with HIPAA regulations are known as covered entities (CE), and that definition includes all organizations that electronically transmit any information that is protected under HIPAA. d. Incorrect.^ Medicare^ defines^ abuse^ as^ “practices^ that^ directly^ or^ indirectly result (^) in unnecessary costs to Medicare.”
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Introduction
QUESTIONTYPE: Multiple Choice
c. Incorrect. The Privacy Rule covers the use and disclosure of PHI that is transmitted or maintained by electronic media, such as over the Internet to “the cloud” or stored on computer modems or remote servers. d. Incorrect.^ Information^ needed^ to^ prevent^ or^ lessen^ imminent^ danger^ may be (^) disclosed to law enforcement if the information is needed to identify or apprehend an escapee or violent criminal.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: 1.2 - Describe the role of HIPAA in the revenue cycle.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:06 AM
DATEMODIFIED: 6/2/2023 2:09 AM
- In the revenue cycle system, which group is responsible for billing and receiving payment for health care services in the normal course of business? a. health care providers b. health care plans c. health care clearinghouses d. health care covered entities
ANSWER: a
FEEDBACK: a. Correct. Health care providers are the people or organizations that furnish, bill,
and are paid for health care in the normal course of business. b. Incorrect.^ Health^ plans^ are^ individual^ or^ group^ health^ insurance^ plans^ that pay (^) for medical care. c. Incorrect.^ Health^ care^ clearinghouses^ are^ companies^ that^ convert nonstandard (^) transactions into standard transactions and transmit the data to health plans and the reverse process. d. Incorrect. Health care organizations that are required to comply with HIPAA regulations are known as covered entities (CE), and that definition includes all organizations that electronically transmit any information that is protected under HIPAA.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.2 - Describe the role of HIPAA in the revenue cycle.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:09 AM
DATEMODIFIED: 6/2/2023 2:11 AM
- What is used to protect how personal health information is transmitted or maintained by electronic media?
a. the Privacy Rule b. clearinghouses c. revenue cycle management d. the Security Rule
ANSWER: a
FEEDBACK: a. Correct. The Privacy Rule covers the use and disclosure of PHI that is
transmitted or maintained by electronic media, such as over the Internet to “the cloud” or stored on computer modems or remote servers. b. Incorrect.^ Health^ care^ clearinghouses^ are^ companies^ that^ convert nonstandard (^) transactions into standard transactions and transmit the data to health plans and the reverse process. c. Incorrect.^ Revenue^ cycle^ management^ consists^ of^ all^ administrative^ and clinical (^) functions that contribute to the capture, management, and collection of patient service revenue. d. Incorrect.^ The^ HIPAA^ Security^ Rule^ protects^ a^ subset^ of^ information^ covered by (^) the Privacy Rule.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.3 - Recommend procedures to ensure compliance with HIPAA regulations.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:11 AM
DATEMODIFIED: 6/2/2023 2:13 AM
- Which rights does the Privacy Rule give to individuals over their PHI? a. the right to direct the transition of an electronic copy to a third party b. the right to high-quality health care c. the right to protection of image in the public health system d. the right to physical well-being
ANSWER: a
FEEDBACK: a. Correct. The Privacy Rule gives individuals rights over their PHI, including the
right to examine and obtain copies of their records, to direct a covered entity to transmit an electronic copy to a third party, and the right to request corrections. b. Incorrect.^ One^ goal^ of^ the^ Privacy^ Rule^ is^ to^ allow^ the^ flow^ of^ health information (^) needed to provide and promote high-quality health care. c. Incorrect.^ One^ goal^ of^ the^ Privacy^ Rule^ is^ to^ allow^ the^ flow^ of^ health information (^) needed to protect the public's health and well-being. d. Incorrect.^ One^ goal^ of^ the^ Privacy^ Rule^ is^ to^ allow^ the^ flow^ of^ health information (^) needed to provide and promote high-quality health care that protects the public's well-being.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
HASVARIABLES: False
LEARNINGOBJECTIVES: 1.3 - Describe the standard precaution guidelines for disease prevention.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:13 AM
DATEMODIFIED: 6/2/2023 2:16 AM
- Which qualifier under HIPAA limits the amount of PHI shared to only that needed to accomplish the intended purpose of the use of disclosure? a. minimum necessary b. security management c. integrity controls d. transmission security
ANSWER: a
FEEDBACK: a. Correct. Minimum necessary is a qualifier that appears in HIPPA. It means that
disclosures to other health care providers for treatment purposes must be only the minimum amount of PHI needed to accomplish the intended purpose of the use or disclosure. b. Incorrect.^ Security^ management^ is^ an^ administrative^ safeguard^ used^ to identify (^) and analyze potential risks to ePHI. c. Incorrect.^ Integrity^ controls^ are^ types^ of^ technical^ safeguards^ that^ relate to (^) policies and procedures to ensure the ePHI is not improperly altered or destroyed. d. Incorrect.^ Transmission^ security^ is^ a^ technical^ safeguard^ that^ guards against (^) unauthorized access to ePHI that is being transmitted over an electronic network.
POINTS: 1
DIFFICULTY: Medium
REFERENCES: HIPAA and the Revenue Cycle
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.3 - Recommend procedures to ensure compliance with HIPAA regulations.
OTHER: Bloom's: Analyze
DATECREATED: 6/2/2023 2:16 AM
DATEMODIFIED: 6/2/2023 2:18 AM
- What is a large portion of HIPAA regulation used in the attempt to prevent fraud and abuse based on? a. the Medicare Integrity Program b. the False Claims Act c. the Medicare and Medicaid Patient and Program Protection Act of 1987 d. Operation Restore Trust
ANSWER: a
FEEDBACK: a. Correct. Although HIPAA is widely known for its privacy and security
protections, a large portion of the act focuses on preventing fraud and abuse through the Medicare Integrity Program. This program reviews provider claims, cost reports, and payment determinations for fraud and abuse.
POINTS: 1
b. Incorrect.^ The^ False^ Claims^ Act^ began^ during^ the^ Civil^ War.^ This^ act prohibited (^) federal contractors from knowingly filing a fraudulent claim using false statements or otherwise conspiring to defraud the U.S. government. c. Incorrect.^ The^ False^ Claims^ Act^ formed^ the^ foundation for^ more^ recent^ laws, like the Medicare and Medicaid Patient and Program Protection Act of
d. Incorrect.^ In^ 1995,^ Operation^ Restore^ Trust^ targeted^ fraud^ and^ abuse among (^) health care providers.
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: 1.4 - Define fraud and abuse.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:19 AM
DATEMODIFIED: 6/2/2023 2:21 AM
- Which of the following would qualify as abuse under Medicare? a. billing for unnecessary services b. billing for services more complex than that provided c. billing for appointments that the patient did not keep d. billing for unnecessary items of service
ANSWER: a
FEEDBACK: a. Correct. Medicare defines abuse as “practices that directly or indirectly result in
unnecessary costs to Medicare.” These include practices that are not medically necessary services or that do not meet professionally recognized standards of care. b. Incorrect. Fraud includes knowingly billing for services at a level of complexity higher than the services actually provided or documented in the medical record. c. Incorrect.^ Fraud^ includes^ billing^ Medicare^ for^ appointments^ patients^ did not (^) keep. d. Incorrect.^ Fraud^ includes^ knowingly^ ordering^ medically^ unnecessary^ items of (^) service for a patient.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: What Is Fraud and Abuse?
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.4 - Define fraud and abuse.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:22 AM
DATEMODIFIED: 6/2/2023 2:23 AM
- What of the following is the pre-established fixed payment per patient per unit to time that is paid to help care
a. capitation b. fee schedule c. clean claim d. Charge Description Master
ANSWER: a
FEEDBACK: a. Correct. Capitation is a pre-established fixed payment per patient per unit of
time paid in advance to the physician for the delivery of health care services for patients/beneficiaries in a health care plan. The provider agrees to accept, in full, the payment established in the contract. b. Incorrect.^ A^ fee^ schedule^ is^ a^ predetermined^ list^ of^ fees^ that^ the^ payer allows (^) for the payment of all health care services. c. Incorrect.^ All^ providers^ strive^ to^ submit^ a^ clean^ claim—one^ that^ is correctly (^) completed without errors or omissions. d. Incorrect.^ The^ Charge^ Description^ Master^ is^ a^ database^ that^ contains^ all the (^) information necessary for the system to place the information on the claim form.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Revenue Cycle Basics in Three Parts
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.1 - Identify the steps in the revenue cycle.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:25 AM
DATEMODIFIED: 6/2/2023 2:27 AM
- From a revenue cycle perspective, when is it best to get the most accurate information and minimize errors in thepatient's encounter? a. during front-end tasks b. when applying the Charge Description Master c. when claims are undergoing adjudication d. during the patient visit to the health care provider
ANSWER: a
FEEDBACK: a. Correct. From a revenue cycle perspective, getting the most accurate
information up front starts with patient scheduling and registration. Successful health care revenue cycle management strategies focus on front-end tasks. b. Incorrect. Accurate code assignment by the HIM coding staff and having an updated Charge Description Master, which is a database that contains all the information necessary for the system to place the information on the claim form, leads to the submission of more clean claims. c. Incorrect. Claims adjudication is used to verify that the patient on the claim is covered by their company’s policy, the services are necessary, and the patient will benefit from them. They also verify the policy’s deductibles, copays, and coinsurance. d. Incorrect. Inthe middle ofthe revenue cycle, the patient isseen bythe health care provider. The visit is documented , including all physical examinations or treatmentsthatareprovided.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Revenue Cycle Basics in Three Parts
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.5 - Define a clean claim.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:27 AM
DATEMODIFIED: 6/2/2023 2:31 AM
- Which of the following will happen when a claim goes under the adjudication process? a. The claim is compared to the health plan benefits. b. Codes from the Charge Description Master are applied to the claim. c. Claims are electronically transferred to a clearinghouse. d. Precertification and authorization is provided.
ANSWER: a
FEEDBACK: a. Correct. The payer compares the claim to the payer edits and the patient’s
health plan benefits to verify that all required information is available to process the claim, that the claim is not a duplicate submission, and that the procedures performed or services provided are covered benefits. b. Incorrect. A clean claim is one that is correctly completed without errors or omissions. This means accurate code assignment by the HIM coding staff and having an updated Charge Description Master. c. Incorrect.^ Before^ the^ claim^ is^ adjudicated,^ all^ the^ required^ data^ is^ posted^ to the (^) claims and the claims are in a computer file, which are then transmitted electronically to a clearinghouse. d. Incorrect.^ Pre-certification^ or^ authorization^ assesses^ medical^ necessity^ and is (^) done before patient check-in.
POINTS: 1
DIFFICULTY: Medium
REFERENCES: Cycle Basics in Three
Parts QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO:1.6-Identifytheimportanceofacleanclaimtotherevenuecycle.
OTHER: Bloom's: Analyze
DATECREATED: 6/2/2023 2:31 AM
DATEMODIFIED: 6/2/2023 2:33 AM
- When is a determination of the patient's annual deductible, copay, and coinsurance made? a. during claims adjudication b. during the sending of the remittance advice c. during the establishment of the fee schedule d. during claims capitation
ANSWER: a
DATECREATED: 6/2/2023 2:39 AM
DATEMODIFIED: 6/2/2023 2:42 AM
- What role does the HIM professional play in ensuring compliance with regulations? a. ensuring accuracy of claims b. understanding the historical roots of health care c. applying Medicare coverage to all patients regardless of income d. managing clinical and administrative functions of patient services
ANSWER: a
FEEDBACK: a. Correct. Ensuring that claims are accurate and correctly represent the services
provided is an important focus of compliance with regulations. This is where HIM professionals play an important role. b. Incorrect. The evolution of health care reimbursement that brought us to this place in history began in the 1930s in Texas at Baylor University, and continues to be amended by the government. c. Incorrect.^ Medicare^ applies^ only^ to^ older^ adults^ or^ people^ with^ lower^ incomes. d. Incorrect.^ Revenue^ cycle^ management^ consists^ of^ all^ administrative^ and clinical (^) functions that contribute to the capture, management, and collection of patient service revenue.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Introduction
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.7 - Differentiate between a copay, coinsurance, and deductibles.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:42 AM
DATEMODIFIED: 6/2/2023 2:44 AM
- Which type of information can a patient find on their Explanation of Benefits? a. how much of the plan deductible has been met b. lists of in-network providers c. diagnostic and procedure codes d. which clearinghouse handled the claim
ANSWER: a
FEEDBACK: a. Correct. The patient receives an Explanation of Benefits which details how the
payer paid the claim. It also lists the plan deductible that the patient has met and what their out-of-pocket expenses are. b. Incorrect.^ The^ insurance^ companies^ assure^ their^ members^ quality^ care^ at lower (^) costs by providing lists of providers who have negotiated to provide health care to their members under their insurance plan. c. Incorrect. HIM professionals use diagnoses and procedures codes for inpatients and outpatients based on the clinical documentation and according to all official guidelines. d. Incorrect. After data has been posted to the claims, claims are sent to a clearinghouse, where data is mapped into a transaction format. The clearinghouses electronically transmit the claims to the payer’s clearinghouse.
DIFFICULTY: Easy
REFERENCES: Revenue Cycle Basics in Three Parts
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.6 - Identify the importance of a clean claim to the revenue cycle.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:44 AM
DATEMODIFIED: 6/2/2023 2:46 AM
- Why is the role of HIM professionals important in managing health care revenue cycles? a. The complexity of the system requires a high degree of coordination. b. HIPAA does not stipulate how information is shared or processed. c. Most information is protected under security rules. d. Medicare does not allow information to be shared over the cloud.
ANSWER: a
FEEDBACK: a. Correct. Health care revenue cycle management requires people, processes,
and technology within a multidisciplinary team composed of clinical, admissions, health information management, clinical documentation integrity, and billing departments. b. Incorrect. HIPAA stipulates how personally identifiable protected health information (PHI) is maintained by health care providers, health plans, and health care clearinghouses, including how it should be protected. c. Incorrect.^ The^ privacy^ rule^ stipulated^ under^ HIPAA^ strives^ to^ protect information (^) and provides rights to individuals over their personal information. d. Incorrect.^ HIPAA^ has^ specific^ requirements^ for^ security^ of^ information shared (^) over the cloud, as do Medicare and Medicaid.
POINTS: 1
DIFFICULTY: Medium
REFERENCES: Revenue Cycle Basics in Three Parts
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.7 - Differentiate between a copay, coinsurance, and deductibles.
OTHER: Bloom's: Analyze
DATECREATED: 6/2/2023 2:46 AM
DATEMODIFIED: 6/2/2023 2:48 AM
- Which of the following includes individually identifiable health information created, received, and maintained by a CE that is transmitted electronically between provider and insurance clearinghouses? a. ePHI b. security management c. CMS d. Charge Description Master
ANSWER: a
FEEDBACK: a. Correct. All individually identifiable health information a CE creates, receives,
maintains, or transmits in electronic form is referred to as ePHI.
POINTS: 1
b. Incorrect.^ Security^ management^ is^ an^ administrative^ safeguard^ that identifies (^) and analyzes potential risks to ePHI. c. Incorrect.^ Operation^ Restore^ Trust^ targeted^ fraud^ and^ abuse^ among^ health care (^) providers in a joint effort between HHS (Department of Health and Human Services), OIG (Office of Inspector General), CMS (Centers for Medicare and Medicaid Services), and the Administration on Aging. d. Incorrect.^ A Charge Description Master is a database that contains all the information necessary for the system to place the information on the claim form.
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.8 - Compare how the various Security Rule safeguards protect ePHI.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:48 AM
DATEMODIFIED: 6/2/2023 2:49 AM
- Which of the following is part of the physical safeguards identified under the HIPAA Security Rule that helps to protect health information? a. workstation and security devices b. information access management c. integrity controls d. workforce training
ANSWER: a
FEEDBACK: a. Correct. Physical safeguards include facility access and control as well as
workstation and device security. Policies and procedures should include the transfer, removal, disposal, and re-use of electronic media. b. Incorrect.^ Information^ access^ management^ is^ an^ administrative^ safeguard. c. Incorrect.^ Integrity^ controls,^ including^ policies^ and^ procedures^ to^ ensure that (^) ePHI is not improperly altered or destroyed, fall under technical safeguards. d. Incorrect.^ Workforce^ training^ and^ management,^ as^ administrative safeguards, (^) include training, policies and procedures, and sanctions against employees who violate policies and procedures.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: HIPAA and the Revenue Cycle
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.8 - Compare how the various Security Rule safeguards protect ePHI.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:50 AM
DATEMODIFIED: 6/2/2023 2:51 AM
DIFFICULTY: Easy
REFERENCES: Health Information Management's Role
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.9 - Explain the role of Health Information within the revenue cycle.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:53 AM
DATEMODIFIED: 6/2/2023 2:55 AM
- What is the set of concepts and relationships that create common reference points for comparisons and data collection? a. clinical terminology b. classification systems c. robotic process automation d. predictive analytics
ANSWER: a
FEEDBACK: a. Correct. Clinical terminology refers to a set of concepts and relationships that
provide a common reference point for comparisons and collection of data about the entire health care process, recorded by multiple different individuals, systems, or health care organizations. b. Incorrect. Clinical classification systems are intended for the classification of clinical conditions and procedures in support of statistical data analysis, but they are widely used for reimbursement, public health reporting, quality of care assessment, education, research, and monitoring the performance of providers. c. Incorrect. Robotic process automation helps to reduce costs and fill the gaps across the revenue cycle by engaging patients digitally to pre-register, providing self-service options that patients can initiate at their convenience, and prompting patients for additional information when data is missing or questions arise. d. Incorrect.^ Predictive^ analytics^ is^ a^ type of^ machine^ learning^ that^ can^ be^ used to (^) forecast revenue, allowing the health care administration to correct issues that impact revenue before they occur.
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Health Information Management's Role
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: LO: 1.9 - Explain the role of Health Information within the revenue cycle.
OTHER: Bloom's: Understand
DATECREATED: 6/2/2023 2:55 AM
DATEMODIFIED: 6/2/2023 2:57 AM
- How can HIM professionals use predictive analytics to better manage the revenue cycle? a. to correct issues that impact revenue before they occur b. to redesign revenue cycle staff roles c. to train staff in clinical terminology
