A claim is being adjudicated when

Question 1

  1. Which statement below was NOT a primary issue that Congress focused on when creating the 1996 legislation known as HIPAA?

      Hospitals own hospital records

    Courts have ruled that patients have no right to own the x-rays or slides

    Physicians own the portion of the hospital record on which they document care

    Patients have right of access to medical records but do not own the original record

5 points   


Question 2

  1. PHI includes information which is created or received by several types of organizations. Which of the following organizations is (are) not one of those that creates PHI?


    Health insurer


    All of the above create PHI

5 points   

Question 3

  1. According to the Department of HHS website, which of the following privacy rule compliance issues are not among those most often investigated?

    Impermissible use and disclosure of PHI

    Lack of patient access to their PHI

    Transferring PHI through electronic means

    Distributing more than the minimal information necessary for the purpose

5 points   

Question 4

  1. How did one court rule in a case that involved a hospital where nurses were permitted to ‘chart by exception’ in postoperative monitoring?

    The court found that the record keeping was incomplete, which inferred negligence

    The court found that the patient was not informed and the hospital was negligent

    The court found that charting by exception was adequate as the practice was common at the hospital and was documented in hospital policies and procedures

    The court found that paper notes kept by the nurse in her pocket were an adequate means of record keeping and communicating with others

5 points   

Question 5

  1. Computerized recordkeeping provides advantages and disadvantages that include

    More standardization of datakeeping

    They assist in the reduction of medical errors

    Computerized systems are costly

    All of the above

5 points   

Question 6

  1. When a provider accepts a pre-established amount to provide services over a period of time, this is known as a method of payment called





5 points   

Question 7

  1. When the provider agrees to accept as payment in full whatever amount the insurance allows or approves, the provider is agreeing to

    accept assignment

    assignment of benefits

    authorize services

    coordination of benefits

5 points   

Question 8

  1. Which document is used to generate the patient’s financial and medical record?

5 points   

Question 9

  1. Case law is based on court decisions that establish precedent, and is also called ______ law.

5 points   

Question 10

  1. The recognized difference between fraud and abuse is

5 points   

Question 11

  1. The ICD-9-CM system classifies

5 points   

Question 12

  1. The following is true about Medicare

     It is a two part program with Part A and B and the program includes Parts C and D

    It only consists of Parts A and B

    It is a two part program where Part A pays for doctor’s services

    It consists of Part A only

5 points   

Question 13

  1. The Medicare physician fee schedule amount for code 99213 is $100. The participating provider’s usual charge for this service is $125. Calculate the Medicare reimbursement amount.

5 points   

Question 14

  1. A claim is being adjudicated when &..

5 points   

Question 15

  1. The first-listed diagnosis reported on a CMS-1500 claim form is

    used in the outpatient setting

    is determined in accordance with ICD-9-CM’s rules and general coding guidelines

    a and b

    none of the above

5 points   

Question 16

  1. The concept of linking diagnosis codes with procedure/service codes is

    medical matching

    medical necessity

    prospective payment


5 points   

Question 17

  1. Medicare is available to an individual who has worked at least

5 points   

Question 18

  1. Which statement below is correct about a managed care contract and gag clause?

    Medicare and many states prohibit managed care contracts from containing gag clauses

    There is federal law that restricts any type of gag clauses in all medical contracts.

    Only HMO’s are allowed to have gag clauses, but the law only covers restricting discussion between a doctor and patient about of surgery’s that the plan does not cover.

    There are no specific laws about if a managed care company may or may not have gag clauses in the contracts between the doctor and the company.

5 points   

Question 19

  1. The government agency that functions as the insuring body to cover workers’ compensation claims is called the

    Office of Federal Employees’ Compensation Act

    Office of Federal Employment Liability Act

    Office of State Insurance Fund.

    Office of Workers’ Compensation Board

5 points   

Question 20

  1. The OWCP administers programs for those injured at work and

    that provide wage replacement benefits

    that provide medical treatment

    that provide vocational rehabilitation

    all of the above


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