Deck 17: Financial and Administrative Aspects of Healthcare Organizations

Question 1

The use of financial reports on the __________ level will demonstrate the government's ability to show effective and efficient processes and social, political, and economic impact of various uses of federal resources.

A) federal
B) state
C) local
D) public

Answer 1

A

Question 2

The SEC works closely with a number of institutions and agencies, such as:

A) the Federal Accounting Standards Advisory Board (FASAB).
B) local tax preparers.
C) stock exchanges.
D) All of these are correct.

Answer 2

C

Question 3

__________ affects the organization's ability to meet obligations such as payroll, accounts payable, and loans along with paying dividends to the shareholders.

A) Cash flow
B) A balance sheet
C) Accounts receivable
D) Equity

Answer 3

A

Question 4

Organizations will be structured based on their __________, and two characteristics that define the type of organizations are for-profit organizations and not-for-profit organizations.

A) financing
B) leadership
C) tax status
D) All of these are correct.
E) None of these is correct.

Question 5

A __________ is a legal entity that is separate from the owners, pays its own taxes, and has its own legal rights and responsibilities.

A) sole proprietorship
B) partnership
C) corporation
D) not-for-profit
E) for-profit

Question 6

In the __________ area, the management team reviews all transactions for the entire facility that impact the financials in the clinical and support areas.

A) Patient Accounts
B) Clinical Services
C) Health Information Management
D) Administration

Question 7

A(n) __________ budget is designed for expected activity in the upcoming year based on historical data; it will not change during the year even if the volume of business changes.

A) variable
B) fixed
C) activity-based
D) zero-based

Question 8

The __________ method of allocating costs will distribute the costs involved with overhead to the revenue-producing departments. The costs will be distributed to the individual revenue-generating departments based on a percentage of revenue or square footage.

A) direct
B) step-down allocation
C) double distribution
D) simultaneous equations

Question 9

A(n) __________ cost is incurred in the organization as it provides products or services to a customer, but the cost is not directly related to the manufacturing of goods or services provided by the organization.

A) semi-fixed
B) variable
C) fixed
D) indirect
E) None of these is correct.

Question 10

The __________ is part of the accounting system where all the entries are recorded in chronological order, and they are posted to the individual accounts that the transaction is associated with in the company.

A) notes receivable
B) general ledger
C) inventory
D) accounts payable

Question 11

Beginning accounts receivable + __________ − collections = __________.

A) accounts payable, ending accounts receivable
B) sales, ending accounts receivable
C) inventory, ending accounts payable
D) None of these is correct.

Question 12

A(n) __________ claim is any claim submitted using the HIPAA mandated transaction ASC X12N 837-Health Care Claim: Professional or the CMS-1500 paper claim form.

A) professional
B) institutional
C) statement
D) provider's
E) customer's

Question 13

Suppliers of durable medical equipment, prosthetics, orthotics, and supplies, as well as parenteral and enteral nutrition (PEN), submit claims to:

A) Durable Medical Equipment Medicare Administrative Contractors (DME MACs).
B) Fiscal Intermediaries (FI).
C) Health Insurance portion of Medicare (HI).
D) Supplemental Insurance portion of Medicare (SI).

Question 14

If the provider, practitioner, or supplier expects payment for the items or services to be denied by Medicare, the provider, practitioner, or supplier must advise the beneficiary __________ the items or services are furnished that, in the opinion of the provider, practitioner, or supplier, the beneficiary will be personally and fully responsible for payment.

A) immediately after
B) before
C) within 60 days of the day
D) during an office visit

Question 15

To inform a Medicare beneficiary that Medicare certainly or probably won't pay for a product or service, the provider must issue an ABN to the beneficiary or the beneficiary's:

A) neighbor.
B) relative.
C) co-worker.
D) physician or healthcare professional.
E) authorized representative.

Question 16

The second-level appeal is an appeal with a(n) __________ that must be started no later than 180 days from the date of receipt of the redetermination.

A) Administrative Law Judge
B) Qualified Independent Contractor
C) Department Appeals Board
D) Federal Court

Question 17

According to the Centers for Medicare and Medicaid Services (CMS), a worker must have ___________ to qualify for the health insurance portion of Medicare Part A.

A) a specific number of quarters of coverage (QCs)
B) a disability
C) end-stage renal disease
D) None of these is correct.

Question 18

Medicare covers beneficiaries who __________ and have elected to pay a premium for coverage.

A) are entitled to Social Security
B) are entitled to Railroad Retirement
C) have ESRD
D) All of these are correct.

Question 19

For a Medicare beneficiary to have home health services initiated, a physician's order is needed to start care. Then, a registered nurse will generally be the one to open the case and make the initial visit. After this, a(n) __________ will be established that outlines the care needed for the patient.

A) nursing note
B) admissions packet
C) plan of care
D) physician's order
E) None of these is correct.

Question 20

Which of the following items is considered a financial obligation that is supported by a contract, has a time frame for repayment, and can be associated with a large purchase or loan when an organization uses some of its assets as collateral?

A) Accounts payable
B) Notes payable
C) Accounts receivable
D) Expenses

Question 21

__________ is the managed care option offered by the Department of Defense that offers the most affordable and comprehensive coverage for its beneficiaries. Coverage includes emergency care, outpatient visits, preventative care, hospitalization, maternity care, mental health, behavioral health, and prescription coverage.

A) TRICARE
B) TRICARE Prime
C) TRICARE Standard
D) TRICARE Extra

Question 22

The PPACA will provide for unprecedented funding and commitment to the areas of:

A) prevention.
B) wellness.
C) public health.
D) All of these are correct.
E) None of these is correct.

Question 23

The PPACA looked to increase healthcare access for individuals who have been uninsured because of a preexisting condition for at least __________ months and extended coverage for young adults so that they could stay on their parents' plan until the age of 26 years.

A) three
B) four
C) five
D) six
E) 24

Question 24

The PPACA also looked at providing incentives for physicians to join together and develop __________ that would ultimately allow the physician to better coordinate patient care and improve quality by decreasing infection rate and reducing unnecessary admissions to the hospital.

A) ACOs
B) VBPs
C) DRGs
D) P4Ps

Question 25

__________ oversees the portion of the Act relating to the implementation of private health insurance and working with states to initiate the Health Insurance Marketplace.

A) CCIIO
B) CLASS Act
C) The Health Insurance Marketplace
D) HIPAA

Question 26

The 80/20 Rule is also known as:

A) Pay-for-Performance.
B) Value-Based Purchasing.
C) Medical Loss Ratio.
D) Consumer-Driven Health Plans.

Question 27

A(n) __________ is a large group of hospitals and physicians under contract to service members of a managed care plan.

A) Group Model HMO
B) Independent Practice Association
C) Network Model HMO
D) Preferred Provider Organization
E) Exclusive Provider Organization

Question 28

__________ support multiple practices in the administrative and support functions that they need to operate. They handle medical records, release of information, billing, general office staff, registration, and other administrative functions.

A) PHOs
B) ACOs
C) MSOs
D) GMOs

Question 29

The Episode-of-Care (EOC) payment, which is sometimes called a __________, involves making a lump-sum payment to healthcare providers to cover all services that were delivered to a patient for a specific illness that was treated during a specific period of time.

A) capitated payment
B) block payment
C) transfer payment
D) bundled payment

Question 30

Published every federal working day, the __________ is the official journal of the U.S. government.

A) OIG Work Plan
B) Federal Register
C) Congressional Transcripts
D) Medicare Learning Network
E) None of these is correct.

Question 31

If a hospital treats a high percentage of low-income patients, it will receive a percentage add-on payment that will be applied to the DRG-adjusted base payment rate, which is known as a(n):

A) indirect medical education adjustment.
B) disproportionate share adjustment.
C) cost of living adjustment.
D) high-cost outlier adjustment.
E) transfer case adjustment.

Question 32

Section 1886(d)(5)(A) of the Social Security Act provides for a(n) __________, Medicare payments to Medicare-participating hospitals in addition to the basic prospective payments for cases that consume high amounts of resources.

A) transfer case adjustment
B) high-cost outlier adjustment
C) hospital wage index
D) None of these is correct.

Question 33

The __________ PPS pays for inpatient hospital services in an inpatient rehabilitation hospital or a rehabilitation unit of a hospital.

A) IPF
B) IRF
C) IPPS
D) None of these is correct.

Question 34

Inpatient Rehabilitation Facilities must report quality data to CMS electronically using the program called:

A) IRVEN.
B) OASIS.
C) HEDIS.
D) None of these is correct.

Question 35

The payment for an IPF PPS facility is determined by a federal per diem base rate that is based on inpatient operating costs and capital-related costs, but not certain pass-through costs, such as:

A) allied health education.
B) bad debt.
C) direct graduate medical education.
D) nursing education.
E) All of these are correct.

Question 36

HIPPS codes are used for all of the following, except:

A) IRF.
B) SNF.
C) IPPS.
D) SNF.

Question 37

Earnings are similar to net income and include any accounting adjustments.

Question 38

Comprehensive income takes into account all changes in equity outside of any investments or distributions involving the owners.

Question 39

The acid-test ratio measures current assets versus current liabilities, but with a different approach; the current assets that are measured are only those that are considered truly liquid or have the ability to be turned into cash very quickly.

Question 40

In the debt ratio, the lender will look at the total current assets and total current liabilities that an organization has on its balance sheet.

Question 41

For payment to an employer of a physician, there does not need to be an employer-employee relationship between the physician and the person or organization hiring the physician to perform services.

Question 42

For payments under reciprocal billing arrangements for physicians, generally there is a 60-day limit to this type of relationship, but in the case where a physician is called to active duty in the armed forces, the time limit may not be longer than 60 days.

Question 43

The workers' compensation benefit is made available to most employees to help cover healthcare costs that are caused by a work-related injury.

Question 44

Indian Health Services (IHS) is an agency within the Department of Health and Human Services that is responsible for providing federal healthcare services for the American Indians only.

Question 45

In the Marketplace, nobody can be turned down for coverage, and no insurance company can charge more for those individuals with costly illnesses or medical conditions.

Question 46

The PPACA stops insurance companies from placing limits on coverage for yearly benefits but not lifetime benefits.

Question 47

One of the main ideas with the development of HEDIS was to allow employers to see what they are getting for their healthcare dollars.

Question 48

The Balanced Budget Act of 1997 created the Medicare Part C or Medicare Managed Care. The plan changed its name to Medicare+Choice (M+C) in 1999.

Question 49

Pancreas transplants are generally limited to those patients with severe secondary complications of diabetes, including kidney failure. With that said, pancreas transplantation is not performed on patients with labile diabetes and hypoglycemic unawareness.

Question 50

The budget neutrality portion of IPF PPS requires that the total expenditures of the program in a prospective payment model not exceed what would have been spent in a fee-for-service model had the IPF PPS model not been created.

Question 51

Each individual state can extend the actual enrollment periods for open enrollment.

Question 52

The individual mandate, or formerly known as the individual-shared responsibility provision, will have no changes to it in 2019 or for the years to come. The only part of the individual mandate that has changed is the penalty that goes along with the mandate.

Question 53

Some of the changes for 2019 start with the tax penalty if the minimum essential healthcare insurance coverage is not purchased. There was legislation that passed in December of 2017 that will not remove the penalty for individuals if they do not purchase or enroll in a plan that provides the minimum coverage required.

Question 54

Long-term care hospitals (LTCH) are not considered a short-term option for acute care hospitals and are not part of the prospective payment system (PPS).

Question 55

Medicare certifies LTCHs as a short-term acute care hospital and has an average length of stay of less than 25 days.

Question 56

There is only one interruption of stay policy that impacts the LTC-DRG payment calculations.

Question 57

A high-cost outlier is where the total costs for the admission exceed the outlier threshold.

Question 58

The LTCH-based payment, not under the DRG system, is a payment that is determined by the one to two diagnosis codes that are reported on the individual claim form.

Question 59

The __________ Handbook of Accounting Standards and Other Pronouncements is considered to be the authoritative accounting source for the federal government and other entities.

A) GAAP
B) FASAB
C) SEC
D) IRS

Question 60

__________ is proven if the data provided can impact the individual's decision-making process because it can influence the ability of the person to effectively predict events or to accurately authenticate expectations.

A) Faithful representation
B) Relevance of information
C) Usefulness for decision
D) Complete representation

Question 61

In __________, the organization will account for revenue in the period it was realized even though it was not paid for yet.

A) financial accounting
B) managerial accounting
C) accrual accounting
D) cash basis

Question 62

The budget cycle is generally related to __________ of a company.

A) a calendar year
B) a quarterly period
C) a fiscal year
D) a monthly period

Question 63

All of the following are examples of misdirected claims, except:

A) A claim form was sent via paper or electronic transmission to the wrong carrier.
B) A local carrier received a CMS-1500 claim form that should have gone to a DME MAC for payment.
C) A local carrier received a CMS-1500 for processing that covered a Part-B MAC, and the claim was returned because it couldn't be processed.
D) A local carrier for DME MAC received a claim for a beneficiary in its jurisdiction.

Question 64

Skilled Nursing Facilities (SNF):

A) may not request and accept payment for a Part A deductible and coinsurance amount on or after the day to which it applies.
B) may request and accept payment for a Part B deductible and coinsurance amount at the time of or after the provision of the service to which it applies.
C) may request or accept advance payment of Medicare deductible and coinsurance amounts.
D) None of these is correct.

Question 65

After January 1, 2011, a hospice physician or hospice nurse practitioner must have a __________ each hospice patient prior to the beginning of the third benefit period and prior to each subsequent benefit period.

A) face-to-face encounter with
B) telephone consult with
C) completed patient questionnaire from
D) None of these is correct.

Question 66

The characteristics of the Medicare Advantage plans are local coordinated plans, including:

A) HMOs.
B) PPOs.
C) PSOs.
D) RPPOs.
E) All of these are correct.

Question 67

The PPACA is designed to put __________ in complete control of their health care.

A) business owners
B) the government
C) individuals
D) both business owners and individuals
E) None of these is correct.

Question 68

The PPACA provides for __________ for the staff members of the nursing home that will ultimately improve quality and help to reduce costs.

A) better coverage
B) more staffing
C) better pay
D) enhanced training

Question 69

__________ are considered a closed panel where the physicians are not permitted to treat other managed care patients outside the contracted managed care plan.

A) Group Model HMOs
B) Independent Practice Associations
C) Network Model HMOs
D) Preferred Provider Organizations
E) Exclusive Provider Organizations

Question 70

The __________ is similar to the HMO plans in that the subscriber must select a physician to be the Primary Care Physician (PCP) for the patient.

A) PPO
B) POS
C) EPO
D) IDS

Question 71

__________ offers certification programs that are a subset of the accreditation product that it offers; these programs focus on the organizations that provide a specialty or a more specific line of care and not the comprehensive programs that other organizations provide.

A) NCQA
B) ACO
C) MBO
D) JCAHO

Question 72

A(n) __________ is an MA plan that provides coverage that a) does not place the provider at risk, b) does not have rates that vary based on utilization, and c) does not restrict enrollees' choices of providers that are authorized to provide services and accept the plan's payment terms and conditions.

A) Employer Group Health Plan
B) Private Fee-for-Service Plan
C) Medicare Medical Savings Account Plan
D) Religious Fraternal Benefit Plan

Question 73

Payment Status Indicator __________ is used for a significant procedure that is not discounted when multiple procedures are performed.

A) H
B) G
C) R
D) S
E) T

Question 74

Payment Status Indicator __________ is used for a significant procedure with multiple reductions that apply.

A) H
B) G
C) R
D) S
E) T

Question 75

Payment Status Indicator __________ is used for medical visits.

A) N
B) S
C) T
D) V
E) X

Question 76

Payment Status Indicator __________ is used for ancillary services.

A) N
B) S
C) T
D) V
E) X

Question 77

__________ software determines the appropriate case-mix group for payment of an HH PPS 60-day episode from the results of an OASIS submission for a patient.

A) Case-mix
B) Scrubber
C) Grouper
D) Encoder

Question 78

All entries in a medical record __________ for the facility to properly code the record.

A) must be typewritten
B) must contain sufficient information
C) must be illegible
D) can be in any order
E) All of these are correct.

Question 79

Authentication of medical record entries may include:

A) written signatures.
B) initials.
C) a computer key.
D) All of these are correct.
E) None of these is correct.

Question 80

The __________ health record consists of a conventional or traditional method of maintaining paper-based health records. In this method, health records are organized according to the source or originating department that provided the service to the patient.

A) integrated
B) source-oriented
C) paper
D) problem-oriented
E) None of these is correct.