Question 1

All health-care practices should develop a compliance plan.Compliance plans offer practice safeguards that prevent which of the following?

Accepted Answer

B

Question 2

Each state has criteria defining the level of collaboration required between the APRN and an oversight physician.Which is among the questions an APRN should seek when selecting a practice setting?

Accepted Answer

C

Question 3

Despite the growth in the numbers of advanced practice registered nurses (APRNs) over the last decades, the role of the profession is often not understood by the public.What actions should APRNs undertake to market their services to the public?

Accepted Answer

APRNs should personally seek out the news media to communicate their value. They can do this by offering to speak on radio shows, podcasts, or television segments, or by writing articles for local newspapers or online publications. By taking an active role in marketing their services and educating the public about their role, APRNs can increase awareness and understanding of their profession. The other options may not be as effective in reaching the general public or may not adequately address the lack of understanding about APRN roles.

Question 4

Clinicians who learn how to code and document Evaluation and Management and clinician services will be more successful in gaining timely payment for care delivery.Which of the following CMS practices is designed to financially penalize clinicians who do not bill according to CMS guidelines?

Accepted Answer

Audits and probes are CMS practices designed to financially penalize clinicians who do not bill according to CMS guidelines. Audits involve a review of a provider's claims to ensure compliance with regulations, while probes are targeted reviews of specific claims or services. Both can result in financial penalties for providers who are found to be non-compliant with CMS guidelines. Add-on codes, modifier codes, and HAC guidelines do not involve financial penalties.

Question 5

Maintaining optimum cash flow is a basic fundamental concept in all businesses.Cash flow is impacted at the initial request for appointment and is affected by practices that include:

Accepted Answer

The answer of Maintaining optimum cash flow is a basic...

Question 6

Patients require insurance counseling prior to accessing health-care services for the following reason:

Accepted Answer

Patients may not understand the complex language of insurance policies and their coverage, and may not comprehend their own financial responsibility for services received. Counselors can help them understand their coverage options and how to navigate the health-care system.

Question 7

With the growing shortage of primary care physicians, the demand for advanced practice registered nurses (APRNs) will increase between 2014 and 2016 from:

Accepted Answer

According to the American Association of Nurse Practitioners, the demand for APRNs is expected to grow from 15 to 35 million between 2014 and 2024 due to the shortage of primary care physicians.

Question 8

Beginning in 2014, all medical practices will be required by the CMS to adopt a certified electronic medical record software system for documenting and billing for medical services.What is a primary reason for this implementation mandate?

Accepted Answer

The primary reason for the mandate to adopt certified electronic medical record software systems is to reduce the duplication of services, which is a significant issue in the current system. This implementation aims to improve efficiency and patient care by ensuring that medical records are easily accessible and can be shared among healthcare providers, thus avoiding unnecessary repeat tests or procedures.

Question 9

Medicare advantage plans, also called Medicare HMO Plans, are plans approved by the Centers for Medicare and Medicaid Services (CMS) as alternative carriers for Medicare beneficiaries.Which of the following is not a characteristic of these plans?

Accepted Answer

The answer of Medicare advantage plans, also called Medicare HMO...

Question 10

Identify the primary challenge for insurance carriers in today's health delivery model.

Accepted Answer

The primary challenge for insurance carriers in today's health delivery model is reducing health-care spending. With rising healthcare costs, insurance carriers must find ways to control spending while still providing quality healthcare coverage to their beneficiaries. This requires aligning financial incentives with providers, promoting preventive care and early interventions, and improving care coordination to avoid duplication or waste of services. Failure to address this challenge could result in higher premiums, reduced coverage, or restricted access to care.

Question 11

Accounting keeps track of the financial state of a business.The accounting report that demonstrates the growth in assets is:

Accepted Answer

The answer of Accounting keeps track of the financial state...

Question 12

Health-care billing is a significant reason for bankruptcy in the United States.The following provision of the Affordable Care Act (ACA) legislation was included to reduce this from occurring with insured patients:

Accepted Answer

The elimination of lifetime limits ensures that patients with chronic illnesses requiring long-term care do not reach their insurance limits and then have to pay out-of-pocket for the rest of their care. This reduces the risk of high medical bills and bankruptcy for insured patients.

Question 13

Current procedural terminology (CPT) coding offers the uniformed language used for reporting medical services and procedures performed by physician and nonphysician practitioners.Clinicians are paid based on calculated resource costs that, in turn, are based on practice components.Which of the following is a part of the components used to calculate the per CPT code payment rate?

Accepted Answer

The components used to calculate the per CPT code payment rate include the clinician practice liability and malpractice expense, among other factors. This reflects the costs associated with maintaining a practice, including insurance against malpractice.

Question 14

Medicare benefits were offered to U.S.beneficiaries beginning in 1965.What was the service added with the Medicare D plan in 2006?

Accepted Answer

The Medicare D plan was added in 2006 to provide pharmaceutical coverage to Medicare beneficiaries. This plan helps cover the cost of prescription drugs and is optional for beneficiaries to enroll in.

Question 15

Identify one of the primary reasons for an APRN to develop a business plan?

Accepted Answer

Developing a business plan can help an APRN identify the specific marketing needed to grow their practice. A business plan can help an APRN to define their target patient population, outline their unique selling proposition, and create a plan for reaching and acquiring new patients. Monitoring expenses and meeting accreditation standards are also important considerations, but they are not the primary reasons for developing a business plan.

Quiz 22: Business of Advanced Practice