Deck 22: Business of Advanced Practice

Question 1

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

A)Malpractice claims
B)Conflict of interest claims
C)Health Insurance Portability and Accountability Act violations
D)Occupational Safety and Health Administration violations

Answer 1

Conflict of interest claims

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?

A)List of practice limitations as an APN
B)Standard hourly rate as office staff
C)Expectation for net revenue generation
D)Standard benefit package offered to office staff

Answer 2

Expectation for net revenue generation

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?

A)Request that the physician act as an APRN spokesperson.
B)Increase articles in nursing professional journals about the APRN role.
C)Personally seek out the news media to communicate their value.
D)Rely on patients to communicate their benefits to neighbors..

Answer 3

Personally seek out the news media to communicate their value.

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?

A)Audits and probes
B)Add-on codes
C)Modifier codes
D)HAC guidelines

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:

A)Billing within 15 days of services
B)Beneficiary verification of patient
C)Timely processing of denials
D)Identifying payment below contract rate

Question 6

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

A)Many patients do not understand policy benefits and payment responsibility.
B)Services may change across the beneficiary year.
C)Copayments and deductibles may have already been met by the patient.
D)Coding may need to be adjusted to meet the terms of the patient's benefits.

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:

A)5 to 15 million
B)15 to 35 million
C)20 million to 30 million
D)30 million to 40 million

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?

A)Allows CMS to audit all medical practices' performance
B)Standardizes the billing rules for all clinicians
C)Reduces the duplication of services noted in the current system
D)Reduces costs related to multiple billing systems

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?

A)Offer additional benefits
B)Offer lower copayments
C)Follow Medicare benefit rules
D)Follow the Commercial Carriers rules

Question 10

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

A)Preventing illness
B)Screening for disease
C)Educating the public
D)Reducing health-care spending

Question 11

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

A)Net income statement
B)Balance sheet
C)Cash flow statement
D)Operating statement

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:

A)Consumer assistance programs
B)Preventative care options standardized
C)Young adult coverage (under 26 years)
D)Elimination of lifetime limits

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?

A)Clinician education loans
B)Clinician practice liability and malpractice expense
C)Clinician reported cost reduction efforts
D)Clinician volume of patients treated

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?

A)Health-care screening
B)Health-care education
C)Pharmaceutical coverage
D)Durable medical equipment coverage

Question 15

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

A)To monitor monthly actual expense to budgeted expense
B)To reduce the likelihood of litigation action
C)To identify the marketing needed to grow the APRN practice
D)To assure accreditation standards are met