Which is considered a financial source document from which an insurance claim is generated?
a. CMS-1500 claim
b. encounter form
c. ledger card
d. patient record
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Q. 2) The best example of point-of-care service and documentation is
A. using an automated tracking system to locate a record.
B. using occurrence screens to identify adverse events.
C. doctors using voice recognition systems to dictate radiology reports.
D. nurses using bedside terminals to record vital signs.
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Q. 3) Providers have the option of arranging for __________, which means that payers deposit reimbursement for health care services to the provider's account electronically.
a. electronic data interchange
b. electronic flat file formats
c. electronic funds transfer
d. electronic media claims
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Q. 4) You have been asked by a peer review committee to print a list of the medical record numbers of
all patients who had CABGs performed in the past year at your acute care hospital. Which
secondary data source could be used to quickly gather this information?
A. disease index C. master patient index
B. physician index D. operation index
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Q. 5) Medicare calls its remittance advice a(n) __________.
a. explanation of benefits
b. electronic remittance advice
c. Medicare summary notice
d. provider remittance notice
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Q. 6) Using the SOAP method of recording progress notes, which entry would most likely include a
differential diagnosis?
A. assessment
B. plan
C. subjective
D. objective
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Q. 7) A remittance advice submitted to the provider electronically is called an electronic remittance advice (ERA), and __________.
a. different information is included as compared with a paper-based remittance advice
b. it contains identical information to the information on a paper-based remittance advice
c. payers are required to increase the amount of reimbursement paid to the provider
d. similar information is included in the exact format as a paper-based remittance advice
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Q. 8) In quality review activities, departments are directed to focus on clinical processes that are
A. high volume.
B. high risk.
C. problem prone.
D. All answers apply.
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Q. 9) The patient underwent office surgery on March 18, and the third-party payer determined the allowed charge to be 1,480 . The patient paid the 20 percent coinsurance at the time of the office surgery. The physician and patient each received a check for 1,184, and the patient signed her check over to the physician. The overpayment was __________, and the physician must reimburse the third-party payer.
a. 296
b. 1,184
c. 1,480
d. 2,368
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Q. 10) As part of Joint Commission's National Patient Safety Goal initiative, acute care hospitals are now
required to use a preoperative verification process to confirm the patient's true identity and to
confirm that necessary documents such as x-rays or medical records are available. They must also
develop and use a process for
A. including the primary caregiver in surgery consults.
B. including the surgeon in the preanesthesia assessment.
C. marking the surgical site.
D. apprising the patient of all complications that might occur.
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