A pre-existing condition is any medical condition that was diagnosed and/or treated within a specified period of time __________ the enrollee's effective date of coverage.
a. after
b. before
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Q. 2) A key data item you would expect to find recorded on an ER record but would probably NOT see
in an acute care record is the
A. physical findings. C. time and means of arrival.
B. lab and diagnostic test results. D. instructions for follow-up care.
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Q. 3) An appeal is documented as a(n) __________ why a claim should be reconsidered for payment.
a. addendum to the patient record to justify
b. letter signed by the provider explaining
c. patient release of information form describing
d. resubmitted CMS-1500 insurance claim indicating
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Q. 4) When developing a data collection system, the most effective approach first considers
A. the end user's needs. C. hardware requirements.
B. applicable accreditation standards. D. facility preference.
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Q. 5) Which claims are organized by year and are generated for providers who do not accept assignment?
a. clean claims
b. closed claims
c. open claims
d. unassigned claims
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Q. 6) In an acute care hospital, a complete history and physical may not be required for a new
admission when
A. the patient is readmitted for a similar problem within 1 year.
B. the patient's stay is less than 24 hours.
C. the patient has an uneventful course in the hospital.
D. a legible copy of a recent H&P performed in the attending physician's office is available.
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Q. 7) Which claims are filed according to year and insurance company and include those for which all processing, including appeals, has been completed?
a. clean claims
b. closed claims
c. open claims
d. unassigned claims
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Q. 8) In determining your acute care facility's degree of compliance with prospective payment
requirements for Medicare, the best resource to reference for recent certification standards is the
A. CARF manual. C. Joint Commission accreditation manual.
B. hospital bylaws. D. Federal Register.
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Q. 9) Which claims are organized by month and insurance company after submission to the payer, but for which processing is not complete?
a. closed claims
b. clean claims
c. open claims
d. unassigned claims
(
Q. 10) Which of the following is a form or view that is typically seen in the health record of a long-term
care patient but is rarely seen in records of acute care patients?
A. pharmacy consultation C. physical exam
B. medical consultation D. emergency record
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