The Skilled Nursing Facility Prospective Payment System (SNF PPS) was implemented to cover all costs (routine, ancillary, and capital) related to services furnished to Medicare Part A beneficiaries. SNF PPS generates per diem payments for each admission. These payments are case-mix adjusted using a resident classification system called __________.
a. diagnosis-related groups
b. minimum data set
c. outcomes and assessment information set
d. resource utilization groups
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Q. 2) The State Children's Health Insurance Program (SCHIP) was established to provide health assistance to uninsured, low-income children, either through separate programs or through expanded eligibility under state __________ programs.
a. CHAMPUS
b. CHAMPVA
c. Medicaid
d. Medicare
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Q. 3) Which act governs privacy, security, and electronic transactions standards for health care information and was implemented to provide better access to health insurance, limit fraud and abuse, and reduce administrative costs?
a. BBA
b. HIPAA
c. MMA
d. TEFRA
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Q. 4) The National Correct Coding Initiative (NCCI) was created to promote national correct coding
methodologies and to eliminate __________ coding.
a. credentialed
b. improper
c. outdated
d. provider
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Q. 5) The Resource-Based Relative Value Scale (RBRVS) system reimburses physicians' practice expenses using a __________.
a. fee schedule
b. guaranteed issue method
c. prospective payment system
d. usual and reasonable payment basis
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Q. 6) CPT includes a section called Evaluation and Management (E/M), which describes patient encounters with providers for the purpose of the evaluation and management of __________.
a. general health status
b. lifetime insurance benefits
c. preadmission testing
d. surgical procedures
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Q. 7) Clinical Laboratory Improvement Act (CLIA) legislation established __________ for all
laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test was performed.
a. advance directives
b. case management
c. plan administration
d. quality standards
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Q. 8) The CHAMPUS Reform Initiative (CRI) of 1988 resulted in a new program called TRICARE, which includes __________.
a. certificates of insurance
b. group health insurance
c. health care marketplaces
d. multiple options
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Q. 9) Which act allows employees to continue health care coverage beyond the benefit termination date?
a. Consolidated Omnibus Budget Reconciliation Act of 1985
b. Health Insurance Portability and Accountability Act of 1996
c. Omnibus Budget Reconciliation Act of 1981
d. Tax Equity and Fiscal Responsibility Act of 1982
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Q. 10) Medicare requires providers to submit the __________ claim for payment of outpatient and office services.
a. CMS-1450
b. CMS-1500
c. UB-02
d. UB-04
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