RHIT Revenue Cycle Management 4

Question 1

Under HIPAA, which transaction standard is used for electronic claim submission from providers to payers?

Accepted Answer

ASC X12 837

Answer

ASC X12 835

Answer

ASC X12 270/271

Answer

ASC X12 276/277

Question 2

A provider bills Medicare for a service not medically necessary per LCD criteria. What document should be given to the patient before the service?

Accepted Answer

Advance Beneficiary Notice (ABN)

Answer

Notice of Privacy Practices (NPP)

Answer

General Consent Form

Answer

Financial Hardship Waiver

Question 3

The term 'upcoding' in the context of revenue cycle compliance refers to:

Accepted Answer

Assigning a higher-level code than documented to increase reimbursement

Answer

Assigning a lower-level code than documented to reduce costs

Answer

Correcting a previously submitted claim

Answer

Adding a modifier to justify a service

Question 4

Which reimbursement methodology pays a fixed amount per member per month regardless of services utilized?

Accepted Answer

Capitation

Answer

Fee-for-service

Answer

Per diem reimbursement

Answer

Case rate

Question 5

Which present-on-admission (POA) indicator is assigned when the condition is present at the time of inpatient admission?

Accepted Answer

Y

Answer

N

Answer

U

Answer

W

Question 6

A claim is denied with reason code CO-4. This means:

Accepted Answer

The procedure code is inconsistent with the modifier

Answer

The claim was filed after the timely filing deadline

Answer

The service requires prior authorization

Answer

The claim is a duplicate

Question 7

Which federal law prohibits hospitals from refusing emergency treatment based on ability to pay or insurance status?

Accepted Answer

EMTALA

Answer

HIPAA

Answer

ACA

Answer

COBRA