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Chapter 3 Introduction To Revenue Management Questions And Answers Most Reviewed Version., Quizzes of Financial Management

Aston UniversityFinancial Management

Chapter 3 Introduction To Revenue Management Questions And Answers Most Reviewed Version. A method of controlling health care costs by reviewing the necessity of care, length of stay, and discharge planning is called a. utilization review b. preadmission certification c. quality assurance d. accreditation - utilization review A nonparticipating provider: a. is eligible to receive health care benefits b. pays the bill for health care services c. contracts with the insurance plan d. does not contract with the insurance plan - does not contract with the insurance plan A participating provider (PAR): a. does not contract with the insurance plan b. is not allowed to bill patients for the difference between the contracted rate and their normal fee c. may bill patients for the difference between the contracted rate and their normal fee d. is responsible for paying health care fees. is not allowed to bill patients for the difference between the contracted rate and their normal fee.

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Chapter 3 Introduction To Revenue Management Questions And
Answers Most Reviewed Version.
A method of controlling health care costs by reviewing the necessity of care, length of stay, and
discharge planning is called
a. utilization review
b. preadmission certification
c. quality assurance
d. accreditation - ansa. utilization review
A nonparticipating provider:
a. is eligible to receive health care benefits
b. pays the bill for health care services
c. contracts with the insurance plan
d. does not contract with the insurance plan - ansd. does not contract with the insurance plan
A participating provider (PAR):
a. does not contract with the insurance plan
b. is not allowed to bill patients for the difference between the contracted rate and their normal
fee
c. may bill patients for the difference between the contracted rate and their normal fee
d. is responsible for paying health care fees. - ansb. is not allowed to bill patients for the
difference between the contracted rate and their normal fee.
A provider who accepts assignment
a. does not contract with the health insurance plan
b. accepts full payment of a claim as determined by the payer
c. agrees to be responsible for paying health care fees
d. remains eligible to receive health care benefits - ansb. accepts full payment of a claim as
determined by the payer.
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Answers Most Reviewed Version.

A method of controlling health care costs by reviewing the necessity of care, length of stay, and discharge planning is called a. utilization review b. preadmission certification c. quality assurance d. accreditation - ansa. utilization review A nonparticipating provider: a. is eligible to receive health care benefits b. pays the bill for health care services c. contracts with the insurance plan d. does not contract with the insurance plan - ansd. does not contract with the insurance plan A participating provider (PAR): a. does not contract with the insurance plan b. is not allowed to bill patients for the difference between the contracted rate and their normal fee c. may bill patients for the difference between the contracted rate and their normal fee d. is responsible for paying health care fees. - ansb. is not allowed to bill patients for the difference between the contracted rate and their normal fee. A provider who accepts assignment a. does not contract with the health insurance plan b. accepts full payment of a claim as determined by the payer c. agrees to be responsible for paying health care fees d. remains eligible to receive health care benefits - ansb. accepts full payment of a claim as determined by the payer.

Answers Most Reviewed Version.

A revenue code consists of a. four digits and indicates the location or type of service provided to an institutional patient b. five digits and describes procedures or services provided in an outpatient setting c. two digits and provides additional information regarding the product or service reported d. one digit and is used to verify the validity of a unique identifier - ansa. four digits and indicates the location or type of service provided to an institutional patient. A review by health plans to grant prior approval for reimbursement of health care services is called a. preauthorization b. concurrent review c. discharge planning d. preadmission review - ansa. preauthorization Arranging appropriate health care services for the patient after hospital admission is referred to as a. concurrent review b. case management c. retrospective review d.. discharge planning - ansd. discharge planning Development of patient care plans for the coordination and provision of care for complicated cases is a part of a. case management b. discharge plannin c. preadmission certification d. utilization review - ansa. case management

Answers Most Reviewed Version.

b. birthday of the dependent child c. coinsurance amount d. primary and secondary policyholders - ansd. primary and secondary policyholders. The CMS-1500 claim is submitted for reimbursement of a. hospital inpatient stays b. physician office procedures and services c. nursing facility care d. outpatient surgery - ansb. physician office procedures and services The day sheet is also called a(n) a. patient ledger b. patient account record c. accounts receivable aging report d. manual daily accounts receivable journal - ansd. manual daily accounts receivable journal. The patient account record (or patient ledger) is a(n) a. chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day b. permanent computerized record of all financial transactions between the patient and the practice c. abstract of all recent claims filed on each patient d. financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter - ansb. permanent computerized record of all financial transactions between the patient and the practice. The patient or insured authorizes the payer to reimburse the provider directly through a. electronic funds transfer

Answers Most Reviewed Version.

b. electronic data interchange c. explanation of benefits d. assignment of benefits - ansd. assignment of benefits. The person responsible for paying the bill for health care services is the a. nonPAR b. PAR c. beneficiary d. guarantor - ansd. guarantor. The primary insurance is a. in the mother's name for the child b. always determined by third-party administrators c. based on the later birth date of the parent d. responsible for paying the health insurance claim first - ansd. responsible for paying the health insurance claim first. The review of the medical necessity of tests and procedures ordered during an inpatient hospitalization is called a. preadmission certification b. discharge planning c. utilization review d. concurrent review - ansd. concurrent review. What report identifies claims that are not finalized due to coding or billing delays? a. claim rejections b. claim denials

Answers Most Reviewed Version.

Which of these is a provision of group health insurance policies intended to keep multiple insurers from paying benefits covered by other policies? a. Accepting the assignment b. Claims adjudication c. Coordination of benefits d. Electronic data interchange - ansc. Coordination of benefits Which of these is a review of the appropriateness and necessity of care provided to patients prior to the administration of care a. preadmission certification b. utilization review c. second surgical opinion d. prospective review - ansd. prospective review Which of these is the financial record source document used by health care providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter? a. CMS- b. Encounter form c. Day sheet d. UB-04 - ansb. Encounter form Which of these is the process of collecting appropriate reimbursement for services rendered? a. accounts receiveable management b. clearinghouse c. claims submission d. electronic data interchange - ansa. Accounts receivable management

Answers Most Reviewed Version.

Why is the "insurance verification and eligibility" function of accounts receivable management important? a. it confirms the patient's insurance plan and eligibility information wiht the third-party payer to determine the patient's financial responsibility for services rendered b. it allows for account follow-up and payment resolution by reviewing remittance advice documents and contacting payers to resolve claims c. It facilitates patient and family counseling about insurance and payment issues, which includes advising patients and families about insurance benefits d. it involves capturing charges and posting payments by entering charges for services and procedures in the medical practice management's billing system. - ansa. It confirms the patient's insurance plan and eligibility information with the third-party payer to determine the patient's financial responsibility for services rendered.