CPAT Aaham Final Practice Exam
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Practice Exam
- 1._____________ is defined as the period in time when a person is qualified for healthcare services covered by the insurance plan or entity (third party payer).
- A.
Pre-certification.
- B.
Benefit level.
- C.
Eligibility period.
- D.
Authorization.
- 2.It is through the verification process we confirm the accuracy and completeness of key:
- A.
Demographic, encounter, and family information.
- B.
Encounter, payer, and demographic information.
- C.
Payer, encounter, and geographic information.
- D.
Demographic, insurance, and physician information.
- 3.____________ is to attest as meeting a standard of care prior to service.
- A.
Pre-certification.
- B.
Benefit level.
- C.
Eligibility period.
- D.
Referral
- 4.The key patient demographic information we gather at intake to identify if the Patient has previously been at the hospital includes:
- A.
Social security number, date of birth, gender, and address.
- B.
Name, date of birth, driver's license, and gender.
- C.
Date of birth, name, social security number, and gender.
- D.
Name, address, date of birth, and gender.
- 5._____________ is to give official approval or permission for the service.
- A.
Pre-certification.
- B.
Benefit level.
- C.
Eligibility period.
- D.
Authorization
- 6._____________ is defined as the service the third party payer will pay, based on the Patient's coverage plan.
- A.
Pre-certification.
- B.
Benefit level.
- C.
Eligibility period.
- D.
Referral.
- 7.Necessary data needed to make an effective collection call include all of the following except:
- A.
Date of birth
- B.
Date of service
- C.
Insurance information
- D.
Patient’s address
- 8.Common stalls and delays include all of the following except:
- A.
Pre-existing conditions
- B.
Stop loss issues
- C.
Authorization not completed or on file
- D.
Incorrect patient phone number
- 9.Work lists to assist in third party follow up include all of the following except:
- A.
Physical bill form, ie UB04
- B.
Superbill
- C.
Paper aged trial balance
- D.
Automated collection work list
- 10.All of the following are advantages of a Courtesy Discharge except:
- A.
Reduces accounts receivables
- B.
Allows for greater accuracy in billing
- C.
Improves traffic flow
- D.
Improves patient-hospital relations
- 11.What is an uncollectable account resulting from the extension of credit?
- A.
Tort liability
- B.
Lien
- C.
Bad debt
- D.
Judgment
- 12.What is a legally verified claim against a debtor?
- A.
Tort liability
- B.
Lien
- C.
Bad debt
- D.
Judgment
- 13.What is a liability for an injury or wrongdoing done by one person to another resulting from a breach of legal duty?
- A.
Tort liability
- B.
Lien
- C.
Bad debt
- D.
Judgment
- 14.What is a recorded claim against real or personal property, generally arising out of a debt?
- A.
Tort Liability
- B.
Lien
- C.
Bad debt
- D.
Judgment
- 15.Problems with electronic billing include all of the following except:
- A.
Creates challenges
- B.
Less paper
- C.
Vendor reporting is inflexible and/or not available
- D.
Upload / download issues
- 16.Elements of a chargemaster include all of the following except:
- A.
Modifiers
- B.
Revenue codes
- C.
ICD-9 codes
- D.
CPT/HCPCS codes
- 17.In a divorce or separation which plan is primary?
- A.
Father
- B.
The parent who has custody
- C.
Mother
- D.
The parent that presented the child for treatment
- 18.What is a written authorization, signed by the policyholder to an insurance company, to pay benefits directly to the hospital?
- A.
Assignment of Benefits
- B.
Medicare Secondary Payer
- C.
Conditional Payments
- D.
Medicare Administrative Contractor
- 19.A system generated free-form statement that is used to communicate the status of a patient’s account:
- A.
Data Mailer
- B.
Superbill
- C.
Itemized Statement
- D.
Both B and C
- 20.SNF days 21 through 100:
- A.
$125 per day
- B.
$127.50 per day
- C.
$148.00 per day
- D.
$150.00 per day
- 21.The Medicare Part A Lifetime Reserve 91 through 150 days:
- A.
$275 per day
- B.
$350 per day
- C.
$592 per day
- D.
$1100 per spell of illness
- 22.The Medicare Part A deductible for days 1 through 60 is:
- A.
$1000
- B.
$1184
- C.
$1200
- D.
$1500
- 23.A clean claim is one which:
- A.
If investigated does not require contact with the provider
- B.
Will pass all front end edits
- C.
Is processed electronically
- D.
All of the above
- 24.The first digit in the type of bill indicates:
- A.
Frequency
- B.
Type of facility
- C.
Bill Classification
- D.
None of the above
- 25.ICD-9 codes are used to identify:
- A.
Procedures
- B.
Diagnosis
- C.
Supplies
- D.
Office visits
- 26.Medicare supports the electronic health record for which reason(s):
- A.
Lowers the chances of medical errors
- B.
Provider and organizations will have the same knowledge about a patients medical condition
- C.
Improve over all quality of patient care
- D.
All of the above
- 27.RBRVS is the acronym for:
- A.
Resource based relative value system
- B.
Resource based related value system
- C.
Resource based related value scale
- D.
Resource based relative value scale
- 28.A _____________ is to send or direct for treatment, aid, information, or decision. Some third party payers utilize this process to monitor and manage patient care.
- A.
Pre-certification.
- B.
Benefit level.
- C.
Eligibility period.
- D.
Referral.
- 29.The purpose of this act is to protect consumers from inaccurate or unfair practices by issuers of open-ended credit.
- A.
Fair and Accurate Credit Transaction Act
- B.
Fair Credit Billing Act
- C.
Fair Credit Reporting Act
- D.
Truth in Lending Act
- 30.This act requires creditors to inform debtors of their rights and responsibilities under the act.
- A.
Fair and Accurate Credit Transaction Act
- B.
Fair Credit Billing Act
- C.
Fair Credit Reporting Act
- D.
Truth in Lending Act
- 31.Patient accounts that occur after the petition and/or were not included in the notification will be subject to the discharge.
- A.
True
- B.
False
- 32.A Bankruptcy notice that releases the guarantor/patient from financial responsibility of any and all account balances listed on the bankruptcy petition is called:
- A.
Dismissal
- B.
Bankruptcy Notice
- C.
Discharge of Debtor
- D.
Chapter 7
- 33.A debtor can be placed in involuntary bankruptcy under chapter 7 or 11 if the debtor has:
- A.
10 or more creditor, three of which have claims in excess of $2500 each
- B.
12 or more creditors, three of which have claims in excess of $5000 each
- C.
15 or more creditors, five of which have claims in excess of $10,000 each
- D.
20 or more creditor, ten of which have claims in excess of $15,000 each
- 34.Under chapter 13, how long is a debtor permitted to repay creditors?
- A.
1 year
- B.
2 years
- C.
3 years
- D.
5 years
- 35.Under chapter 13, in no case may a plan provide for payments over a period of longer than:
- A.
1 year
- B.
2 years
- C.
3 years
- D.
5 years
- 36.How long does a business have to initially draft a repayment plan:
- A.
1 month
- B.
3 months
- C.
6 months
- D.
1 year
- 37.70% of all bankruptcies are filed under this chapter:
- A.
Chapter 7
- B.
Chapter 11
- C.
Chapter 12
- D.
Chapter 13
- 38.Elements of a chargemaster include all of the following except:
- A.
Modifiers
- B.
Revenue codes
- C.
ICD-9-codes
- D.
CPT/HCPCS codes
- 39.The assignment of benefits is usually acquired at what time:
- A.
Discharge
- B.
Admission
- C.
After surgery
- D.
None of the above
- 40.The medicare Part B annual deductible is:
- A.
$147.00
- B.
$155.00
- C.
$120.00
- D.
Free for STUDS Like Eric
- 41.Under this act a patient has 60 days after a statement to notify the hospital of any errors. and the hospital has 30 days to respond to the complaint.
- A.
Fair Credit Reporting Act
- B.
Fair Credit Billing Act
- C.
Truth in Lending Act
- D.
Chocolate Honey Buns are the Best
- 42.The Fair Debt Collections Act is also known as (which title):
- A.
Title I
- B.
Fair Credit Reporting Act
- C.
Title VI
- D.
Title VIII
- 43.This act imposed strict limitations on communications with consumers for call times, harassment and false or misleading info.
- A.
Fair Debt Collections Act
- B.
Truth in Lending Act
- C.
Fair Credit Reporting Act
- D.
Fair Credit Billing Act
- 44.This legislation creates federal standards for insurers, HMOs, and employer plans including those who are also self insured.
- A.
The Hill-Burton Act
- B.
False Claims Act
- C.
HIPAA
- D.
Food and Drug Administration
- 45.Fraud and abuse Initiatives are enforced by who:
- A.
Department of Justice
- B.
Office of Inspector General
- C.
Kenny Koerner
- D.
Answers A and B
- 46.CMS was formerly known as what?
- A.
HCFA (Health Care Financing Administration)
- B.
Centers for Disease Control and Prevention (CDC)
- C.
Food and Drug Administration (FDA)
- D.
Indian Health Services (IHS)
- 47.Medicare is which title:
- A.
Title XVIII (title 18)
- B.
Title I (title 1)
- C.
Title VI (title 6)
- D.
Title XIX (title 19)
- 48.The intentional or illegal deception or misrepresentation made for the purpose of personal gain is called:
- A.
Abuse
- B.
Fraud
- C.
Living Will
- D.
None of the Above
- 49.Total # of patient days/ total number of discharges is the equation for which:
- A.
Average Daily Census
- B.
Percentage of Occupancy
- C.
Average Length of Stay
- D.
Midnight Census
- 50.For Medicare Part B patients, a mammogram screening is covered:
- A.
Twice Every 12 Months
- B.
Once every 24 Months
- C.
Never
- D.
Once Every 12 Months
- 51.For Medicare Part B patients, a pap smear and pelvic examination is covered:
- A.
Once Every 24 Months
- B.
Once Every 12 Months if at risk for vaginal cancer
- C.
Monthly
- D.
Both answers A and B
- 52.________ is a health insurance sold by private insurance companies to fill in the "gaps" in coverage (like deductibles, coinsurance, and copayments) under the Original Medicare Plan. Also known as a Medicare Supplemental Plan
- A.
Medicaid
- B.
Worker's Compensation
- C.
TRICARE
- D.
Medigap
- 53.This level of HCPCS consists of CPT codes:
- A.
Level 3
- B.
Level 6
- C.
Level 1
- D.
Level 2
- 54.Hospital Inpatient Admit through Discharge:
- A.
131
- B.
134
- C.
111
- D.
110
- 55.This code identifies the specific date defining a significant event relating to the bill that may affect payment processing
- A.
Condition Code
- B.
Value Code
- C.
Revenue Code
- D.
Occurence Code
- 56.UPIN stands for:
- A.
Unique Physician Identification Number
- B.
Universal Physician Identification Number
- C.
Unique Provider Identification Number
- D.
Unique Provide Identification Number
- 57.This code identifies the condition(s) relating to the bill that may affect payer processing.
- A.
Revenue Code
- B.
Condition Code
- C.
Occurence Code
- D.
Value Code
- 58._____ examines a record for the correct use of ICD-9-CM codes
- A.
Clinical Edits
- B.
Code Edits
- C.
Coverage Edits
- D.
Charlie Sheen
- 59.Which part of Mediare pays for Outpatient Services?
- A.
Part B
- B.
Part A
- C.
Part C
- D.
Part D
- 60.A skip caused by clerical error at the time of registration is a(n):
- A.
Unintentional Skip
- B.
Intentional Skip
- C.
False skip
- D.
All of the Above
- 61.
- A.
$96.40 per month
- B.
$108.00 per month
- C.
Whatever you feel like paying
- D.
$104.90 per month
- 62.
- A.
Consistent with the symptoms or diagnosis
- B.
Not furnished primarily for the convenience of the patient
- C.
Ordered by the physician
- D.
Medically necessary
- 63.Reimbursement based on a set rate per day in the hospital regardless of any actual charges or cost incurred:
- A.
Fee schedule
- B.
Capitation
- C.
Per diem
- D.
Fee for service
- 64.For Medicare beneficiary, the outpatient observation limit is:
- A.
24 hours
- B.
48 hours
- C.
72 hours
- D.
96 hours
- 65.CLIA is the acronym for:
- A.
Clinical laboratory Improvement Act
- B.
Clinical Laboratory Improvement Assessment
- C.
Clinical Laboratory Improvement Amendment
- D.
Clerical Laboratory Improvement Act
- 66.If the HICN ends with a C, this would indicate the cardholder is:
- A.
Husband
- B.
Non-wage earner
- C.
Wife
- D.
Child
- 67.If the HICN ends with a B, this would indicate the cardholder:
- A.
Husband
- B.
Non-wage earner
- C.
Wife
- D.
Child
- 68.Medicare Part B covers all of the following except:
- A.
Eye Exam
- B.
Mammograms
- C.
Glaucoma Screening
- D.
Pneumonia Vaccinations
- 69.In order to obtain Medigap coverage the beneficiary must have:
- A.
Part A only
- B.
Part B only
- C.
Parts A and B
- D.
Medicare/ Medicaid
- 70.Each HICN will include either ____ or ____ numeric digits:
- A.
5 or 8
- B.
6 or 9
- C.
4 or 9
- D.
1 or 100
- 71.Which are included in patient access' collection control points:
- A.
At discharge
- B.
Admission
- C.
In-House
- D.
All of the Above
- 72.One of the tasks of a ______ is to reduce unncessary admissions:
- A.
Referring Physician
- B.
Registered Nurse
- C.
Case Manager
- D.
Ordering Physician
- 73.Resource Utilization Groups are used to assess payment for which facilities:
- A.
Skilled Nursing Facility
- B.
Inpatient Hospital
- C.
Outpatient Hospital
- D.
Ambulatory Surgical Facility
- 74.How many days does CMS allow a hospital to file a subsequent inpatient DRG adjustment?
- A.
30 Days
- B.
45 Days
- C.
60 Days
- D.
90 Days
- 75.Assignment of a MS-DRG uses the following elements in order for correct selection except:
- A.
Principle diagnosis
- B.
Condition codes
- C.
Discharge Status
- D.
Surgical Procedure
- 76.How many major diagnostic categories are there?
- A.
25
- B.
50
- C.
745
- D.
500
- 77.The assignment of benefits is usually acquired at what time?
- A.
Discharge
- B.
Admission
- C.
After Surgery
- D.
None of the above
- 78.The Critical Hospital Access Program was created to assure Medicare benficiaries access to health care services in which areas:
- A.
Suburbs
- B.
Rural
- C.
Urban
- D.
All of the above
- 79.What is a payment made by Medicare where another payer is responsible for payment and the claim is not expected to be paid promptly:
- A.
Assignment of Benefits
- B.
Medicare Secondary Payer
- C.
Conditional Payments
- D.
Medicare Administrative Contractor
- 80.What is a written authorization, signed by the policyholder to an insurance company, to pay benefits directly to the hospital?
- A.
Assignment of Benefits
- B.
Medicare Secondary Payer
- C.
Conditional Payments
- D.
Medicare Administrative Contractor
- 81.A claim that contains complete and necessary information but the information is illogical or incorrect is:
- A.
Clean claim
- B.
Incomplete claim
- C.
Invalid claim
- D.
None of the above
- 82.A UB04 code that identifies a specific accommodation, ancillary service or billing calculation:
- A.
Condition code
- B.
Occurrence code
- C.
Value code
- D.
Revenue code
- 83.A UB04 code used to identify values of monetary nature:
- A.
Condition code
- B.
Occurrence code
- C.
Value code
- D.
Revenue code
- 84.A UB04 code used which identifies the specific date defining a significant event relating to the bill that my affect payment processing:
- A.
Condition code
- B.
Occurrence code
- C.
Value code
- 85.The UB-04 contains how many data elements?
- A.
78
- B.
81
- C.
92
- 86.Level II HCPCS codes are used to identify all of the following except:
- A.
Product
- B.
Office Visits
- C.
Supplies
- D.
DME
- 87.The standard code set adopted by HIPAA EDI include all of the following except:
- A.
CPT-4
- B.
RBRVS
- C.
CDT
- D.
ICD-9
- 88.The RBRVS contained which major elements:
- A.
Limits on the amount that a non-participating physician can charge benficiaries
- B.
Fee schedule for the payment of physician services
- C.
MVPS for the rates of increase in Medicare expenditures for physician services
- D.
All of the above
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