#1
Which organization is responsible for creating the Healthcare Common Procedure Coding System (HCPCS)?
Centers for Disease Control and Prevention (CDC)
Centers for Medicare & Medicaid Services (CMS)
Food and Drug Administration (FDA)
American Medical Association (AMA)
#2
What is the primary purpose of the Diagnosis-Related Group (DRG) system?
To categorize patients based on their age
To classify patients based on their primary diagnosis and treatment procedures
To determine patient satisfaction levels
To allocate hospital funds
#3
Which entity is responsible for overseeing the implementation of the Health Insurance Portability and Accountability Act (HIPAA) in the United States?
Centers for Disease Control and Prevention (CDC)
Centers for Medicare & Medicaid Services (CMS)
Office for Civil Rights (OCR)
Food and Drug Administration (FDA)
#4
What does the term 'Explanation of Benefits (EOB)' refer to in healthcare billing?
A document detailing the diagnosis of a patient
A statement sent to the patient explaining services provided and payments made
A report of patient demographics
A summary of insurance policies
#5
What is a deductible in health insurance?
The total amount of money the insurance company will pay for a covered healthcare service
The fixed amount of money you pay out of pocket for covered healthcare services before your insurance plan starts to pay
The percentage of costs of a covered healthcare service you pay (20%, for example) after you've paid your deductible
The maximum amount of money you will have to pay out of pocket for covered healthcare services in a year
#6
Which government agency administers the Medicaid program in the United States?
Centers for Medicare & Medicaid Services (CMS)
Department of Health and Human Services (HHS)
Food and Drug Administration (FDA)
Social Security Administration (SSA)
#7
Which of the following is a characteristic of fee-for-service payment model in healthcare?
Providers receive a fixed payment regardless of the services provided
Providers are paid based on the number of services they deliver
Providers receive payments based on patient outcomes
Patients pay a fixed fee for their healthcare services
#8
What is the purpose of the International Classification of Diseases (ICD) coding system in healthcare?
To track patient demographics
To classify diseases and health problems
To determine healthcare reimbursement rates
To manage hospital facilities
#9
What is the purpose of the Centers for Medicare & Medicaid Services (CMS) 1500 claim form?
To request authorization for medical procedures
To submit claims for reimbursement to Medicare and Medicaid
To track patient appointments
To report patient demographics
#10
What role does the Current Procedural Terminology (CPT) coding system serve in healthcare billing?
To classify medical diagnoses
To track patient demographics
To report services and procedures provided to patients
To determine patient eligibility for insurance coverage
#11
What is a 'clean claim' in healthcare billing?
A claim that has been submitted electronically
A claim that has been processed by the insurance company
A claim that contains all required data elements and is processed without errors
A claim that has been paid in full by the patient
#12
What is the primary purpose of the National Provider Identifier (NPI) system?
To track patient medical history
To identify healthcare providers in standard transactions
To determine patient eligibility for insurance coverage
To report healthcare outcomes
#13
Under the prospective payment system (PPS), how are payments to healthcare providers determined?
Based on the provider's annual revenue
Based on the provider's location
Based on predetermined rates for specific services or conditions
Based on the number of patients served
#14
In value-based healthcare payment models, what is the primary focus of reimbursement?
The volume of services provided
The cost of healthcare procedures
The quality and outcomes of patient care
The complexity of medical diagnoses
#15
What is the primary role of the Office of Inspector General (OIG) in healthcare?
To regulate pharmaceutical companies
To investigate fraud and abuse in healthcare programs
To oversee medical licensing
To enforce healthcare privacy laws
#16
In healthcare reimbursement, what does the term 'bundled payment' refer to?
A single payment made to cover all services related to a specific condition or procedure
Payment made directly to patients for healthcare services
Payment made by patients for elective procedures
Payment made by insurance companies for preventive care services
#17
In healthcare billing, what is the purpose of a 'precertification' process?
To authorize medical procedures before they are performed
To review medical records after treatment
To process claims for reimbursement
To bill patients for services rendered