3 components of E & M coding - ANS - history, physical, medical decision making (risks,
data, diagnosis)
\5 things to consider when ordering tests - ANS - cost
convenience
sensitivity
specificity
predictive value
\A clinical guideline may be found useful if the guideline was:
A. Published 2 years ago
B. Created using one group
C. Authored by a relatively unknown source
D. Funded by an anonymous source - ANS - A.
Published 2 years ago
\Accountable Care Organizations - ANS - groups of providers—providers, hospitals,
outpatient-care facilities—that come together to coordinate the care of patients, seeking
to offer a high quality of care at a lower cost
\Accounting keeps track of the financial state of a business. The accounting report that
demonstrates the growth in assets is:
A. Net income statement
B. Balance sheet
C. Cash flow statement
D. Operating statement - ANS - A.
Net income statement
\All health-care practices should develop a compliance plan. Compliance plans offer
practice safeguards that prevent which of the following?
A. Malpractice claims
B. Conflict-of-interest claims
C. Health Insurance Portability and Accountability Act violations
D. Safety and Health Administration violations - ANS - B.
Conflict-of-interest claims
\All medical practices are required by the CMS to adopt a certified electronic medical
record software system for documenting and billing for medical services. Why is this so
critical?
A. Electronic software allows CMS to audit all medical practices' performance.
B. Electronic filing protects patient information as required by the Health Insurance
Portability and Accountability Act.
C. Electric billing and automated electronic filing sets makes timely transition to new
provider fee schedule rates possible.
D. Medical record software eliminates the possibility for duplicate bills and overcharging
patients. - ANS - C.
, Electric billing and automated electronic filing sets makes timely transition to new
provider fee schedule rates possible.
\Assessment - ANS - DDX
\Common Procedure Terminology (CPT) - ANS - recognized universally. Service is
represented by a 5 digit code in: Evaluation andMGMT, Anesthesiology, Surgery,
Radiology, and Patho and Medicine
\CPT coding E&M system - ANS - place of service (inpt vs outpt), type of service (consult,
office visit, admitted), patient status (new vs established)
\Despite the growth in the numbers of APRNs over the last decades, the role of the
profession is often not understood by the public. What actions should APRNs undertake
to market their services to the public?
A. Request that the physician act as an APRN spokesperson.
B. Increase articles in nursing professional journals about the APRN role.
C. Personally seek out the news media to communicate their value.
D. Rely on patients to communicate their benefits to neighbors. - ANS - C.
Personally seek out the news media to communicate their value.
\Differential Diagnosis - ANS - list of possible diagnosis usually listed in priority order
\Each state has criteria defining the level of collaboration required between the Advanced
Practice Registered Nurse (APRN) and an oversight physician. Which is among the
questions an APRN should seek when selecting a practice setting?
A. List of practice limitations as an APRN
B. Standard hourly rate as office staff
C. Expectation for net revenue generation
D. Standard benefit package offered to office staff - ANS - C.
Expectation for net revenue generation
\False negative - ANS - patient has condition but test results as negative
\False positive - ANS - patient doesn't have disease but test results as positive
\Fee for Service - ANS - A model that is structured so a provider is given a set amount of
monetary reimbursement for a specific visit/procedure performed that is adjusted for
geographical location
\Global Capitation - ANS - Global capitation is a payment model specifically for integrated
health care delivery. In this model, capitation payment for services delivered by different
providers or at different levels of care is combined into a single prospective payment to
an integrated care organization or a large physician group.
\How do bundled payments differ from fee-for-service or global capitation?
A. Bundled payments are designed to reduce the number of payments to providers.
B. Bundled payments align payment to care outcomes delivered by the team.
C. Bundled payments reduce the amount of paperwork required for payment.
D. Bundled payments allow for streamlined and coordinated billing for providers. - ANS -
B.
Bundled payments align payment to care outcomes delivered by the team.
\Identify one of the primary reasons for an APRN to develop a business plan:
A. To monitor monthly actual expense to budgeted expense
B. To reduce the likelihood of litigation action
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