HSA 525 MIDTERM EXAM / HSA525 MIDTERM EXAM.: GRADED A | 100% CORRECT |STRAYER
HSA 525 MIDTERM EXAM
Question 1
What are the two types of forms used for health services billing? CMS 1501 and CMS 1450
UB 04
CMS 1100 and CMS 1450
UB-05 and UB-1450
Question 2
Describe how Medicaid pa...
hsa 525 midterm exam question 1 what are the two types of forms used for health services billing cms 1501 and cms 1450 ub 04 cms 1100 and cms 1450 ub 05 and ub 1450
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HSA 525 MIDTERM EXAM
Question 1
What are the two types of forms used for health
services billing? CMS 1501 and CMS 1450
UB 04
CMS 1100 and CMS
1450
UB-05 and UB-1450
Question 2
Describe how Medicaid payments to providers are limited by the federal government.
The payments to providers are not limited by the federal government but rather by
state agencies that have predetermind estimates.
The law requires that Medicaid payments to qualified hospitals, nursing facilities,
ICF/MRs, and clinics not exceed a reasonable estimate of the amount that
Medicare would pay for equivalent services in the aggregate within state-owned or
operated, non-state-owned or operated, and private facilities.
CMS reviews state payment methodologies and supporting documentation to
ensure that the state plan methodology may be audited and is comprehensively
described and that payment rates are economic, efficient, and sufficient to attract
willing and qualified providers.
All of the statements are
correct.
None of the statements are
correct
Question 3
What is charge explosion?
When charges increase dramatically over a set period of time
When the set of charges is explained in line item fashion on a
master bill
When a uniform set of supplies is utilized for a services or
procedure When charge masters are delivered to a large group
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Question 4
How does the False Claims Act (FCA) impact providers of health care services?
Under the FCA, health care providers who knowingly make false or fraudulent
claims to the government are fined $5,500 to $11,000 per claim plus up to
three times the amount of the damages caused to the federal program.
Under the FCA, health care providers who knowingly make false or fraudulent
claims to the government are fined $1,500 to $110,000 per claim plus up to
three times the amount of the damages caused to the federal program.
Under the FCA, health care providers who knowingly make false or fraudulent
claims to the government are fined $5,500 to $11,000 per claim plus up to five
times the amount of the damages caused to the federal program.
Under the FCA, health care providers who knowingly make false or fraudulent
claims to the government are fined $5,500 to $10,000 per claim plus up to 10 times
the amount of the damages caused to the federal program.
Question 5
What are the elements that should be present, at a minimum, in all charge masters?
The six elements are: charge code, item description, department number, charge
(price), revenue code, and CPT/HCPCS code.
Only three are required. Those are charge code, item description, and charge (price).
The five elements are charge code, item description, department number, charge
(price), and CPT/HCPCS code.
The six elements are: charge code, item description, physician, charge (price), revenue
code, and CPT/HCPCS code.
Question 6
Prosecution under the FCA requires that specific intent to defraud the government
was present.
True
False
Question 7
What is the objective in a managed-care environment that often leads to
conflict between hospitals and doctors?
Increase in patient
load
Empty hospital
beds
Decrease costs
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