1. MIS 4243

2. Question 1 Which Medicare plan pays for hospital services? A. Part A B. Part B C. Part C D. Part D

3. Question 2 What does comorbidity mean? A. The patient died B. The patient developed an infection after being admitted C. The patient developed a complication D. The patient had more than one condition when admitted

4. Question 3 A participating provider charges $80, but the Medicare allowed amount is $70. What is the write-down amount? A. 10 percent B. 80 percent C. $10 D. $80

5. Question 4 Diagnosis codes assigned to represent disease or medical condition treated are: A. HCPCS B. CPT-4 C. ICD-9-CM D. All of the above

6. Question 5 A prospective payment system (PPS) is being used by a hospital. Which of the following is NOT true? A. There will be a maximum limit per discharge. B. It will be based on reasonable costs given the diagnosis. C. The hospital can be any type (general, children’s, cancer, and so forth). D. Patients who stay one night versus two nights will be charged the same amount if their diagnosis is the same.

7. Question 6 Which paper form was designed for institutional claims? A. Part A B. UB-04 C. CMS-1500 D. W-4

8. Question 7 A(n) _________ statement shows all unpaid items with payment, adjustments, and balance for each item. A. Balance forward B. Open item C. Either balance forward or open item D. Neither balance forward or open item

9. Question 8 Which of the following EDI transactions is currently NOT required by HIPAA? A. Claim attachment B. Enrollment and de-enrollment in a health plan C. Health plan premium payments D. Referral certification and authorization

10. Question 9 Provider payment delays can be caused by: A. A bill-hold period B. Payment floor C. Secondary insurance plan billing D. All of the above

11. Question 10 Special software that examines claim data before it is sent to eliminate preventable billing errors is called: A. Claim edit B. Claim scrubber C. Clearinghouse D. EMC

12. Question 11 What type of statistic can be used to compare patients who receive a therapy versus those who did not? A. Mean B. Mode C. Ratio D. Standard deviation

13. Question 12 Eighteen patients were counseled against smoking and twelve were not. What is the proportion of patients who were counseled? A..40 B..60 C..66 D. 1.5

14. Question 13 A ___________ usually has a separate database created to track specific data types such as childhood immunizations. A. HEDIS B. Index C. ORYX D. Registry

15. Question 14 The data mining technique called __________ could be used to predict length of stay of a patient in a hospital with a particular medical condition. A. Association B. Clustering C. Classification D. Estimation

16. Question 15 CMS developed the _______ program to encourage improvements in quality of care coordination for patients with chronic illnesses. It also gives bonus payments to doctors who meet or exceed performance standards. A. Data mining B. NHQM C. P4P D. Sampling

17. Question 16 Software systems that share a common database are: A. Interfaced B. Integrated C. Indexed D. Regulated

18. Question 17 What department abstracts and reports National Hospital Quality Measures (NHQM)? A. Billing B. Utilization management C. Quality management D. Utility

19. Question 18 Which of the following systems would be used track employee health? A. Financial B. Human resource C. Scheduling D. Quality management

20. Question 19 An employee scheduling system is used for all of the following except: A. Processing doctors’ orders B. Managing employee sick days C. Scheduling pre-op cleaning D. Maintaining an on-call schedule

21. Question 20 Which of the following is true regarding the Recovery Audit Contractor (RAC) program? A. It increases the risk of financial loss to the hospital/physician. B. It was created by CMS in 2013. C. It utilizes a public company as its contractor. D. All of the above are true.