The phrase usual and customary refers to:
Question 1The phrase usual and customary refers to:
The success rate of a specified procedure.
How charges for a service compares with charges made to other persons receiving similar services and supplies.
How an insurer evaluates the need for an ordered diagnostic test.
How much an insurer will charge to provide coverage.
Question 2Which of the following statements does not belong in the past medical history portion of your chart note?
Your patient has an allergy to penicillin.
Your patient had a cholecystectomy 3 years prior.
Your patient’s father passed away from lung cancer.
Your patient had lab work done at their last appointment; CBC was normal.
Question 3 Which of the following statements about Medicaid is true?
Medicaid is a federal plan created to provide care for indigent persons.
Eligibility requirements for Medicaid are mandated by the Health Care Financing Administration.
Medicaid is a program for the indigent financed jointly by the federal and state governments.
Medicaid pays for family planning services, dental care, and eyeglasses.
Question 4 In relation to writing a patient encounter note, the acronym SOAP stands for which of the following?
Subjective, outward findings, assessment, plan.
Symptoms, objective findings, assessment, plan.
Subjective, objective, assessment, plan.
Symptoms, observations, assessment, plan.
Question 5 The Affordable Care Act (ACA) which passed in 2010 has a number of provisions, including the establishment of health exchanges. The purpose of a health insurance exchange is to:
Reduce the overall out-of-pocket cost of health insurance to the consumer.
Reduce the number of consumer health claims to the insurer.
Require each state to sell health insurance policies to consumers.
Create an online marketplace for the sale and purchase of health insurance for consumers.
Question 6Which of the following demonstrates a subjective finding?
Extremity edema.
Pain level.
Eye color.
Pulse rate.
Question 7Denial of provider status is something that seriously impedes a nurse practitioner’s ability to practice. If that occurs, some steps one can take include:
“Bashing” the organization to others and contacting an attorney.
Requesting that your clients lobby on your behalf by going to the newspapers.
Writing letters to the organization’s president and chief executive officer (CEO), activating others to lobby on your behalf, and reapplying after a 6-month period.
Requesting that your physician colleagues intervene on your behalf by writing critical letters to the organization in question.
Question 8What is an Accountable Care Organization (ACO)?
A risk pool that saves the overall organization money and maximizes reimbursement.
A payment system for episodes of care to save money for the health care system.
A bundling of pilot organizations.
A group of providers and suppliers who come together voluntarily to give coordinated, high-quality care to Medicare patients.
Question 9What must you do as an advanced practice registered nurse (APRN) before billing for visits?
Obtain a Drug Enforcement Administration (DEA) number.
Establish a collaborative agreement with a physician.
Obtain a provider number and familiarize yourself with the rules and policies of the third-party payer.
Provide evidence of continuing medical education.
Question 10 An 81-year-old patient presents for a physical. She recently had a fall and now has problems walking up her stairs. The only restroom in the house is on the second floor. She also has a flight of stairs outside her house she has to navigate in order to reach street level, and this is difficult for her. Where does this information belong in your chart note?
Assessment.
Plan.
Functional health problems.
Review of systems.
Question 11Which of the following demonstrates an objective finding?
Headache.
Respiratory rate.
Ankle pain.
Shortness of breath.
Question 12 Most health maintenance organizations (HMOs) use a reimbursement mechanism called capitation. What does this mean?
The HMO is not responsible for provider reimbursement.
The HMO reimburses the provider a predetermined fee per client per month based on the client’s age and sex.
The HMO reimburses the provider on a fee-for-service basis.
The HMO reimburses the provider only if the patient has paid their deductible.
Question 13A screening test identified correctly identified 80 individuals who did not have breast cancer out of 100 individuals that were known to be free of the disease (true negatives). Thus, the test failed to recognize 20 individuals who did not have breast cancer. What is the specificity of the screening test?
80%.
20%.
60%.
40%.
Question 14 Which one of the following is true regarding the importance of documentation?
It allows you to communicate your findings to other providers and serves as a record for the visit.
It allows you to communicate your findings with the general public.
It is only important in order to bill the patient for your service.
It is only important for defending yourself in the event of a law suit.
Question 15 Which of the following is the best method for evaluating the efficacy of a new clinical intervention?
A correlational study.
A descriptive study.
A randomized controlled trial.
A case report.
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