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HIIM 242 Study Guide
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HIIM 242 Study Guide
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25 Questions

1. The Centers for Medicare and Medicaid Services (CMS) developed the National Plan and Provider Enumeration System (NPPES) to...

2. A centralized health care system adopted by some Western nations (e.g., Canada) and funded by taxes in which the government pays for each resident's health care is called...

3. Which area of law is based on a court decision that established a precedent?

4. Which offers choice and flexibility to subscribers who want a full range of benefits along with the freedom to use any licensed health care provider?

5. Which program was established to provide health care assistance to uninsured, low-income children under state Medicaid programs?

6. Which contain(s) new and changed Medicare policies and/or procedures that are to be incorporated into a specific CMS program manual?

7. A state-licensed, Medicare-certified supplier of surgical health care services that must accept assignment on Medicare claims is a(n)...

8. The implementation of which was authorized in 1980 by Medicare as a fee for facility services furnished in connection with performing certain surgical procedures?

9. Which is required of outpatient physical, occupational, and speech therapy services as part of an OPAP?

10. Which is employed at a TRICARE Service Center, provides information about using TRICARE, and assists with other matters affecting access to health care?

11. Which was implemented to reduce provider costs and cycle time by minimizing and eventually eliminating paper processing and mailing of medical documentation to review contractors, and to reduce costs and time for review contractors?

12. Medicare Advantage is also known as...

13. Common law is also known as...

14. Which eased restrictions on preferred provider organizations (PPOs) and allowed subscribers to seek health care from providers outside of the PPO?

15. The Fair Credit Reporting Act...

16. Which allows providers to electronically access the state's eligibility file using a point-of-service device, computer software, or an automated voice response system?

17. Which is the process of determining whether services provided are medically reasonable and necessary as defined by CMS?

18. Which is a subclass indicating the extent of physiological decompensation or organ system loss of function that was added to each DRG as part of an expansion of the original DRG system?

19. When the same BCBS payer issues the primary and secondary or supplemental policies...

20. Which is a method of converting information to a secure language format for electronic transmission?

21. Which are located at MTFs and are available to answer questions, help solve health care-related problems, and assist beneficiaries in obtaining medical care through TRICARE?

22. The IPPS is based on what type of payment system?

23. One of the circumstances under which Medicare would award an assigned claim conditional primary payer status and process the claim is when there is no response from a liability payer within ______ days of filing the claim.

24. Which is entered in Block 11c of the CMS-1500?

25. What index adjusts payments to account for geographic variations in hospital labor costs?

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