Managing Financial Resources
RequiredRequired Question(s)
Required 1.

Inland Medical Center is contemplating a per diem reimbursement contract for inpatient services with the local health plan. Which of the following mechanisms must be in place in order for the hospital to have acceptable financial results from its contractual relationship?

Concurrent review
Periodic charge Master increases
Additional resources to improve charge capture
Improvement in DRG coding to identify higher severity services
Required 2.

The two broad categories of reimbursement are:

Fee-for-service and charge based reimbursement
Costs based reimbursement and charge based reimbursement
Fee-for-service and capitation
Capitation and charge based reimbursement
Required 3.

Ambulatory payment classification (APC) and Resource-Based Relative Value Scale (RBRVS) are both approaches to which type of reimbursement:

per diem
Case rate
Per procedure
Required 4.

Paul is reviewing a claim that was denied for payment by an insurer to the physician clinic where he is employed. Which of the following items might have been an error that resulted in the claim not being paid by the insurer?

Medical records were not compiled
E.& M charges were included with procedure charges
There were duplicate E & M charges on the claim
The medical record was not completed by the treating physician
Required 5.

The combined activities of pre-visit, during-visit, post-visit are known collectively as the:

Revenue cycle
Utilization cycle
Adjudication cycle
Billing cycle
Required 6.

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