Chapter 80. The Business of Advanced Practice Nursing
MULTIPLE CHOICE
1. Identify the primary challenge for insurance carriers in today’s health delivery model.
A.
Preventing illness
B.
Screening for disease
C.
Educating the public
D.
Reducing health-care spending
2. Medicare benefits were offered to U.S. beneficiaries beginning in 1965. What was the service
added with the Medicare D plan in 2006?
A.
Health-care screening
B.
Health-care education
C.
Pharmaceutical coverage
D.
Durable medical equipment coverage
3. The cost of care provided by an APRN is approximately:
A.
One-quarter that of a physician
B.
One-third that of a physician
C.
One-half that of a physician
D.
One and one-half that of a physician
4. How do bundled payments differ from fee-for-service or global capitation?
A.
Bundled payments are designed to reduce the number of payments to providers.
B.
Bundled payments align payment to care outcomes delivered by the team.
C.
Bundled payments reduce the amount of paperwork required for payment.
D.
Bundled payments allow for streamlined and coordinated billing for providers.
5. Patients require education prior to accessing health-care services for the following reason:
A.
Many patients do not understand policy benefits and payment responsibility.
B.
Services may change across the beneficiary year.
C.
Copayments and deductibles may have already been met by the patient.
D.
Coding may need to be adjusted to meet the terms of the patient’s benefits.
6. What replaced the Sustainable Growth Rate (SGR) formula?
A.
Advanced Alternate Payment Model (APM)
B.
Merit-Based Incentive System (MIPS)
C.
Medicare Access and CHIP Reauthorization
D.
Quality Payment Program (QPP)
7. Accounting keeps track of the financial state of a business. The accounting report that
demonstrates the growth in assets is:
A.
Net income statement
B.
Balance sheet
C.
Cash flow statement
D.
Operating statement
8. Medicare advantage plans are Medicare managed care organizations (MCOs). These plans
must be approved by the Centers for Medicare and Medicaid Services (CMS) as alternative
carriers for Medicare beneficiaries. Which of the following is not a characteristic of these
plans?
A.
Offer additional benefits
B.
Offer lower copayments
C.
Follow Medicare benefit rules
D.
Follow the Commercial Carriers rules
9. The Current Procedural Terminology (CPT) and payment fee values are applicable only to
CMS services and are regulated and paid by the regional CMS carriers. How does this impact
MCOs?
A.
MCOs are the only groups able to adjust standard payment rules.
B.
MCOs can independently determine whether to utilize certain CPT code rules
and/or the reimbursement values for the payment year.
C.
MCOs can create personalized CPT codes.
D.
MCOs must continue to use modifiers.
10. All medical practices are required by the CMS to adopt a certified electronic medical record
software system for documenting and billing for medical services. Why is this so critical?
A.
Electronic software allows CMS to audit all medical practices’ performance.
B.
Electronic filing protects patient information as required by the Health Insurance
Portability and Accountability Act.
C.
Electric billing and automated electronic filing sets makes timely transition to new
provider fee schedule rates possible.
D.
Medical record software eliminates the possibility for duplicate bills and
overcharging patients.
11. All health-care practices should develop a compliance plan. Compliance plans offer practice
safeguards that prevent which of the following?
A.
Malpractice claims
B.
Conflict-of-interest claims
C.
Health Insurance Portability and Accountability Act violations
D.
Occupational Safety and Health Administration violations
12. What is the purpose of an Evaluation and Management Audit Tool?
A.
To justify CPT coding
B.
To provide guidelines for CMS review
C.
To assist in estimating profit/loss for patient visits
D.
To allow hospitals to comply with CMS guidelines
13. Each state has criteria defining the level of collaboration required between the Advanced
Practice Registered Nurse (APRN) and an oversight physician. Which is among the questions
an APRN should seek when selecting a practice setting?
A.
List of practice limitations as an APRN
B.
Standard hourly rate as office staff
C.
Expectation for net revenue generation
D.
Standard benefit package offered to office staff
14. Identify one of the primary reasons for an APRN to develop a business plan:
A.
To monitor monthly actual expense to budgeted expense
B.
To reduce the likelihood of litigation action
C.
To identify the marketing needed to grow the APRN practice
D.
To assure accreditation standards are met
15. Despite the growth in the numbers of APRNs over the last decades, the role of the profession
is often not understood by the public. What actions should APRNs undertake to market their
services to the public?
A.
Request that the physician act as an APRN spokesperson.
B.
Increase articles in nursing professional journals about the APRN role.
C.
Personally seek out the news media to communicate their value.
D.
Rely on patients to communicate their benefits to neighbors.