America's Benefit Specialist July 2023

CPC QUIZ

1. The _____ has proven to be a landmark piece of healthcare legislation by virtue of initiating sweeping reforms for employer-sponsored group health plans, arguably the most influential ones since the Afford able Care Act was enacted in March 2010. A. FMLA B. CAA C. COBRA D. FSA 2. The _____ provision of the CAA bars health plans or health insurance issuers from entering into contracts with a healthcare provider, network or third-party ad ministrator providing access to a network of providers that restrict a plan from releasing data and informa tion for public consumption. A. No Surprises Act B. gag clause C. qualifying payment amount D. remittance advice remark codes 3. Plans are required to submit an annual _____ that they have not engaged in any such prohibited contractual 4. The first attestation is due _____, which covers the period starting December 27, 2020, through the date of attestation. A. October 1, 2023 B. December 31, 2023 C. January 1, 2024 D. December 31, 2024 5. Which is not a wide-ranging price-transparency provi sion of the CAA? A. patient protections against surprise billing B. prescription drug cost reporting C. mental health parity comparative analysis disclo sures D. deductible adjustments 6. _____ is the policy of having Medicare Part B pay the same amount for the same service with the same case mix regardless of where the service is provided. A. Gag clause B. Site neutrality C. Medicare Advantage D. Inpatient-only procedure list arrangements. A. attestation B. physician fee schedule C. consolidation D. premium

7. Payments for hospital outpatient department services are done through Part B and cover two parts: A. hospital costs and professional services B. hospital costs and inflation C. deductibles and professional services D. capital costs and hospital costs 8. In Part B, the beneficiary generally pays about _____ of the cost of a given service, regardless of site of care.

A. 10% B. 15% C. 20% D. 25%

9. The inpatient-only procedures list specifies services that _____ will only pay for if those services are per formed in an inpatient setting.

A. ICHRA B. COBRA C. self-funded D. Medicare

10. The current payment differential for _____ is widely regarded as a major reason for the cost-increasing consolidation of the U.S. health system, incentivizing hospitals to purchase physician practices in order to receive higher payments and reduce competition.

A. outpatient procedures B. pre-existing conditions C. site-neutral payment policy D. Medicare advantage premiums

11. Which is not a data element that was included of the ownership of more than 6,000 hospices and 11,000 home health agencies certified to participate in the Medicare program? A. enrollment information B. detailed information about each owner C. number of practitioners at the practice D. numerical associate ID for each owner to enable linkage to the enrollment file 12. Making ownership information transparent benefits _____ by allowing them to identify common owners that have had histories of poor performance, analyze data and trends on how market consolidation impacts consumers with increased costs without necessarily improving quality of care, and evaluate the relation ship between ownership and changes in healthcare costs and outcomes. A. researchers and enforcement agencies B. health insurance agents and brokers C. carriers and prescription drug companies D. Medicare Advantage enrollees and underwriters

48 ABS | benefitspecialistmagazine.com