America's Benefit Specialist October 2023

CPC QUIZ

1. Which is not a key takeaway of RxDC reporting? A. Understand the requirements. B. Establish clear responsibility/ownership of tasks in advance. C. Plan ahead for deadlines. D. There will be no updates or changes. 2. RxDC reporting requirements include the following except: A. data elements B. independent dispute resolution C. submission deadlines D. supporting documentation 3. For RxDC reporting, the employer just needs to create and submit the _____. A. P2 and D1 reports B. provider consolidation report C. No Surprises Act D. REGTAP website form

7. On February 10, 2023, _____ announced a temporary halt to reimbursement decisions under the NSA, pend ing review of a court ruling that ruled the IDR regula tions unfairly favored payers.

A. NIH B. DOI C. HHS D. CMS

8. Data compiled by the Health Care Cost Institute con firms that, in 2017, about _____ of emergencies includ ed a “balance-bill.”

A. 11% B. 16% C. 20% D. 64%

9. _____ primarily uses Medicare pricing multiples as a benchmark to establish reasonable payments for ser vices to providers. A. Reference-based pricing B. Medicaid C. Individual insurance D. ICHRA 10. _____ requires health plans to disclose negotiated rates for in- and out-of-network rate history and drug-pric ing information.

4. The reporting deadline for RxDC is _____. A. March 31 B. June 1

C. September 30 D. December 31

5. RxDC reporting requirement is separate from other _____, such as the Medicaid Drug Rebate Program or the reporting obligations under ERISA, HIPAA or the Affordable Care Act.

A. Transparency in coverage B. Mergers and acquisitions

C. Balance-billing D. RxDC reporting

A. reference-based pricing models B. transparency in coverage reporting C. compliance-reporting requirements D. HIOS systems

11. As of 2021, _____ health systems controlled 25% of the national market. A. five

B. 10 C. 15 D. 20

6. _____ applies to participants in group and individual health plans by protecting them from balance-billing for certain emergency services and care received from out-of-network providers at in-network facilities. A. The No Surprises Act B. The Affordable Care Act C. Medicare D. COBRA

12. In metropolitan areas with the highest rates of hospi tal consolidation, the average cost of a hospital stay over a three-year period increased between _____. A. eight percent and 43%

B. 11% and 54% C. 14% and 38% D. 21% and 43%

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