Ch 17: True and False Flashcards

Reimbursement Procedures: Getting Paid

1
Q

T/F: Medicare patients are not included in the PPS system

A

False

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2
Q

T/F: Prospective payment rates are set at a level intended to cover operating costs for treating a typical inpatient in a given DRG

A

True

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3
Q

T/F: Under Medicare’s PPS, hospitals are paid a set fee for treating patients in a single DRG category, regardless of the actual cost of care for the individual

A

True

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4
Q

T/F: The established payment rate for all services that a patient in an acute care hospital receives during an entire stay is based on a predetermined payment level that is selected on the basis of averages

A

True

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5
Q

T/F: The biggest challenge in developing an RVS-based payment schedule was patient diversity

A

False

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6
Q

T/F: The Affordable Care Act eliminated patient cost-sharing requirements (coinsurance and deductible) for most Medicare-covered preventive services

A

True

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7
Q

T/F: DRGs are used for reimbursement in the PPS of the Medicare and Medicaid healthcare insurance systems

A

True

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8
Q

T/F: DRGs adopted by CMS are defined by diagnosis and procedure codes used in the coding manuals

A

True

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9
Q

T/F: A patient’s DRG categorization depends on the coding and classification of the patient’s medical information using only the CPT coding system

A

False

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10
Q

T/F: Each DRG is assigned a relative weight (RW) and an average length of stay (ALOS)

A

True

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11
Q

T/F: When patients are admitted to either a residential healthcare facility or a nursing home, physicians are required to prepare a written plan of care for treatment

A

True

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12
Q

T/F: Activities of daily living are behaviors related strictly to mental health

A

False

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13
Q

T/F: Medicare payment rules are established by Congress

A

False

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14
Q

T/F: The Medicare program is administered mainly at the local and regional level by private insurance companies that contract with CMS to handle day-to-day billing and payment matters

A

True

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15
Q

T/F: One of the chief objectives in creating the PPS was to monitor the quality of hospital services for Medicare beneficiaries

A

True

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16
Q

T/F: Being a successful health insurance professional stops with knowing how to complete and submit insurance claims

A

False

17
Q

T/F: CMS uses the same PPS for reimbursement to acute inpatient hospitals, hospital outpatient services, and skilled nursing facilities

A

False

18
Q

T/F: Not all peer review organizations (PROs) deal with healthcare

A

True

19
Q

T/F: Non-PARs not accepting assignment can change beneficiaries no more than 115% of the Medicare allowance

A

True

20
Q

T/F: Contractual write-offs and bad-debt write-offs are basically the same

A

False

21
Q

T/F: A computerized practice management system can alleviate potential administrative problems a healthcare practice may encounter in complying with the HIPAA Privacy Rules

A

True

22
Q

T/F: The HHS mandates that all medical facilities use the same format for submitting electronic health transactions

A

False

23
Q

T/F: The VBPM applies only to physician payments under the Medicare PFS

A

True

24
Q

T/F: Many different patient accounting systems are available today that are capable of performing comparable patient accounting information

A

True

25
Q

T/F: If a medical practice contracts with a “business associate,” the practice should ensure that the agreement includes certain protections defined by HIPAA

A

True