Ch 18: True and False

Question 1

T/F: Clinics generally provide outpatient services only

Answer 1

True

Question 2

T/F: Ambulatory surgery centers (ASCs) are facilities at which surgeries are performed that do not require hospital admission

Answer 2

True

Question 3

An ASC (ambulatory surgery center) treats patients who already have seen a healthcare provider and patients who have not

Answer 3

False

Question 4

T/F: Because ASC (ambulatory surgery center) patients are not formally admitted to the hospital, ASCs are among the more loosely regulated healthcare facilities

Answer 4

False

Question 5

T/F: A subacute care facility provides a level of maintenance care at which there is no urgent or life-threatening condition that requires medical treatment

Answer 5

True

Question 6

T/F: A nursing home can qualify as an SNF

Answer 6

True

Question 7

T/F: Licensed hospitals must provide care within the minimum health and safety standards established by state rules and regulations

Answer 7

True

Question 8

T/F: All hospitals must seek accreditation by nationally recognized accrediting agencies

Answer 8

False

Question 9

T/F: Critical Access Hospitals are certified under a different set of Medicare Conditions of Participation (CoP) that are more flexible than those of acute care hospitals

Answer 9

True

Question 10

T/F: Privacy and confidentiality issues are not as important in hospitals compared with physicians’ offices

Answer 10

False

Question 11

T/F: The HIPAA Privacy Rule is not intended to prohibit providers from talking to other providers and to their patients

Answer 11

True

Question 12

T/F: Each state’s Medicaid program determines the method it uses to pay for hospital inpatient services

Answer 12

True

Question 13

T/F: An NAS is necessary for all outpatient procedures

Answer 13

False

Question 14

T/F: Inpatient TRICARE payments are calculated using the same PPS as Medicare

Answer 14

True

Question 15

T/F: Most third-party payers require preauthorization for inpatient hospitalization and some outpatient procedures and diagnostic testing

Answer 15

True

Question 16

T/F: Most private insurers negotiate contracts with facilities regarding hospital inpatient payment methods on a month-to-month basis

Answer 16

False

Question 17

T/F: The hospital billing process begins when the patient is discharged from the facility

Answer 17

False

Question 18

T/F: The “principal diagnosis” is defined as the condition determined after study to be chiefly responsible for the patient’s admission to the hospital

Answer 18

True

Question 19

T/F: In ICD-10 coding, some body system categories include codes for nonspecific conditions, which should be ignored

Answer 19

False

Question 20

T/F: Transaction Standard Version 5010 accommodates the proposed new ICD-10 codes sets

Answer 20

True

Question 21

T/F: CPT-4/HCPCS codes are used only in physicians’ offices and outpatient clinics

Answer 21

True

Question 22

T/F: The 72-hour rule states that all diagnostic services provided for Medicare patients within 72 hours of the hospital admission must be billed separately from inpatient charges

Answer 22

False

Question 23

T/F: APC is the grouping system that the CMS developed for facility reimbursement of hospital outpatient services

Answer 23

True

Question 24

T/F: The primary goal of the Affordable Care Act is to provide free healthcare to all American citizens

Answer 24

False

Question 25

T/F: Hospitals submitting claims electronically can use any format available

Answer 25

False

Question 26

T/F: The accrediting body for many allied health education programs is CAAHEP

Answer 26

True

Question 27

T/F: The law requires electronic processing of all documents between the healthcare provider and the insurance carrier, without exception

Answer 27

False

Question 28

T/F: Secondary conditions are either comorbidities or complications, frequently referred to as “CCs”

Answer 28

True

Question 29

T/F: Like ICD-10-CM codes, ICD-10-PCS codes contain seven characters, which can be numbers or letters and are based on the type of procedure performed, the approach, the body part, and other characteristics

Answer 29

True

Question 30

T/F: Each character in the structure of an ICD-10-PCS code must be alphabetic

Answer 30

False