Exam 2

Question 1

Five reasons the ACA is bad for doctors?

Answer 1

1. Adds more patients to Medicaid
2. Leaves the flawed Medicare payment system on the books
3. Creates a new board to further cut payments to providers
4. Exacerbates Future Physician Shortages
5. Destroys or deteriorates the Physician-Patient Relationship

Question 2

EMTALA requirements for transferring a patient?

Answer 2

• They must check for illness or injury!
• If the facility has the means to treat the patient then they must perform treatment!
• If treatment is possible, the facility is obligated to treat you!
• If the patient is actively in Labor

Question 3

Nickname for EMTALA

Answer 3

Patient anti-dumping act

Question 4

What are “Outlier Payments”?

Answer 4

Medicare pays hospitals per-discharge rates that vary by category of inpatient case. Under this system, hospitals have a financial incentive to avoid extremely costly patients. To counter this incentive and promote access to hospital care for these extremely costly patients, Medicare makes additional payments, called outlier payments.

Question 5

What is a Tort?

Answer 5

A civil wrong committed against a person or property, excluding breach of contract.

Question 6

Intentional Tort

Answer 6

When one person

Question 7

Unintentional Tort

Answer 7

Acts that are not intended to cause harm but are committed unreasonably or with disregard for the consequences. In legal terms, this constitutes negligence.

Question 8

Three acts that the department of health and human services has responsibility

Answer 8

National Organ Transplantation Act
Human Genome Project
The Affordable Care Act

Question 9

What is the Joint Commission/Years in business/Number or facilities that use them?

Answer 9

• An independent, not-for-profit organization. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.
• 60 years in business
• 4,168 general, children’s, long term acute, psychiatric, rehabilitation and specialty hospitals and 378 critical access hospitals. (82% of the nation’s hospitals)

Question 10

What are Disproportionate Share Payments?

Answer 10

The original rationale for the Medicare Disproportionate Share (DSH) payment adjustment was to compensate hospitals for the higher operating costs they incur in treating a large share of low-income patients. Low-income Medicare patients tend to be sicker and more costly to treat than other Medicare patients with the same diagnosis. Higher costs also result from the need for additional staffing and services, such as translators and social workers, to care for low-income patients.

Question 11

Who qualifies for Medicaid?

Answer 11

• Limited-income families with children
• Children under age 6 whose family income is at or below 133%
• Pregnant women whose family income is below 133% FPL
• Infants born to Medicaid-eligible women
• SSI recipients in most states
• Aged, blind, disabled (state specific)
• Adoption or foster care assistance recipients
• Special Protected Groups
• All children under 19 in families at or below the FPL
• Certain Medicare beneficiaries

Question 12

What is Medicaid and Who regulates it?

Answer 12

• Pays for medical assistance for certain individuals
  and families with low-incomes and resources.
• Both State and Federally regulated

Question 13

Tertiary Care Definition

Answer 13

Intensive care (highly specialized) usually only have 1 nurse

Question 14

ACHE Definition

Answer 14

American College of Healthcare Executives
Mission: To advance our members and healthcare management excellence.
Vision: To be the preeminent professional society for healthcare executives dedicated to improving health.

Question 15

Deductible Definition

Answer 15

The amount of expenses that must be paid out of pocket before an insurer will pay any expenses.

Question 16

Critical Care Definition

Answer 16

An illness or injury that acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.

Question 17

IRB Definition

Answer 17

Institutional Review Board
A committee established to review and approve research involving human subjects. The purpose of the IRB is to ensure that all human subject research be conducted in accordance with all federal, institutional, and ethical guidelines.

Question 18

Ambulatory Definition

Answer 18

Medical technology or procedures delivered on an outpatient basis.

Question 19

ASC Definition

Answer 19

Facilities focused on providing same-day surgical care, including diagnostic and preventive procedures.

Question 20

PHI Definition

Answer 20

Protected Health Information

Question 21

Advocacy Organization Definition

Answer 21

They try to reduce the burden of administration rules on physicians. Secure regulatory improvements and significant Legislative victories at the federal and state levels.

Question 22

ANA Definition

Answer 22

The American Nurses Association is a professional organization to advance and protect the profession of nursing.

Question 23

PIP Definition

Answer 23

Periodic Interim Payments
- Biweekly payments made to a Provider enrolled in the PIP program, and are based on the hospital’s estimate of applicable Medicare reimbursement for the current cost report period.

Question 24

USDHHS Definition

Answer 24

US Department of Human and Health Services
One of the largest civilian departments in the federal government because it oversees the implementation of numerous health and welfare-related programs. (Medicare, Medicaid, Marketplace, and Children’s Health Insurance Program)

Question 25

Five disadvantages that hospital has by being not for profit

Answer 25

1. Loss of control
2. Paperwork
3. Limited Purposes
4. Public Scrutiny
5. Continual Challenges - over tax exempt property, the sale of goods and services that compete with the for profit sector, or for profits moving in on your territory.

Question 26

Four Parts of Medicare

Answer 26

Part A (Hospital Insurance)
Part B (Supplementary Medical Insurance)
Part C (Medicare Advantage Plan) 
Part D (Subsidized Prescription Drug Coverage)

Question 27

Six legislative initiatives and what each one was meant to do and what they are.

Answer 27

1. HIPAA – Health Insurance Portability and Accountability Act of 1996
2. False Claims Act Senate Bill 2041
3. Healthcare Quality Improvement Act (HCQIA)-1986
4. EMTALA – Emergency Medical Treatment and Active Labor Act 1986
5. Stark Legislation – preventing physician
   self-referral.
6. Patient Protection and Affordable Care Act (PPACA)-2010

Question 28

DRG Definition

Answer 28

Medicare pays predetermined, per-discharge rates or 509 patient categories–called Diagnosis Related Groups (DRGs)–to hospitals for inpatient care. These categories group patients with similar clinical problems who are expected to require similar amounts of hospital resources. For example, a patient who has a hip replacement would be in DRG 209: Major Joint and Limb Reattachment Procedures of Lower Extremity.