Mid-Term Flashcards by Amy Harvey

Hospital clinics are rarely organized by medical specialty.

True or False

False

How well did you know this?

Not at all

Perfectly

A partial hospitalization program is considered to be a type of inpatient psychiatric program

True or false

False

How well did you know this?

Not at all

Perfectly

Hospital observation services maybe billed to all payers as outpatient services for observation stay up to 72 hours.

True or False

False

How well did you know this?

Not at all

Perfectly

For referred outpatients, the hospital provides diagnostic or therapeutic services, but it does not take responsibility for evaluating or managing the patient’s care.

T or F

True

How well did you know this?

Not at all

Perfectly

A hospitalist is a physician who provides comprehensive care to hospitalized patients, as well as seeing patient’s outside of the hospital setting.

T or F

False

How well did you know this?

Not at all

Perfectly

Hospitals that meet the standards of the Joint Commission, HFAP or DNV are deemed to meet the Conditions of Participation.

T or F.

True

How well did you know this?

Not at all

Perfectly

According to the Joint Commission, the records of patients receiving continuing ambulatory care services must contain a summary list of known significant diagnoses, conditions, procedures, drug allergies and medications.

T of F

True

How well did you know this?

Not at all

Perfectly

When a resident, as part of his or her medical education, participates with a teaching physician in providing service, the resident is usually paid a salary by the hospital, and the teaching physician is reimbursed by Medicare.

T or F

True

How well did you know this?

Not at all

Perfectly

The PATH audit demonstrated that teaching physician documentation almost always supported the levels of service billed to Medicare; therefore, these audits did not result in significant reimbursement of fund to Medicare.

T or F.

False

How well did you know this?

Not at all

Perfectly

Charges for ancillary services, such as laboratory and radiology charges are usually captured through the hospital chargemaster.

T or F

True.

How well did you know this?

Not at all

Perfectly

With regard to Medicare, hospitals should bill separately any changes for ancillary services provided on an outpatient basis within 72 hours prior to the hospital admissions.

T or F

False

How well did you know this?

Not at all

Perfectly

According to the American Hospital Association (AHA), a hospital must maintain at least six inpatient beds and care must be readily available for the patients who stay an average of 24 hours or more per admission.

T or F

True

How well did you know this?

Not at all

Perfectly

Acute and chronic illnesses can both be treated on an ambulatory basis.

T of F

True

How well did you know this?

Not at all

Perfectly

The level of service provided determines the selection and reporting of an appropriate code, which in turn determines the amount of phsyician reimbursement.

T or F

False

How well did you know this?

Not at all

Perfectly

To meed federal requirements that permit participattion in Medicare/Medciaid, the federal governement survyes and certificies nonaccreative hopsitals.

True of Falise

How well did you know this?

Not at all

Perfectly

Dr. Moose admits Mary Knight to Tanner Hospital for observation of her shortness of breath. If he feels like Mary meets the criteria for admission as an inpatient, Dr. Moore must generally make that decision within which of the following time frames.

24-hour

How well did you know this?

Not at all

Perfectly

As required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, CMS has replaced past claims processing contractors known as fiscal intermediaries and Medicare carries with

Medicare Administrative Contractors (MACs)

How well did you know this?

Not at all

Perfectly

Hospitals must be licensed by the state in which they are located.

T or F

True

How well did you know this?

Not at all

Perfectly

The Joint Commission requires that the health record criteria contain a summary list for each patient that should include

Significant medical diagnoses and conditions, significant operative and invasive procedures, and adverse and allergic drug reactions.

How well did you know this?

Not at all

Perfectly

The health record notes how long a patient receiving emergency, urgent or immediate care had to wait for treatment.

T or F

False

How well did you know this?

Not at all

Perfectly

Which of the following hospital units as the setting for performance of elective surgical procedures on patients who are classified as outpatients and typically are discharged on the day of surgery, thus avoiding an overnight stay in the health care facility?

Ambulatory Surgery

How well did you know this?

Not at all

Perfectly

The physician sends the patient to the hospital for a x-ray. The patient returns to the physician’s office for follow-up of the examination results. From the point of view of the hospital , what type of patient is this.

Referred out patient.

How well did you know this?

Not at all

Perfectly

In the hospital settings, the term “resident” is primarily applied to

a physician participating in a approved graduate medical education program.

How well did you know this?

Not at all

Perfectly

When a hospital provides services to a Medicare patient as an outpatient within 72 hours before related inpatient admission, charges for those outpatient services

Must not be billed separately form the inpatient bills.

How well did you know this?

Not at all

Perfectly

Without documented information on the diagnoses or symptoms that prompted a physician to order a test, the hospital lacks the information needed to demonstrate that the test was:

Medically necessary

The hospital may be paid for more than one (1) APC payment per patient visit. T or F

True

"V" represents those services which are not billable under the OPPS. T or False

False

Medicare payments to long-term acute care hospitals (LTACHs) are based on:

MS-LTC-DRGs

Which of the following, containing information on each and every Medicare beneficiary, is composed of regional databases that include data from hospital and physician claims and is used to validate claims and track utilization throughout the United States?

Common working file

The Hospital Outpatient Prospective Payment System (OPPS) allows for additional payments to be made to cover the costs of innovative medical devices, drugs, and biologicals. These payments are referred to as:

Pass-Through Payments

Risk management departments protect health care organizations from financial loss that occur as a result of:

Potentially compensable events

For certain categories of encounter-based hospital outpatient services, "Composite APCs" result in:

only a single payment for certain common combination services provided on the same day of service.

The legislative act which provides incentives to healthcare providers who utilize EHRs to enhance the quality of care provided to their patients is the:

American Recovery and Reinvestment Act (ARRA)

Hospitals receive Medicare reimbursement for ambulatory care through an outpatient prospective payment system (OPPS) based on diagnosis related groups (DRGs). T or F

False

Under EMTALA, hospitals that offer emergency services:

must screen and stabilize, if necessary, any patient who arrives in the emergency department.

Which of the following are considered the main caregivers in ambulatory care?

Physicians

A record format in which the documentation is maintained in chronological regardless of the type or author the documentation is called.

integrated

A freestanding ambulatory care facility generates which of the following at the conclusion of the patient's visit.

Encounter form.

Which of the following freestanding ambulatory care settings provides services to promote the health of the community, such as immunizations and disease screenings?

Public Health department.

What are the characteristics of Urgent Care Centers

Generally no appointment system. | Extended hours/days of operations.

Who publishes standards for some type of ambulatory health care.

The Joint Commission, Accreditation association for ambulatory birth center.

Which of the following is a plan used for ensuring that a facility or practice is following all laws and regulations, including those pertaining to reimbursement under medicare or medicaid.

Compliance plan.

Which ambulatory setting was developed in the 1960s specifically to bring more health care to the economically disadvantaged of particular neighborhood area?

Community health center.

When the consent for surgical treatment is generated at an ambulatory surgery center, who is responsible for explaining the risks and alternatives associated with the surgery and for obtaining the patient's consent prior to the procedure?

Surgeon

Free standing ambulatory care settings are not located within a hospital. T of F.

False

It is not necessary for an ambulatory facility to document telephone communications with patients since insurance companies will not pay for telephone consultations. T or F

False

The current method for physician reimbursement by Medicare, based on relative value units, is called the:

Medicare Physician Fee Schedule

Which of the following is a method of utilization management in which a review is performed before services are provided to ensure that the services planned are needed?

Precertification

Services provided by a NP or PA while a physician is on site are fully reimbursed, and are termed

incident to

An appointment scheduling method that assigns all patients to the same appointment time, then patients are seen on a first-come, first-serve basis is called a:

block appointment scheduling system

Beth Mitchell, RHIT, has been give the responsibility of designing a data collection form to be filled out for every patient at the time of admission to the ASC she works at. The resource that Beth would reference to develop the form is the:

UACDS

An arrangement by which one physician temporarily works in place of another physician is:

locum tenens

The Medicare Physicians Fee Schedule is revised annually to add newly developed HCPSC codes, remove deleted HCPCS codes and adjust the relative value units for physicians procedures and services. In which publication is the new MPFS release to the public for the upcoming year?

Federal Register

This information is published by MAC-Part B contractors to provide further guidance about CMS Program Manuals and Transmittals to providers in the area served by the Part B Contractor. Which are these publications known as?

Local Coverage determinations.

Which of the following nonphysician caregivers are paid based on a rate tied to the RBRVS?

All of the above. | (Certified Registered Nurse Anesthetists, Certified Nurse midwives, Clinical psychologists and clinical social workers.

Often independent contractors rather that employees

Occupational therapists

Residents who need constant oversight and supervision in activities of daily living

Permanent residents receiving nonskilled care.

Responsible for assessing the therapeutic recreational needs and preferences of each resident and developing an individualized program

Activities staff

A periodic, resident centered inspection that gathers information about the quality of service furnished in a facility to determine compliance with the requirements of participation in the Medicare and Medicaid programs

Standard survey

Making arrangements for adaptive equipment, clothing and financial assistance.

Social Services

Designed to care for residents diagnosed with conditions such as Alzheimer's.

Permanent residents, special care.

In some states, can assume responsibilities to lessen the load of licensed nursing professionals.

Certified medication technicians.

Residents receive frequent skilled care from licensed professionals.

Permanent residents, skilled care

Provide daily care needs to long term care residents.

Nursing assistants.

Ability to bathe, dress, groom, transfer and ambulate, eat, use speech, languages, ect

activities of daily living.

Predominant licensed caregivers in the long term care setting.

Licensed practical nurses

Residents length of stay is less than 100 days.

Short-term residents.

Physical presence in the long-term care facility is limited

Licensed physicians

Clinically relevant information about an individual that identifies specific problems and forms the basis for individual care planning.

Care area triggers.

Coordinate long-term daily care and hold supervisory positions.

Registered nurses

Short stay to provide relief to primary caregivers of the frail elderly

Respite care.

Developed by an interdisciplinary team, which of the following includes measurable objectives and timetable to meet a resident's medical, nursing, and psychosocial needs?

Care plan

Long-term care patients are commonly called resident. T or F

True

Which of the following is a facility in which the majority of patients are regarded as permanent residents.

Nursing Facility

Which of the following would initiate a complaint investigation in response to a hotline call concerning alleged abuse or neglect in a long-term facility

The state licensing agency

What is/are a core set of screening and assessment elements which constitutes a standardized means of assessing all residents in Medicare/Medicaid certified long-term care facilities, such as skilled nursing facilities (SNFs)

Minimum data set

Components of the care area assessment process include care area triggers, care area assessment resources, care area assessment survey, and the care plan. T of F.

False

According to federal regulations, the care plan should be completed within how long after completion of the comprehensive assessment?

7 days

When a care area is triggered, the long-term care interdisciplinary team documents the outcome of the assessment process for that particular care area and:

their decision regarding care planning for the particular problem or need.

Which of the following providers sturcture for assessing social, medical and psychosocial problems by providing a systemized methods of reviewing key components of the minimum data set and directing caregivers to evaluate causes, interrelationships, and particular strengths that affect development of the care plan?

Care area assessment process

Which of the following are fines levied by the federal government against providers who are found to be in substantial noncompliance with federal regulations.

Civil money penalties.

What are the 2 primary agencies that regulate long-term facilities?

The Centers for Medicare and Medicaid Services at the federal level; Medicaid at the state level

What are the primary reimbursement categories and pay sources for care of residents in long-term care facilities?

Medicaid; Medicare Part A for up to 100 days per spell of illness in skilled nursing facilities; Medicare Part B for services such as physicians' visits and durable medical equipment; Managed care; Commercial insurance; private pay.

Who determines how long-term care facilities are reimbursed under the Medicaid program?

The individual state agency through state legislation

What are the 3 categories for which ratings are provided in the 5-star Rating System for nursing homes? What are some of the specific long-stay and short-stay quality measures used in this system?

Health Inspectors, Nursing home staffing and Quality Measures. Long stay quality measures include ADLs, mobility, pressure ulcers, restraints, UTI, pain and catheterization. For short term measures, delirium, high-risk pressure ulcers and pain are included.

What is the single most important content characteristic of a care plan in a LTC facility that is subject to federal regulations.

Care plans must be individualized to the residents' care needs, strengths, and individual performances. Standardized care plans that do not list the caregiver's daily care responsibilities for the individual resident are not considered as resident centered and may present by legal and regulatory compliance problems in the event of a negative care outcome.

Medicare payments to LTC hospitals are determined by PPSj that is based on assignment of each residents' stay into a specific group. What groups are used for determining reimbursement in the LTCH-PPS?

MS-LTC-DRGs

Which of the following is a LTCH-PPS reimbursement option for patient stay that qualifies as a short stay outlier?

100% of the cost; 120% of the MS-LTC-DRG per diem amount, Full MS-LTC-DRG amount, Blend of IPPS DRG amount and 120% of the MS-LTC-DRG per diem amount.

LTC hospitals are not permitted to report ICD-9-CM diagnosis codes for late effects as they have no bearing on the care being provided. T or F

False

Services typically provided at LTC hospital include

Cancer treatment & pain management.

CMS provides free software for entering and transmitting MDS assessment data. This software is called:

RAVEN

Medicare Part A coverage is limited in that a long-term resident must first qualify with a minimum hospital LOS of how many days.

100 days.

Which of the following pay sources includes pharmaceutical costs in the daily reimbursed rate and does not pay for them separately?

Medicare part A.

Which of the following is a person-centered philosophy that creates a more homelike environment for residents of a nursing facility by providing individuals with privacy and the ability to make choices similar to what they would experience were they living in their own homes.

Culture change movement

The duration of skilled nursing facility Medicare Part A coverage is limite2d to the need for daily skilled care up to a maximum of how many days per spell of illness.

100 days

The phrase "private pay" in the long term care setting denotes payment made by.

the individual or family.

In LTC, CPT codes are used most commonly to bill for:

Medicare part B services.

An agreement between an HMO and CMS to provide services to Medicare beneficiaries under which the health plan received a monthly payment for enrolled Medicare members and must then provide all services needed is called:

Risk contract

The resource utilization group that applies to a given resident is based on:

Minimum data set

According to Medicare, a skilled nursing facility is responsible for billing the entire package of care that residents receive during a stay, with certain specified exceptions such as physicians' professional services. What word is used to describe this type of billing?

consolidated.