PART 10 Flashcards
Which of the following present on admission indicators could result in a reduction of reimbursement on a hospital inpatient admission?
A: N-NO
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Which of the following laws prohibits a physician from referring Medicare patients to clinical labs where they or a member of their family have a financial interest?
A: Stark law
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Suppose a hospital system has admitted to fraudulent billing practices and has agreed to the settlement offered by the Office of Inspector General (OIG). The hospital will be obligated to follow a compliance program which involves substantial government oversight in the hospital compliance activities. The hospital is under a
A: Corporate Integrity Agreement
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Which one of the following represents the best or most positive average age of accounts receivable?
A: 10 days
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The four-digit number used by Medicare to group charges together by service area. These codes are also used in the Cost Report to group costs together by service area.
A: Revenue code
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If a hospitals payment rate is $5,000, what payment would a hospital expect to receive for a patient treated for heart failure and shock and assigned to MS-DRG 292, Heart Failure and Shock with a relative weight of 1.0069?
A: $5034
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Once all data are posted to a patients account, the claim can be reviewed for accuracy and completeness. Many facilities have internal auditing systems. The auditing systems rune each claim through a set of edits specifically designed for the various 3rd party payer. The auditing system identified data that have failed edits and flags the claim for correction. These “Internal auditing systems are called
A: Scrubbers
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This is the difference between what is charged and what is paid.
A: Contractual allowance
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Which of the following employees would be considered expert under Fair Labor Standards Act?
A: The head of the Department of Health Information Services who is involved in decision making and planning 90% of the time.
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