QUESTIONS SET 9 Flashcards
The prospective payment system based on resource utilization groups (RUGs) is used for reimbursement to ____________________ for patients with Medicare.
A. freestanding ambulatory surgery centers
B. hospital-based outpatients
C. intermediate care facilities
D. skilled nursing facilities
skilled nursing facilities
The computer-to-computer transfer of reimbursement data between providers and third-party payers in a data format agreed upon by both parties is called
A. health information exchange (HIE)
B. electronic data interchange (EDI)
C. HIPAA (Health Insurance Portability and Accountability Act)
D. health data exchange (HDE)
Electronic data interchange
When the MS-DRG payment received by the hospital is lower than the actual charges for providing the inpatient services to the Medicare patient, then the hospital
A. makes profit
B. can bill the patient for the difference.
C. absorbs the loss.
D. can bill Medicare for the difference.
absorbs the loss.
The term used to indicate that the service or procedure is reasonable and necessary for the diagnosis or treatment of illness or injury consistent with generally accepted standards of care is
A. appropriateness
B. evidence based medicine
C. benchmarking
D. medical necessity
medical necessity
When health care providers are found guilty under any of the civil false claims statutes, the Office of Inspector General is responsible for negotiating these settlements and the provider is placed under a
A. Noncompliance Agreement
B. Corporate Integrity Agreement.
C. Fraud Prevention Memorandum of Understanding.
D. Recovery Audit Contract
Corporate Integrity Agreement
If the number of individuals impacted by the breach exceeds 500, a healthcare organization must
a. conduct privacy training for members of the community
b. report the incident to the local media and the Department of Health and Human Services
c. do nothing
d. update their notice of privacy practices
Report the incident to the local media and the Department of Health and Human Services
The doctrine of Respondeat Superior imposes liability on employers for breach of confidentiality committed by ___________.
A. Its employees or agents
B. Medicare Surveyors
C. Its accrediting body
D. Organizations it holds contracts with
Its employees or agents
Which of the following health record numbers are in correct terminal digit order?
a. 01-51-25; 02-53-25; 03-22-35; 35-20-35
b. 00-01-10; 52-01-11; 26-00-00; 00-00-12
c. 00-52-84; 07-48-81; 45-58-81; 65-59-87
d.12-25-62; 11-25-68; 18-20-69; 00-24-69
12-25-62; 11-25-68; 18-20-69; 00-24-69
Which of the following is an effective method of evaluating responses to a request for proposal (RFP)?
a. negotiating contracts with all vendors and assessing the best price
b. visiting sites that use the systems of product competitors
c. testing the new system
d. attending user group meetings
Attending user group meetings
The key to an effective retention and retrieval system of health records in a facility is
a. Master patient index
b. Terminal digit filing
c. Microfilm
d. Optical imaging
Master patient index
