Week 4 Review

47 Questions | Total Attempts: 58

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Week 4 Review

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Questions and Answers
  • 1. 
    The Omnibus Budget Reconciliation Act of 1989 (OBRA89) legislated a system to replace the UCR structure, called the
    • A. 

      HCPCS system

    • B. 

      Relative Value Scale (RVS)

    • C. 

      Fee-for-service system

    • D. 

      Resource-Based Relative Value Scale (RBRVS)

  • 2. 
    The amount of payment in the PPS is determined by the assigned
    • A. 

      Diagnosis-related group (DRG)

    • B. 

      Usual,customary, and reasonable (UCR) fee

    • C. 

      Capitation amount

    • D. 

      Either b or c

  • 3. 
    PPS for acute hospital care for Medicare patients was mandated by
    • A. 

      The Department of Health and Human Services in 1981

    • B. 

      The Social Security Amendments of 1983

    • C. 

      Centers for Medicare/Medicaid Services in 1980

    • D. 

      All of the above

  • 4. 
    The presence of more than one disease or disorder that occurs in an individual at the same time is referred to as a
    • A. 

      Comorbidity

    • B. 

      Complication

    • C. 

      Dual diagnosis

    • D. 

      Medical history

  • 5. 
    The method of determining Medicare's reimbursement for services based on establishing a standard unit value for medical and surgical procedures is the
    • A. 

      DRG

    • B. 

      RVS

    • C. 

      PPS

    • D. 

      APC

  • 6. 
    A common method of paying physicians in health maintenance organizations (HMOs) is
    • A. 

      Fee-for-service

    • B. 

      PPG

    • C. 

      Capitation

    • D. 

      UCR

  • 7. 
    The baice idea of the Resource Utilization Groups (RUGs) is to calculate payments according to severity and level of care in
    • A. 

      Skilled nursing facility

    • B. 

      Acute care hospitals

    • C. 

      Outpatient clinics

    • D. 

      Long-term care facilities

  • 8. 
    When an agreement exists between the provider and an insurance carrier whereby the provider agrees to accept the payers allowed fee as payment in full for a particular service or procedure, the process is called
    • A. 

      Prospective payment

    • B. 

      Contractual write-offs

    • C. 

      Patient equity

    • D. 

      Balance billing

  • 9. 
    Primary authority for implementing the PPS was given to the
    • A. 

      Social Security Administration (SSA)

    • B. 

      Individual states

    • C. 

      Department of Health/Human Services (HHS)

    • D. 

      Centers for Medicare/Medicaid Services (CMS)

  • 10. 
    Activites of daily living (ADLs) are behaviors related strictly to metal health.
    • A. 

      T

    • B. 

      F

  • 11. 
    When selecting a hardware/software vendor, it is important to make sure the products comply with the HIPAA Privacy Rule.
    • A. 

      T

    • B. 

      F

  • 12. 
    A system of payment whereby the provider charges a specific fee for each service rendered and is paid that fee by the patient or by the patient's insurance carrier is called
    • A. 

      Discounted fee-for-service

    • B. 

      Prospective payment system

    • C. 

      Capitation

    • D. 

      Fee-for-service

  • 13. 
    AN organization, typically composed of physicians and other health care professionals, paid by the federal government to evaluate the services provided by other practitioners and to monitor the quality of patient care is called a/an
    • A. 

      PPS

    • B. 

      HIPPA

    • C. 

      PRO

    • D. 

      CMS

  • 14. 
    Medicare's system for reimbursing Part A inpatient hospital costs is termed
    • A. 

      Capitation

    • B. 

      Prospective payment system

    • C. 

      Fee-for-service

    • D. 

      Discounted fee-for-service

  • 15. 
    Determination of payment in the Home Health Prospective Payment System (HHPPS) is dependent on
    • A. 

      OASIS

    • B. 

      ALOS

    • C. 

      GPSI

    • D. 

      CMS

  • 16. 
    A service classification system designed to explain the amount and type of resources used in an outpatient encounter is called
    • A. 

      APCs

    • B. 

      ALOs

    • C. 

      PPS

    • D. 

      DRGs

  • 17. 
    A factor used by Medicare to adjust for variance in operating costs of medical practices located in different parts of the country is the
    • A. 

      ANSII

    • B. 

      Both a and C

    • C. 

      RBRVS

    • D. 

      GPCI

  • 18. 
    DRGs are used for reimbursement in the PPS of the Medicare and MEdicaid health care insurance systems.
    • A. 

      T

    • B. 

      F

  • 19. 
    The payment system Medicare reimburses hospitals for providing inpatient care to beneficiaries
    • A. 

      ICD-9

    • B. 

      HCPCS

    • C. 

      CPT

    • D. 

      IPPS

  • 20. 
    The department of Health and Human Services (HHS) mandates that all medical facilities use the same format for submitting electronic health transactions.
    • A. 

      T

    • B. 

      F

  • 21. 
    The key piece of information in determining the DRG classification is the patient's
    • A. 

      Primary diagnosis

    • B. 

      Chief complaint

    • C. 

      Principal diagnosis

    • D. 

      Underlying symptoms

  • 22. 
    The key data in determining the APC payment rate are the coding and classification of services provided the patient based on the  __________ coding system.
    • A. 

      ICD-9

    • B. 

      HCPCS

    • C. 

      CPT

    • D. 

      All of the above

  • 23. 
    When patients are admitted to either a residential health care facility or a nursing home, physicians are required to prepare a written plan of care for treatment.
    • A. 

      T

    • B. 

      F

  • 24. 
    The RBRVS system includes the elimination of balance billing
    • A. 

      T

    • B. 

      F

  • 25. 
    An adjustment to the federal payment rate for LTCH stays that is considerably shorter than the average length of stay for an LTC-DRG is called
    • A. 

      ALOS

    • B. 

      Short-stay outlier

    • C. 

      Minimum-stay adjuster

    • D. 

      GPCI