Question 1

Why is the MDS for LTC so different from the UHDDS?

Accepted Answer

Because length of stay and intensity of care vary dramatically in LTC, regardless of the diagnosis, the data set must reflect all of the issues and the treatments for each. UHDDS does not contain sufficient data fields to convey that level of detail.

Question 2

Referring to health care provider fees, the rate established by an insurance company, based on the regional charges for the particular service, is called ___________.

Accepted Answer

usual and customary fees

Question 3

The potential exposure to loss, financial expenditure, and/or other undesirable events is called _________.

Accepted Answer

risk

Question 4

The party that assumes the risk of paying some or all of the cost of providing health care services in return for the payment of a premium by or on behalf of the individual is the ___________.

Accepted Answer

The answer of The party that assumes the risk of...

Question 5

The systematic collection of specific charges for services rendered to a patient is called ___________.

Accepted Answer

The answer of The systematic collection of specific charges for...

Question 6

CMS's prospective payment system for hospital-based ambulatory care is based on ___________.

Accepted Answer

ambulatory

Question 7

Under normal circumstances, prospective payment systems take into consideration all of the following EXCEPT:

Accepted Answer

A)  Actual current charges 
B)  Diagnosis 
C)  Historical average charges 
D)  Procedures (treatments) 
A)  Actual current charges 
B)  Diagnosis 
C)  Historical average charges 
D)  Procedures (treatments)

Question 8

Medicare uses __________ to process its claims and reimbursements.

Accepted Answer

fiscal int

Question 9

An organization that insures covered lives as well as owns (exerts employer control over) the health care providers is a(n):

Accepted Answer

A)  Health maintenance organization 
B)  Preferred provider organization 
C)  Indemnity company 
D)  Blue Cross organization 
A)  Health maintenance organization 
B)  Preferred provider organization 
C)  Indemnity company 
D)  Blue Cross organization

Question 10

An HMO contracted with a group of physicians to provide health care services to its members. This is characteristic of a(n) _____ model HMO.

Accepted Answer

A)  Staff 
B)  Group practice 
C)  Independent practice association 
D)  All of the above 
A)  Staff 
B)  Group practice 
C)  Independent practice association 
D)  All of the above

Question 11

Health care insurance involves the assumption of the risk of financial loss by a party other than the patient. Describe how insurance companies can afford to assume such risk.

Accepted Answer

Risk is the danger that an activity will

Question 12

The exchange of cash, goods, or services for professional services rendered at a specific rate, typically determined by the provider, and associated with specific activities (such as a physical examination) is called __________.

Accepted Answer

The answer of The exchange of cash, goods, or services...

Question 13

How would someone use an unbilled list (DNFB)?

Accepted Answer

Monitor each account on a dail

Question 14

Patients are "grouped" into the same DRG because they have all of the following criteria in common EXCEPT similar:

Accepted Answer

A)  Diagnosis 
B)  Resource intensity 
C)  Treatment 
D)  Length of stay 
A)  Diagnosis 
B)  Resource intensity 
C)  Treatment 
D)  Length of stay

Question 15

Any of several reimbursement methods that pay an amount predetermined by the payer, based of the diagnosis, procedures, and other factors (depending on setting) rather than actual, current resources expended by the provider, is called ________.

Accepted Answer

The answer of Any of several reimbursement methods that pay...

Question 16

The federal law that established Medicare PPS is __________.

Accepted Answer

Tax Equity and Fisca

Question 17

Insurance policies that supplement Medicare coverage are called _________.

Accepted Answer

The answer of Insurance policies that supplement Medicare coverage are...

Question 18

The exchange of cash for professional services rendered, at a rate less than the normal fee for the service, is called ___________.

Accepted Answer

discounted

Question 19

Explain the difference in healthcare coverage between an HMO and PPO for the patient.

Accepted Answer

For the patient: The HMO requires patien

Question 20

The systematic reimbursement to a health care provider based on the number of patients contractually in the physician's care, regardless of diagnoses or services rendered, is called ___________.

Accepted Answer

The answer of The systematic reimbursement to a health care...

Why is the MDS for LTC so different from the UHDDS?

Referring to health care provider fees, the rate established by an insurance company, based on the regional charges for the particular service, is called ___________.

The potential exposure to loss, financial expenditure, and/or other undesirable events is called _________.

The party that assumes the risk of paying some or all of the cost of providing health care services in return for the payment of a premium by or on behalf of the individual is the ___________.

The systematic collection of specific charges for services rendered to a patient is called ___________.

CMS's prospective payment system for hospital-based ambulatory care is based on ___________.

Under normal circumstances, prospective payment systems take into consideration all of the following EXCEPT:

Medicare uses __________ to process its claims and reimbursements.

An organization that insures covered lives as well as owns (exerts employer control over) the health care providers is a(n):

An HMO contracted with a group of physicians to provide health care services to its members. This is characteristic of a(n) _____ model HMO.

Health care insurance involves the assumption of the risk of financial loss by a party other than the patient. Describe how insurance companies can afford to assume such risk.

The exchange of cash, goods, or services for professional services rendered at a specific rate, typically determined by the provider, and associated with specific activities (such as a physical examination) is called __________.

How would someone use an unbilled list (DNFB)?

Patients are "grouped" into the same DRG because they have all of the following criteria in common EXCEPT similar:

Any of several reimbursement methods that pay an amount predetermined by the payer, based of the diagnosis, procedures, and other factors (depending on setting) rather than actual, current resources expended by the provider, is called ________.

The federal law that established Medicare PPS is __________.

Insurance policies that supplement Medicare coverage are called _________.

The exchange of cash for professional services rendered, at a rate less than the normal fee for the service, is called ___________.

Explain the difference in healthcare coverage between an HMO and PPO for the patient.

The systematic reimbursement to a health care provider based on the number of patients contractually in the physician's care, regardless of diagnoses or services rendered, is called ___________.

Health Care Delivery Systems

Collecting Health Care Data

Electronic Health Records

Acute Care Records

Health Information Management Processing

Code Sets

Health Information Management Issues in Other Care Settings

Managing Health Records

Statistics

Quality and Uses of Health Information

Confidentiality and Compliance

Him Department Management

Training and Development

Filters

Exam 7: Reimbursement

Why is the MDS for LTC so different from the UHDDS?

Referring to health care provider fees, the rate established by an insurance company, based on the regional charges for the particular service, is called ___________.

The potential exposure to loss, financial expenditure, and/or other undesirable events is called _________.

The party that assumes the risk of paying some or all of the cost of providing health care services in return for the payment of a premium by or on behalf of the individual is the ___________.

The systematic collection of specific charges for services rendered to a patient is called ___________.

CMS's prospective payment system for hospital-based ambulatory care is based on ___________.

Under normal circumstances, prospective payment systems take into consideration all of the following EXCEPT:

Medicare uses __________ to process its claims and reimbursements.

An organization that insures covered lives as well as owns (exerts employer control over) the health care providers is a(n):

An HMO contracted with a group of physicians to provide health care services to its members. This is characteristic of a(n) _____ model HMO.

Health care insurance involves the assumption of the risk of financial loss by a party other than the patient. Describe how insurance companies can afford to assume such risk.

The exchange of cash, goods, or services for professional services rendered at a specific rate, typically determined by the provider, and associated with specific activities (such as a physical examination) is called __________.

How would someone use an unbilled list (DNFB)?

Patients are "grouped" into the same DRG because they have all of the following criteria in common EXCEPT similar:

Any of several reimbursement methods that pay an amount predetermined by the payer, based of the diagnosis, procedures, and other factors (depending on setting) rather than actual, current resources expended by the provider, is called ________.

The federal law that established Medicare PPS is __________.

Insurance policies that supplement Medicare coverage are called _________.

The exchange of cash for professional services rendered, at a rate less than the normal fee for the service, is called ___________.

Explain the difference in healthcare coverage between an HMO and PPO for the patient.

The systematic reimbursement to a health care provider based on the number of patients contractually in the physician's care, regardless of diagnoses or services rendered, is called ___________.

Health Care Delivery Systems

Collecting Health Care Data

Electronic Health Records

Acute Care Records

Health Information Management Processing

Code Sets

Health Information Management Issues in Other Care Settings

Managing Health Records

Statistics

Quality and Uses of Health Information

Confidentiality and Compliance

Him Department Management

Training and Development

Filters