Deck 2: Hospital-Based Care

Question 1

The physician sends the patient to the hospital for a radiological examination. The patient returns to the physician's office for follow-up of test results. From the point of view of the hospital, what type of hospital patient is this?

A) inpatient
B) emergency outpatient
C) clinic outpatient
D) referred outpatient

Answer 1

referred outpatient

Question 2

What is a program for the performance of elective surgical procedures on patients who are classified as outpatients and typically are released from the surgery center on the day of surgery, thus avoiding an overnight stay in the health care facility?

A) ambulatory surgery
B) partial hospitalization
C) adult day care
D) surgery clinic

Answer 2

ambulatory surgery

Question 3

Medicare Part A and Part B beneficiary information is maintained in __________________, allowing real-time eligibility requests for coverage using a secure closed private network to communicate with a CMS data center or via the CMS Extranet.

A) the HIPAA Eligibility Transaction System
B) ambulatory patient groups
C) uniform ambulatory care data sets
D) charge description masters

Answer 3

the HIPAA Eligibility Transaction System

Question 4

In the hospital setting, the term "resident" is primarily applied to_______ .

A) a licensed physician participating in an approved graduate medical education program
B) an outpatient evaluated and treated in the observation area of the hospital
C) a computer program that resides in RAM, used to diagnose emergency patients quickly
D) patients enrolled in the hospital's long­term ambulatory care program

Question 5

Select the TRUE statement below with regard to Medicare hospital outpatient reimbursement.

A) The hospital may be paid for only one RBRVS per day per patient
B) The hospital may be paid for only one APC per day per patient
C) The hospital may be paid for only one APC per patient per 72 hours
D) The hospital may be paid for more than one APC per patient visit

Question 6

Under EMTALA, hospitals that offer emergency services ___________________.

A) are free to refuse emergency services to patients who do not show proof of insurance
B) can refuse emergency services to patients as long as another hospital agrees to accept the patient as a transfer
C) must screen and stabilize, if necessary, any patient who arrives in the emergency department
D) must provide emergency services free of charge to a certain number of individual to meet the EMTALA charity obligations

Question 7

Partial hospitalization services are paid for under Ambulatory Payment Classifications (APCs) when _____________________.

A) received by unstable dialysis patients in a part of the hospital where patients generally do not stay overnight
B) psychiatric or behavioral health patients receive certain services and spend part of the day or the night in the hospital
C) an observation patient has been in the hospital for over 48 hours and the patient's condition still does not permit discharge to home
D) an inpatient length of stay is too short for a regular diagnosis related group (DRG) payment

Question 8

Which of the following statements is FALSE?

A) Documentation of telephone calls is an important element in good risk management for ambulatory care.
B) A hospital compliance officer may be concerned with avoiding fraudulent coding and billing as well as with monitoring compliance with federal regulations such as HIPAA.
C) Because of their knowledge of coding, health information managers can help review, revise, and maintain the hospital's chargemaster.
D) Hospitals receive Medicare reimbursement for ambulatory care through an outpatient prospective payment system (OPPS) based on DRGs.

Question 9

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

A) LTC-DRGs
B) PIP-DCGs
C) DRGs
D) RUGs

Question 10

Which of the following statements is TRUE?

A) Hospitals must be accredited by The Joint Commission.
B) Hospitals must be licensed by the state in which they are located.
C) Hospitals must have a hospitalist on staff to qualify for CMS certification.
D) Hospitals do not have to be licensed to admit patients.

Question 11

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 _____________________.

A) performed in a timely manner
B) professionally administered
C) medically necessary
D) critically assessed

Question 12

The Joint Commission requires that the medical record contain a summary list for each patient that should include all of the following EXCEPT ____________________.

A) significant medical diagnoses and conditions
B) significant operative and invasive procedures
C) adverse and allergic drug reactions
D) past insurance and billing accounts with significant balances

Question 13

Which of the following statements is FALSE in relation to documentation requirements specific to patients receiving urgent or immediate care?

A) When emergency, urgent, or immediate care is provided, the time and means of arrival are also documented in the medical record.
B) The medical record notes how long a patient receiving emergency, urgent, or immediate care had to wait for treatment.
C) The medical record of a patient receiving emergency, urgent, or immediate care notes the conclusions at termination of treatment including final disposition, condition at discharge, and instructions for follow -up care.
D) The medical record contains a copy of the information made available to practitioners or organizations providing follow-up care.

Question 14

Which audit initiative resulted in many teaching hospitals having to repay millions of dollars to the Medicare program because they lacked documentation to substantiate Medicare payments to faculty physicians who supervised residents?

A) PATH
B) EMTALA
C) MAC
D) HOPPS

Question 15

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 carriers with ________________________.

A) Medicare Payment Processors (MPPs)
B) Medicare Evaluation Boards (MEBs)
C) Medicare Administrative Contractors (MACs)
D) Medicare Revenue Exchanges (MREs)

Question 16

MS-DRGs differ from DRGs in that MS-DRGs take into account __________________.

A) patient demographic data such as address, insurance type, etc.
B) various levels of patient illness using secondary diagnoses.
C) whether the hospital is a "teaching" hospital or "non­teaching" hospital
D) whether the patient has had any previous hospitalizations

Question 17

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

A) must be billed separately from the inpatient bill
B) must not be billed separately from the inpatient bill
C) must be written off as "uncollectable" expenses
D) must be billed prior to the inpatient admission

Question 18

Which of the following statements is FALSE in relation to APC status indicators?

A) "S" represents a significant service that is not discounted when more than one APC is present on a claim.
B) "T" represents a significant procedure that is discounted when other procedures are performed with it.
C) "P" represents a partial hospitalization service.
D) "V" represents those services which are not billable under the OPPS.

Question 19

For certain categories of encounter­based hospital outpatient services, "Composite APCs" result in _______________________.

A) only a single payment for certain common combination services provided on the same day of service
B) individual payments for each service provided during the outpatient visit
C) additional payments for hospital supplies and technical assistance
D) zero payments due to the fact that these services are not covered by Medicare

Question 20

Which of the following is NOT one of the payment mechanisms created by Medicare to discourage the transfer of patients between the LTCH and other facilities for financial rather than clinical reasons?

A) The "Interrupted Stay" Rule
B) The "5 Percent" Rule
C) The "10 Day" Rule
D) The "25 Percent" Rule

Question 21

The standard form for submitting information to third-party payers when filing claims for hospital services is the ______________.

A) UB-04
B) CMS 1500
C) DRG 919
D) APC 8000

Question 22

HCPCS "Level II" or national codes refer to_____ .

A) CPT codes
B)ICD-9-CM codes
C) APC codes
D) codes that CMS developed

Question 23

In most hospitals, the patient record starts with the ___________________.

A) registration process
B) initial evaluation by nursing staff
C) first physician visit
D) discharge process

Question 24

The legislative act that provides incentives to health care providers who utilize EHRs to enhance the quality of care provided their patients is the _____________________________.

A) Emergency Medical Treatment and Active Labor Act (EMTALA)
B) American Recovery and Reinvestment Act (ARRA)
C) Health Insurance Portability and Accountability Act (HIPAA)
D) Electronic Health Record Adoption Act (EHRAA)

Question 25

Which of the following uses of electronic systems can enhance patient safety?

A) Use of computerized provider order entry (CPOE) for orders directly entered by authorizing provider
B) Record smoking status for patients 13 years old or older
C) Check insurance eligibility electronically from public and private payers
D) Use of voice recognition systems in radiology

Question 26

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

A) meaningful use activities
B) potentially compensable events
C) disagreements between staff members
D) ICU patients who are transferred to LTACHs

Question 27

Mr. Smith goes to the emergency room at Northpark Hospital complaining of chest pain. He states that he does not have health insurance and does not have the money to immediately pay for treatment. According to EMTALA, the hospital must _______________________.

A) refuse to treat Mr. Smith if the ER physician is not willing to admit him to the hospital for full treatment
B) explain all billing practices including collection agency policies before Mr. Smith can be treated
C) screen and stabilize Mr. Smith before attempting to transfer him to another facility
D) contact CMS to verify that Mr. Smith qualifies for public assistance

Question 28

All of the following are potential roles for HIM professionals within a hospital setting EXCEPT __________________.

A) Performance Improvement Analyst
B) Coding Supervisor
C) Cancer Registrar
D) Chief Medical Officer
E) EHR Implementation Specialist

Question 29

Amy Williams is the HIPAA Compliance Officer for Wayne County Hospital. In her role she will be expected to _________________.

A) audit records against codes submitted
B) purchase supplies for the operating room suite
C) ensure insurance information is obtained upon patient admission
D) track patient disposition after discharge

Question 30

The ______________ involves all of the activities from pricing to selling of health care services and then collecting what is owed from the purchaser for those services.

A) APC System
B) Revenue Cycle
C) HIPAA Program
D) Utilization Review Plan

Question 31

A computer file that contains a list of the Healthcare Common Procedural Coding System (HCPCS) codes and associated charges for the services provided to hospital patients is referred to as a ______________________.

A) fiscal intermediary
B) revenue code
C) chargemaster
D) status indicator

Question 32

Dr. Moore admits Mary Knight to Tanner Hospital for observation. If he feels that Mary meets the criteria for admission as an inpatient, Dr. Moore must generally make that decision within a ___________ timeframe.

A) 12-hour
B) 24-hour
C) 48-hour
D) 72-hour

Question 33

Under an inpatient prospective payment system (IPPS) that pays a hospital according to the diagnosis related group (DRG) assigned to each patient's stay, what would the payment be for a DRG with a relative weight of 1.75 if the hospital's PPS rate is $8,225?

A) $4,700.00
B) $14,393.75
C) $21,276.60
D) Not enough information to calculate

Question 34

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 __________________.

A) disproportionate share hospital payments
B) experimental incentives
C) research and development incentives
D) pass-through payments

Question 35

The __________ specifies definitions and rules for selecting the principal diagnosis, other diagnoses, principal procedure, and several other elements that are critical in DRG assignment and payment for hospital-based care.

A) UHDDS
B) UACDS
C) DEED
D) NCVHS

Question 36

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

Question 37

Hospital clinics are often organized by medical specialty to facilitate medical education

Question 38

Hospital observation services may be billed to all payers as outpatient services for observation stays up to 72 hours.

Question 39

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

Question 40

A hospitalist is a physician who provides comprehensive care to hospitalized patients, but who does not ordinarily see patients outside of the hospital setting.

Question 41

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

Question 42

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.

Question 43

When a resident, as part of his or her graduate medical education, participates with a teaching physician in providing a service, the teaching physician cannot receive reimbursement for the service from Medicare under any circumstances.

Question 44

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

Question 45

A hospital would likely be reimbursed for more than one APC for an emergency department patient whose visit includes evaluation and management, X-rays, and a procedure.

Question 46

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

Question 47

With regard to Medicare, hospitals should bill separately any charges for ancillary services provided on an outpatient basis within 72 hours prior to an inpatient admission.

Question 48

A revenue code appropriate to the HCPCS code listed with it must be included on the bill for outpatient services or the claim may be rejected.

Question 49

Voice recognition systems are becoming more common in hospital emergency departments.

Question 50

Potentially compensable events (PCEs) are occurrences that may result in litigation against the health care provider or that may require the health care provider to compensate an injured party.

Question 51

The hospitalist is a specialist dealing with conditions that require hospitalization and is therefore not distracted by the duties of seeing patients in the clinic setting.

Question 52

Medical visits in a hospital clinic or emergency department (ED) are classified and paid according to level of service based on evaluation and management (E&M) codes assigned according to each individual hospital's own criteria.

Question 53

The Healthcare Common Procedural Coding System (HCPCS) is the system required by CMS for coding hospital outpatient services provided to Medicare patients.

Question 54

?Give three examples of benefits of electronic health records in hospitals.

Question 55

?Describe three data elements for DEEDS.

Question 56

Describe two roles where an HIM professional can utilize his or her skills in a hospital setting.​

Question 57

Describe the difference between the following types of patients: clinic outpatient, referred hospital outpatient, emergency outpatient​

Question 58

Describe what utilization management is and how it helps health care facilities.​

Question 59

Describe how a compliance officer benefits a health care facility.​