Question 1

The ICD-9-CM book is divided into three volumes; Volume I is:

Accepted Answer

Volume I of the ICD-9-CM is a tabular list of diseases and injuries, organized to facilitate the coding of health information for statistical purposes.

Question 2

The coding guidelines are published by the AHA in Coding Clinic for ICD-9-CM. This is the only official publication for ICD-9-CM coding guidelines and advice, which include:

Accepted Answer

The Coding Clinic for ICD-9-CM, published by the AHA, includes official coding advice and guidelines, correct code assignments for new technologies, and practical information articles and topics, making all the options correct.

Question 3

The Medicare NCCI or the Correct Coding Initiative (CCI) was implemented to promote a __________ correct coding methodology and to control improper coding that can lead to inappropriate payments.

Accepted Answer

The Medicare National Correct Coding Initiative (NCCI) was implemented to promote a national correct coding methodology and to control improper coding leading to inappropriate payments, thus the correct answer is "national."

Question 4

In fee-for-service, the provider and the payer acted in __________ manner with regard to managing the revenue cycle.

Accepted Answer

In a fee-for-service model, the provider and payer typically act in a retrospective manner with regard to managing the revenue cycle, meaning that payment is made after services are rendered based on claims submitted by the provider.

Question 5

__________ is required to educate the patients on their responsibility for their encounters with the healthcare provider.

Accepted Answer

Financial counseling is required to educate patients on their responsibilities for their encounters with the healthcare provider, including understanding the costs involved and how their insurance coverage works.

Question 6

Medicare's National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) define specific __________ codes or conditions that will support coverage for the service or equipment.

Accepted Answer

The answer of Medicare's National Coverage Determinations (NCDs) and Local...

Question 7

The overall goal of the case manager is to __________ to find the optimum situation for all.

Accepted Answer

The overall goal of a case manager is to both improve the quality of care for the patient and balance the needs of the patient with the financial constraints or requirements of the payer, ensuring an optimum situation for all parties involved.

Question 8

__________ is a process in which all charges are documented, posted, and reconciled for all patients for all services and supplies that they may have received.

Accepted Answer

Charge capture is the process where all charges are documented, posted, and reconciled for all patients for all services and supplies they have received. This ensures that healthcare providers are accurately reimbursed for the services and supplies provided to patients.

Question 9

Medicare abuse may include:

Accepted Answer

Medicare abuse involves practices that may indirectly result in unnecessary costs to the Medicare program. This includes misusing codes on a claim (upcoding or unbundling codes to increase reimbursement), charging excessively for services or products, and billing for items or services that are not medically necessary. All these actions represent forms of abuse as they inflate healthcare costs without directly defrauding the system but still represent improper practices under Medicare guidelines.

Question 10

The __________ were created to perform program integrity functions in zones for Medicare Part A and Part B, Durable Medical Equipment (DME), Prosthetics, Orthotics, Supplies, Home Health and Hospice, and Medicare-Medicaid data matching.

Accepted Answer

Zone Program Integrity Contractors (ZPICs) were specifically created to perform program integrity functions across various zones for Medicare Part A and Part B, Durable Medical Equipment (DME), Prosthetics, Orthotics, Supplies, Home Health and Hospice, and Medicare-Medicaid data matching.

Question 11

The __________ component of a compliance program will help to evaluate if individuals are properly carrying out their responsibilities and claims are submitted appropriately.

Accepted Answer

Both auditing and monitoring are essential components of a compliance program. Auditing is a formal, systematic process to check if procedures are followed, and monitoring is an ongoing process that ensures day-to-day compliance. Together, they help evaluate if responsibilities are carried out properly and claims are submitted appropriately.

Question 12

Meaningful use is a provider's use of a certified EHR system to:

Accepted Answer

Meaningful Use is a program that was part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009. The program was designed to promote the adoption and meaningful use of health information technology, specifically electronic health records (EHRs). The goals of Meaningful Use include improving quality, safety, and efficiency in healthcare, which encompasses improving care coordination, reducing healthcare disparities, engaging patients and their families, ensuring adequate privacy and security protection for personal health information, and improving population and public health. Therefore, the correct answer is E, as it encompasses the primary objectives of the Meaningful Use program.

Question 13

During Stage 1, the 90 days of year 1 and the entire following year, a total of 24 objectives are included in a Core Set and a Menu Set of objectives. Out of these 24 total objectives, __________ of them must be met to successfully qualify for the incentive payment.

Accepted Answer

The answer of During Stage 1, the 90 days of...

Question 14

The EP must implement __________ clinical decision support tool(s) that make(s) sense for the practice and will trigger alerts or clinical information for the provider when encountering patients with certain treatments or diagnoses. All EPs must meet this objective as there is no exclusion for this objective.

Accepted Answer

The correct answer is one clinical decision support tool. This is because the requirement is for Eligible Professionals (EPs) to implement at least one clinical decision support tool that is relevant to their practice, which will provide alerts or clinical information for specific treatments or diagnoses.

Question 15

The EP must have more than______ of all unique patients who are seen with at least one entry in the EHR indicating that the patient is unaware of any problems or that the patient is not experiencing any problem. There are no exclusions for this objective.

Accepted Answer

The answer of The EP must have more than______ of...

Question 16

In the P4P, the care needs to be safe, effective, and:

Accepted Answer

In the Pay for Performance (P4P) model, healthcare services aim to be safe, effective, patient-centered, timely, efficient, and equitable, encompassing all the dimensions of quality healthcare.

Question 17

__________ measures the patient's perception of care received during a stay in the hospital or the care given as an outpatient.

Accepted Answer

Patient experience specifically measures the patient's perception of care received, whether during a hospital stay or as an outpatient. This includes aspects like communication with healthcare providers, understanding of the care plan, and overall satisfaction with the care received.

Question 18

Purchasers thinking of using or implementing P4P need to consider the idea of payment incentives and make sure that they fit into current strategies that may be in place, such as:

Accepted Answer

P4P, or Pay for Performance, strategies often complement existing healthcare strategies like private and public report cards and disease management programs. These elements work together to improve healthcare quality and efficiency.

Question 19

__________ covers the measure of Medicare Spending per Beneficiary (MSPB).

Accepted Answer

The Efficiency Domain covers the measure of Medicare Spending per Beneficiary (MSPB), focusing on the cost efficiency of care provided to Medicare beneficiaries.

Question 20

The VBP Program is funded through a process that __________ of the Diagnosis-Related Group (DRG) payments from participating hospitals.

Accepted Answer

The VBP (Value-Based Purchasing) Program funds itself by withholding a percentage of the Diagnosis-Related Group (DRG) payments from participating hospitals. This approach incentivizes hospitals to improve the quality of care.

Quiz 17: Financial and Administrative Aspects of Healthcare Organizations