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?

Accepted Answer

This patient is considered a referred outpatient from the hospital's perspective because they were sent to the hospital specifically for a radiological examination and then returned to the referring physician's office for follow-up, indicating they were not admitted to the hospital for an overnight stay.

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?

Accepted Answer

Ambulatory surgery refers to surgical procedures done on an outpatient basis, allowing patients to go home the same day without the need for an overnight hospital stay.

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.

Accepted Answer

The HIPAA Eligibility Transaction System (HETS) is designed to allow for real-time eligibility requests for Medicare coverage, using a secure network to communicate with CMS data centers or through the CMS Extranet. This system helps in maintaining Medicare Part A and Part B beneficiary information efficiently.

Question 4

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

Accepted Answer

A resident in the hospital setting refers to a licensed physician who is undergoing further training in a specialized area of medicine through an approved graduate medical education program. This period follows the completion of medical school and is a requirement for the physician to become fully licensed in their specialty.

Question 5

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

Accepted Answer

Medicare hospital outpatient services are reimbursed under the Outpatient Prospective Payment System (OPPS), which uses Ambulatory Payment Classifications (APCs) to determine payment. Hospitals can be paid for multiple APCs during a single patient visit if multiple services are provided, reflecting the resources used for each service.

Question 6

Under EMTALA, hospitals that offer emergency services ___________________.

Accepted Answer

Under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals that have an emergency department are required to provide a medical screening examination to anyone who comes to the emergency department and requests care, to determine if an emergency medical condition exists. If such a condition is found, the hospital is then obligated to either provide treatment until the patient is stabilized or to transfer the patient to another hospital that can provide the necessary treatment. This requirement applies regardless of the patient's insurance status or ability to pay.

Question 7

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

Accepted Answer

Partial hospitalization services are specifically designed for psychiatric or behavioral health patients who require intensive treatment but do not need 24-hour care. These services allow patients to spend part of the day or night in the hospital for treatment.

Question 8

Which of the following statements is FALSE?

Accepted Answer

Hospitals receive Medicare reimbursement for ambulatory care through the Outpatient Prospective Payment System (OPPS), which is based on Ambulatory Payment Classifications (APCs), not Diagnosis-Related Groups (DRGs). DRGs are used for inpatient hospital services.

Question 9

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

Accepted Answer

Medicare payments to long-term acute-care hospitals (LTACHs) are based on Long-Term Care Diagnosis-Related Groups (LTC-DRGs). This system is specifically designed to account for the higher level of care and longer stays typical of LTACHs compared to standard acute-care hospitals.

Question 10

Which of the following statements is TRUE?

Accepted Answer

Hospitals must be licensed by the state in which they are located to ensure they meet certain regulatory standards and requirements. This is a fundamental requirement for operation and to ensure patient safety and quality of care.

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 _____________________.

Accepted Answer

The correct answer is C) medically necessary because without documented information on diagnoses or symptoms, a hospital cannot prove that a test was required for medical reasons, which is essential for justifying the test's necessity and for insurance or regulatory purposes.

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 ____________________.

Accepted Answer

The Joint Commission's requirements for a summary list in the medical record focus on clinical and treatment-related information, such as diagnoses, procedures, and drug reactions, rather than financial or insurance information. Therefore, past insurance and billing accounts with significant balances are not required to be included in the summary list.

Question 13

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

Accepted Answer

The statement that is false in relation to documentation requirements for patients receiving urgent or immediate care is that the medical record notes how long a patient had to wait for treatment. While documentation typically includes the time and means of arrival, conclusions at termination of treatment, and information for follow-up care, specific wait times are not a standard documentation requirement.

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?

Accepted Answer

The Professional Activity Study (PATH) audit initiative led to many teaching hospitals having to repay millions of dollars to the Medicare program due to insufficient documentation for Medicare payments to faculty physicians overseeing residents.

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 ________________________.

Accepted Answer

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 led to the replacement of past claims processing contractors, known as fiscal intermediaries and Medicare carriers, with Medicare Administrative Contractors (MACs). These entities are responsible for processing Medicare Part A and Part B medical claims from hospitals, physicians, and other healthcare providers.

Question 16

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

Accepted Answer

MS-DRGs (Medicare Severity Diagnosis Related Groups) differ from the basic DRGs by incorporating the severity of illness and the risk of mortality by taking into account secondary diagnoses, which can affect the patient's treatment plan and resource use.

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 __________________________.

Accepted Answer

Outpatient services provided within 72 hours before a related inpatient admission to a Medicare patient must be included on the inpatient bill and not billed separately. This is to avoid duplicate billing for services related to the inpatient admission.

Question 18

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

Accepted Answer

APC status indicator "V" actually represents clinic or emergency department visits that are payable under the OPPS. It does not signify services that are not billable under the OPPS. Each of the other statements correctly describes the meaning of the respective APC status indicators: "S" for significant services not discounted, "T" for significant procedures that are discounted when performed with other procedures, and "P" for partial hospitalization services.

Question 19

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

Accepted Answer

Composite Ambulatory Payment Classifications (APCs) are designed to provide a single payment for certain combinations of services that are commonly provided together during a hospital outpatient visit, rather than paying individually for each service. This approach aims to encourage efficiency in service delivery.

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?

Accepted Answer

The "10 Day" Rule is not a recognized payment mechanism by Medicare aimed at discouraging the transfer of patients between Long-Term Care Hospitals (LTCHs) and other facilities for financial reasons. The "Interrupted Stay" Rule, the "5 Percent" Rule, and the "25 Percent" Rule are all mechanisms designed to regulate patient transfers and admissions to ensure they are based on clinical needs rather than financial incentives.

Quiz 2: Hospital-Based Care

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?

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?

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.

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

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

Under EMTALA, hospitals that offer emergency services ___________________.

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

Which of the following statements is FALSE?

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

Which of the following statements is TRUE?

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 _____________________.

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

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

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?

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 ________________________.

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

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 __________________________.

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

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

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?

Quiz 2: Hospital-Based Care

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?

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?

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.

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

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

Under EMTALA, hospitals that offer emergency services ___________________.

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

Which of the following statements is FALSE?

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

Which of the following statements is TRUE?

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 _____________________.

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

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

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?

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 ________________________.

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

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 __________________________.

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

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

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?

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