Question 1

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

Accepted Answer

Hospitals accredited by The Joint Commission, Healthcare Facilities Accreditation Program (HFAP), or Det Norske Veritas Germanischer Lloyd (DNV) are recognized as meeting the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation, which are the regulatory standards hospitals must meet to participate in Medicare and Medicaid.

Question 2

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.

Accepted Answer

The Joint Commission requires that the records of patients receiving continuing ambulatory care services include a summary list of significant diagnoses, conditions, procedures, drug allergies, and medications to ensure comprehensive and coordinated care.

Question 3

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.

Accepted Answer

Teaching physicians can receive reimbursement from Medicare for services provided in conjunction with residents under certain conditions, such as when the teaching physician is physically present during the critical or key portions of the service or procedure.

Question 4

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.

Accepted Answer

The PATH (Physicians at Teaching Hospitals) audits found that teaching physician documentation often did not support the level of service billed to Medicare, leading to significant repayments to Medicare.

Question 5

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.

Accepted Answer

APCs, or Ambulatory Payment Classifications, are used in the outpatient setting to classify services and procedures for payment purposes. A patient receiving multiple services, such as evaluation and management, X-rays, and a procedure, would likely generate more than one APC, leading to multiple reimbursements for the different types of services provided during their visit.

Question 6

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

Accepted Answer

The hospital chargemaster is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider, which includes charges for ancillary services such as laboratory and radiology.

Question 7

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.

Accepted Answer

Medicare requires that hospitals include any charges for outpatient services provided within the 72 hours prior to an inpatient admission as part of the inpatient claim, rather than billing them separately, under the "3-day (or 1-day) payment window" rule.

Question 8

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.

Accepted Answer

Revenue codes are used on hospital bills to tell the insurance companies what type of service was provided, and they must match the Healthcare Common Procedure Coding System (HCPCS) codes for the claim to be processed correctly. If they do not match, the claim may be rejected.

Question 9

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

Accepted Answer

Voice recognition systems are increasingly being used in hospital emergency departments to improve efficiency and accuracy in patient documentation, allowing healthcare professionals to quickly record and access patient information.

Question 10

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.

Accepted Answer

Potentially compensable events (PCEs) are incidents or occurrences within the healthcare setting that could lead to legal action or the need for compensation due to harm or injury to a patient, indicating a possible failure in the standard of care provided.

Question 11

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.

Accepted Answer

Hospitalists specialize in the care of patients in the hospital setting, focusing on those who are acutely ill and require hospitalization, which allows them to not be distracted by outpatient clinic duties.

Question 12

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.

Accepted Answer

E&M codes are assigned according to each individual hospital's own criteria.

Question 13

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

Accepted Answer

The Healthcare Common Procedure Coding System (HCPCS) is indeed the coding system used by healthcare providers to bill Medicare and other health insurance programs for services provided to patients, including hospital outpatient services.

Question 14

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

Accepted Answer

The answer of ?Give three examples of benefits of electronic...

Question 15

?Describe three data elements for DEEDS.

Accepted Answer

The answer of ?Describe three data elements for DEEDS....

Question 16

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

Accepted Answer

The answer of Describe two roles where an HIM professional...

Question 17

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

Accepted Answer

The answer of Describe the difference between the following types...

Question 18

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

Accepted Answer

The answer of Describe what utilization management is and how...

Question 19

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

Accepted Answer

The answer of Describe how a compliance officer benefits a...

Quiz 2: Hospital-Based Care