HCAD640 - week 6 - All correct

Asked by sharpie
Dated: 5th Jul'18 05:38 AM
Bounty offered: $35.00

What factor is medical necessity based on?

Question 1 options:

 

A)

The beneficial effects of a service for the patient’s physical needs and quality of life

 

B)

The cost of a service compared with the beneficial effects on the patient’s health

 

C)

The availability of a service at the facility

 

D)

The reimbursement available for a given service

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Question 2(1 point)

 

The first prospective payment system (PPS) for inpatient care was developed in 1983. The newest PPS is used to manage the costs for

Question 2 options:

 

A)

medical homes.

 

B)

assisted living facilities.

   
   

 

C)

home health care

 

D)

inpatient psychiatric facilities

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Question 3(1 point)

 

The category “Commercial payers” includes private health information and

Question 3 options:

 

A)

employer-based group health insurers.

 

B)

Medicare/Medicaid.

 

C)

TriCare

 

D)

Blue Cross and Blue Shield

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Question 4(1 point)

 

The prospective payment system used to reimburse hospitals for Medicare hospital outpatients is called

Question 4 options:

 

A)

MS-DRGs

 

B)

APGs

 

C)

RBRVS

 

D)

APCs.

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Question 5(1 point)

 

Under APCs, the payment status indicator "N" means that the payment

Question 5 options:

 

A)

is packaged into the payment for other services.

   
   
   

 

B)

is for ancillary services.

 

C)

is discounted at 50%.

 

D)

is for a clinic or an emergency visit.

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Question 6(1 point)

 

Under the APC methodology, discounted payments occur when

Question 6 options:

 

A)

there are two or more (multiple) procedures that are assigned to status indicator "S."

 

B)

there are two or more (multiple) procedures that are assigned to status indicator "T."

 

C)

modifier-78 is used to indicate a procedure is terminated after the patient is prepared but before anesthesia is started.

 

D)

pass-through drugs are assigned to status indicator "K."

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Question 7(1 point)

 

What prospective payment system reimburses the provider according to prospectively determined rates for a 60-day episode of care?

Question 7 options:

 

A)

long-term care Medicare severity diagnosis-related groups

 

B)

home health resource groups

 

C)

inpatient rehabilitation facility

 

D)

the skilled nursing facility prospective payment system

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Question 8(1 point)

 

The 2017 Hospital Value-Based Purchasing (Hospital VBP) Program adjusts a hospital's payments based on their performance in all of these domains except

Question 8 options:

 

A)

the Patient & Caregiver Centered Experience of Care/Care Coordination Domain

 

B)

the Clinical Care Domain

 

C)

the Safety Domain

 

D)

the Efficiency & Cost Reduction Domain

 

E)

the Risk and Quality Domain

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Question 9(1 point)

 

These are financial protections to ensure that certain types of facilities (e.g., children's hospitals) recoup all of their losses due to the differences in their APC payments and the pre-APC payments.

Question 9 options:

 

A)

limiting change

 

B)

pass through

 

C)

indemnity insurance

 

D)

hold harmless

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Question 10(1 point)

 

Under the inpatient prospective payment system (IPPS), there is a 3-day payment window (formerly referred to as the 72-hour rule). This rule requires that outpatient preadmission services that are provided by a hospital up to three calendar days prior to a patient's inpatient admission be covered by the IPPS MS-DRG payment for

Question 10 options:

 

A)

diganostic services and therapeutic (or nondiagnostic) services whereby the inpatient principal diagnosis code (ICD-10-CM) exactly matches the code used for preadmission services.

 

B)

diagnostic services.

 

C)

therapeutic (or nondiagnostic) services whereby the inpatient principal diagnosis code (ICD-10-CM) does not match the code used for preadmission services.

 

D)

therapeutic (or nondiagnostic) services whereby the inpatient principal diagnosis code (ICD-10-CM) exactly matches the code used for preadmission services.

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Question 11(1 point)

 

Under APCs, payment status indicator "T" means

Question 11 options:

 

A)

significant procedure, multiple procedure reduction applies.

 

B)

significant procedure, not discounted when multiple.

 

C)

clinic or emergency department visit (medical visits).

 

D)

ancillary services.

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Question 12(1 point)

 

_______________________ offers voluntary, supplemental medical insurance to help pay for physician's services, outpatient hospital services, medical services, and medical-surgical supplies not covered by the hospitalization plan.

Question 12 options:

 

A)

Medicare A

 

B)

Medicare B

 

C)

Medicare C

 

D)

Medicare D

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Question 13(1 point)

 

Under APCs, payment status indicator "C" means

Question 13 options:

 

A)

significant procedure, not discounted when multiple.

 

B)

inpatient procedures/services.

 

C)

ancillary services.

 

D)

significant procedure, multiple procedure reduction applies.

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Question 14(1 point)

 

The prospective payment system based on resource utilization groups (RUGs) is used for reimbursement to ____________________ for patients with Medicare.

Question 14 options:

 

A)

intermediate care facilities

 

B)

freestanding ambulatory surgery centers

 

C)

hospital-based outpatients

 

D)

skilled nursing facilities

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Question 15(1 point)

 

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Most of the children who are seen at MMBC will have a well child visit and two immunizations. If you add the reimbursement for two immunizations to the reimbursement for each well child visit, which insurance company benefits MMBC most?

Question 15 options:

 

A)

SureHealth

 

B)

Getwell

 

C)

Lifecare

 

D)

BeHealthy

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Question 16(1 point)

 

APCs are groups of services that the OPPS will reimburse. Which one of the following services is not included in APCs?

Question 16 options:

 

A)

screening exams

 

B)

preventative services

 

C)

organ transplantation

 

D)

radiation therapy

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Question 17(1 point)

 

Commercial insurance plans usually reimburse health care providers under some type of __________ payment system, whereas the federal Medicare program uses some type of _________ payment system.

Question 17 options:

 

A)

prospective, concurrent

 

B)

retrospective, concurrent

 

C)

prospective, retrospective

 

D)

retrospective, prospective

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Question 18(1 point)

 

The prospective payment system used to reimburse home health agencies for patients with Medicare utilizes data from the:

Question 18 options:

 

A)

UACDS (Uniform Ambulatory Core Data Set).

 

B)

MDS (Minimum Data Set).

 

C)

UHDDS (Uniform Hospital Discharge Data Set).

 

D)

OASIS (Outcome and Assessment Information Set).

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Question 19(1 point)

 

If fewer high school graduates pursue a career in Health Informatics Administration (HIMS) and Health Care Administration (HCAD), what effects will this have on healthcare markets? With the plans to repeal the Affordable Care Act (ACT) also coined as the "Obama Care", what effect will a decline in the number of HIMS & HCAD graduates have?

Question 19 options:

 

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Question 20(1 point)

 

Prices serve various purposes, including the price of providing healthcare services and treatments. Identify and briefly explain at least three (2) purposes. and provide an example for each.

Question 20 options:

 

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Question 21(1 point)

 

Why are hospitals able to charge different purchasers different

prices for the same medical services

Question 21 options:

 

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Question 22(1 point)

 

Explain how cost shifting differs from price discrimination.

Question 22 options:

 

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Question 23(1 point)

 

Briefly compare and contrast each of the following: managed fee-for-service plans, HMOs, POS plans and PPOs.

Question 23 options:

 

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Question 24(1 point)

 

What is the primary distinction between prospective payment and retrospective payment?

Question 24 options:

 

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Question 25(1 point)

 

Which of the following is the primary payer for acute-care (hospital) services?

Question 25 options:

 

A)

Medicaid

 

B)

Government payers (all sources)

 

C)

Private payers

 

D)

None of the above

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Question 26(1 point)

 

One use of financial information is to assess the efficiency of operations. In that context,

efficiency refers to:

Question 26 options:

 

A)

the degree of financial viability achieved by the organization

 

B)

the degree to which the organization is in compliance with directives

 

C)

the extent to which malfeasance

is minimized in the organization

 

D)

the ratio of the organization’s outputs to its inputs

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Question 27(1 point)

 

The controller in a hospital is usually responsible for which of the following activities (choose all that apply):

Question 27 options:

 

A)

Collection of accounts receivable

 

B)

Developing budgets

 

C)

Filing Medicare cost reports

 

D)

B and C

 

E)

All of the above

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Question 28(1 point)

 

Which of the following is the primary goal of a not-for-profit healthcare organization?

Question 28 options:

 

A)

To serve the community through the provision of health care services

 

B)

To balance revenues with expenses

 

C)

To provide jobs for those in the communit

 

D)

To deliver very high-quality

health care services

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Question 29(1 point)

 

Culver County Hospital has the lowest cost of any hospital in its region. However, it has

continually reported very large operating losses and has depended upon tax support from

the county. Assuming that positive operating margins

are an objective of Culver County Hospital, the hospital could be described as:

Question 29 options:

 

Efficient and effective

 

Effective but not efficient

 

Efficient but not effective

 

None of the above

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Question 30(1 point)

 

A department manager most often uses his or her hospitals’ financial information for which of the following uses:

Question 30 options:

 

A)

Assess the financial condition of the hospital

 

B)

Assess the efficiency of operations

 

C)

Evaluate the hospital’s stewardship

 

D)

Assess the effectiveness of operations

 

HCAD640 - week 6 - All correct
Answered by sharpie
Expert Rating: 385 Ratings
Dated: 5th Jul'18 05:38 AM
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