Healthcare Administration Discussion Assignment

Healthcare Administration Discussion Assignment

Question 1 (1 point)

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What factor is medical necessity based on?

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

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B)

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

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C)

The availability of a service at the facility

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D)

The reimbursement available for a given service

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Question 2 (1 point)

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

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medical homes.

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B)

assisted living facilities.

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C)

home health care

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D)

inpatient psychiatric facilities

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Question 3 (1 point)

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The category “Commercial payers” includes private health information and

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employer-based group health insurers.

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B)

Medicare/Medicaid.

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C)

TriCare

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D)

Blue Cross and Blue Shield

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Question 4 (1 point)

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LCDs and NCDs are review policies that describe the circumstances of coverage for various types of medical treatment. They advise physicians which services Medicare considers reasonable and necessary and may indicate the need for an advance beneficiary notice. They are developed by the Centers for Medicare and Medicaid Services (CMS) and Medicare Administrative Contractors. LCD and NCD are acronyms that stand for

Question 4 options:

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local contractor’s decisions and national contractor’s decisions.

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B)

list of covered decisions and noncovered decisions.

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C)

local covered determinations and noncovered determinations.

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D)

local coverage determinations and national coverage determinations.

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Question 5 (1 point)

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A Medicare patient was seen by Dr. Zachary, who is a nonparticipating physician. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The Medicare Fee Schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termed as “balance billing,” which means that the patient is

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financially liable for charges in excess of the Medicare Fee Schedule, up to a limit.

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B)

financially liable for the Medicare Fee Schedule amount.

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C)

financially liable for only the deductible.

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D)

not financially liable for any amount.

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Question 6 (1 point)

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CMS adjusts the Medicare Severity DRGs and the reimbursement rates every

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quarter

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B)

calendar year beginning January 1

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C)

month

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D)

fiscal year beginning October 1

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Question 7 (1 point)

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

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A)

MS-DRGs

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B)

APGs

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C)

RBRVS

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D)

APCs.

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Question 8 (1 point)

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An Advance Beneficiary Notice (ABN) is a document signed by the

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physician advisor indicating that the patient’s stay is denied.

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provider indicating that Medicare will not pay for certain services.

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C)

patient indicating whether he/she wants to receive services that Medicare probably will not pay for.

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D)

utilization review coordinator indicating that the patient stay is not medically necessary

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Question 9 (1 point)

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In a global payment methodology, which is sometimes applied to radiological and similar types of procedures that involve professional and technical components, all of the following are part of the “technical” components EXCEPT

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radiological supplies.

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B)

physician services.

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C)

radiologic technicians.

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D)

radiological equipment.

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Question 10 (1 point)

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The standard claim form used by hospitals to request reimbursement for inpatient and outpatient procedures performed or services provided is called the

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UB-04

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B)

CMS-1491

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C)

CMS-1500

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D)

CMS-1600

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Question 11 (1 point)

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A Medicare Summary Notice (MSN) is sent to ________ as their EOB.

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patients (beneficiaries)

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B)

skilled nursing facilities

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C)

physicians

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D)

hospitals

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Question 12 (1 point)

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When a provider, knowingly or unknowingly, uses practices that are inconsistent with accepted medical practice and that directly or indirectly result in unnecessary costs to the Medicare program, this is called

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A)

abuse

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B)

fraud

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C)

economic shift

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D)

unbundling

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Question 13 (1 point)

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In calculating the fee for a physician’s reimbursement, the three relative value units are each multiplied by the

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cost of living index for the particular region.

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B)

national conversion factor.

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C)

usual and customary fees for the service.

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D)

geographic practice cost indices.

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Question 14 (1 point)

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Which of the following helps the organization prioritize investment opportunities?

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A)

profitability index

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B)

return on investment

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C)

internal rate of return

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D)

net present value

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Question 15 (1 point)

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Your organization’s employees consist of a mixture of women and men. The women are of all ages, some are single mothers, others are married women with no children, and still others are women who care for older parents at home. The men also have varying personal lifestyles. Human Resources have designed a new benefit program that allows employees to choose from an array of benefits based on their own needs or lifestyle. The new benefit program is called a(n)

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flexible benefit plan.

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B)

employee-driven benefit plan.

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C)

prepaid benefit plan.

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D)

cafeteria benefit plan.

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Question 16 (1 point)

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Under APCs, the payment status indicator “N” means that the payment

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is packaged into the payment for other services.

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is for ancillary services.

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C)

is discounted at 50%.

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D)

is for a clinic or an emergency visit.

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Question 17 (1 point)

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Assume the patient has already met his or her deductible and that the physician is a Medicare participating (PAR) provider. The physician’s standard fee for the services provided is $120.00. Medicare’s PAR fee is $60.00. How much reimbursement will the physician receive from Medicare?

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A)

$60.00

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B)

$48.00

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C)

$96.00

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D)

$120.00

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Question 18 (1 point)

Question 18 Unsaved

This information is published by the Medicare Administrative Contractors (MACs) to describe when and under what circumstances Medicare will cover a service. The ICD-10-CM, ICD-10-PCS, and CPT/HCPCS codes are listed in the memoranda.

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A)

SI/IS (Severity of llness/Intensity of Service Criteria)

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B)

PEPP (Payment Error Prevention Program)

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C)

OSHA (Occupational Safety and Health Administration)

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D)

LCD (Local Coverage Determinations)

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Question 19 (1 point)

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____ are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients.

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Misadventures

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B)

Never events or Sentinel events

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C)

Potential compensable events

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D)

Adverse preventable events

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Question 20 (1 point)

Question 20 Unsaved

The term used to indicate that the service or procedure is reasonable and necessary for the diagnosis or treatment of illness or injury consistent with generally accepted standards of care is

Question 20 options:

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A)

appropriateness

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