Question 1

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

Accepted Answer

A)   only a single payment for certain common combination services provided on the same day of service
B)   individual payments for each service provided during the outpatient visit
C)   additional payments for hospital supplies and technical assistance
D)   zero payments due to the fact that these services are not covered by MedicareE) All of the above
F) A) and D) A

Question 2

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

Accepted Answer

A)    "S" represents a significant service that is not discounted when more than one APC is present on a claim.
B)    "T" represents a significant procedure that is discounted when other procedures are performed with it.
C)    "P" represents a partial hospitalization service.
D)    "V" represents those services which are not billable under the OPPS.E) None of the above
F) A) and B)

Question 3

Hospital observation services may be billed to all payers as outpatient services for observation stays up to 72 hours.

Accepted Answer

A) True 
 B)False

Question 4

A computer file that contains a list of the Healthcare Common Procedural Coding System (HCPCS)  codes and associated charges for the services provided to hospital patients is referred to as a ______________________.

Accepted Answer

A)    fiscal intermediary
B)    revenue code
C)    chargemaster
D)    status indicatorE) B) and D)
F) A) and B)

Question 5

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

A)   the HIPAA Eligibility Transaction System 
B)    ambulatory patient groups
C)    uniform ambulatory care data sets
D)    charge description mastersE) C) and D)
F) A) and B) A

Question 6

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

Accepted Answer

A)    a licensed physician participating in an approved graduate medical education program
B)    an outpatient evaluated and treated in the observation area of the hospital
C)    a computer program that resides in RAM, used to diagnose emergency patients quickly
D)    patients enrolled in the hospital's long­term ambulatory care programE) A) and B)
F) B) and C)

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

A) True 
 B)False

Question 8

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

A)    must be billed separately from the inpatient bill
B)    must not be billed separately from the inpatient bill
C)    must be written off as "uncollectable" expenses
D)    must be billed prior to the inpatient admissionE) A) and B)
F) None of the above

Question 9

The hospital outpatient prospective payment system (OPPS)  allows for additional payments to be made to cover the costs of innovative medical devices, drugs, and biologicals. These payments are referred to as __________________.

Accepted Answer

A)    disproportionate share hospital payments
B)    experimental incentives
C)    research and development incentives
D)    pass-through paymentsE) B) and C)
F) B) and D)

Question 10

Amy Williams is the HIPAA Compliance Officer for Wayne County Hospital. In her role she will be expected to _________________.

Accepted Answer

A)    audit records against codes submitted
B)    purchase supplies for the operating room suite
C)    ensure insurance information is obtained upon patient admission
D)    track patient disposition after dischargeE) None of the above
F) A) and B)

Question 11

Which of the following uses of electronic systems can enhance patient safety?

Accepted Answer

A)   Use of computerized provider order entry (CPO
E)   for orders directly entered by authorizing provider
B)    Record smoking status for patients 13 years old or older
C)    Check insurance eligibility electronically from public and private payers
D)    Use of voice recognition systems in radiologyE) C) and D)
F) A) and B) A

Question 12

Under EMTALA, hospitals that offer emergency services ___________________.

Accepted Answer

A)    are free to refuse emergency services to patients who do not show proof of insurance
B)    can refuse emergency services to patients as long as another hospital agrees to accept the patient as a transfer
C)    must screen and stabilize, if necessary, any patient who arrives in the emergency department
D)    must provide emergency services free of charge to a certain number of individual to meet the EMTALA charity obligationsE) All of the above
F) None of the above

Question 13

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

Accepted Answer

A)    patient demographic data such as address, insurance type, etc.
B)    various levels of patient illness using secondary diagnoses.
C)    whether the hospital is a "teaching" hospital or "non­teaching" hospital
D)    whether the patient has had any previous hospitalizationsE) None of the above
F) C) and D)

Question 14

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

A) True 
 B)False

Question 15

A partial hospitalization program is considered to be a type of outpatient psychiatric program.

Accepted Answer

A) True 
 B)False

Question 16

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

Accepted Answer

A)    When emergency, urgent, or immediate care is provided, the time and means of arrival are also documented in the medical record.
B)    The medical record notes how long a patient receiving emergency, urgent, or immediate care had to wait for treatment.
C)    The medical record of a patient receiving emergency, urgent, or immediate care notes the conclusions at termination of treatment including final disposition, condition at discharge, and instructions for follow -up care.
D)   The medical record contains a copy of the information made available to practitioners or organizations providing follow-up care.E) All of the above
F) A) and D)

Question 17

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

Accepted Answer

A) True 
 B)False

Question 18

The legislative act that provides incentives to health care providers who utilize EHRs to enhance the quality of care provided their patients is the _____________________________.

Accepted Answer

A)   Emergency Medical Treatment and Active Labor Act (EMTAL
A)  
B)   American Recovery and Reinvestment Act (ARR
A)  
C)   Health Insurance Portability and Accountability Act (HIPA
A)  
D)   Electronic Health Record Adoption Act (EHRA
A)  E) A) and D)
F) None of the above

Question 19

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

Accepted Answer

A) True 
 B)False

Question 20

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

A) True 
 B)False

Exam 2: Hospital-Based Care

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

Correct AnswerverifiedA

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

Correct AnswerverifiedShow Answer

Hospital observation services may be billed to all payers as outpatient services for observation stays up to 72 hours.

Correct AnswerverifiedShow Answer

A computer file that contains a list of the Healthcare Common Procedural Coding System (HCPCS) codes and associated charges for the services provided to hospital patients is referred to as a ______________________.

Correct AnswerverifiedShow Answer

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.

Correct AnswerverifiedA

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

Correct AnswerverifiedShow Answer

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.

Correct AnswerverifiedShow Answer

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 __________________________.

Correct AnswerverifiedShow Answer

The hospital outpatient prospective payment system (OPPS) allows for additional payments to be made to cover the costs of innovative medical devices, drugs, and biologicals. These payments are referred to as __________________.

Correct AnswerverifiedShow Answer

Amy Williams is the HIPAA Compliance Officer for Wayne County Hospital. In her role she will be expected to _________________.

Correct AnswerverifiedShow Answer

Which of the following uses of electronic systems can enhance patient safety?

Correct AnswerverifiedA

Under EMTALA, hospitals that offer emergency services ___________________.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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.

Correct AnswerverifiedShow Answer

A partial hospitalization program is considered to be a type of outpatient psychiatric program.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

The legislative act that provides incentives to health care providers who utilize EHRs to enhance the quality of care provided their patients is the _____________________________.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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.

Correct AnswerverifiedShow Answer

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

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