HIF 200- Chapter 12

An associate or member of a particular business.

Affiliate

A formal way of checking financial and other records.

Audit

The federal agency within the Department of Health and Human Services responsible for administering Medicare programs related to home health is the ________________________________.

Centers for Medicare & Medicaid Services (CMS)

Lack of payment for services rendered due to failure to meet requirements or some other reason.

Denial

T/F: A physician must have a face-to-face encounter with a home health patient within seven days prior to the start of home health care, or within three days after the start of care.

False

T/F: An upcode occurs when the provision of care to a patient results in unusually high costs to the home care agency.

False

T/F: The Community Health Accreditation Program (CHAP) is responsible for the development of the OASIS data set and manages data collection using OASIS for home care providers nationwide.

False

T/F: The home care patient's physician must review, update, and recertify (if necessary) the plan of care at least every six months, a timeframe referred to as the certification period.

False

Software available from CMS which can be used for data entry, editing, and validation of OASIS data is called _______________________.

HAVEN

____________________ are the basis for home health reimbursement under Medicare.

HHRGs

Any happening that is not consistent with routine operations.

Incident

_____________________ is a data set that is a requirement under Medicare for home health.

OASIS-1

Data set required of home health care agencies.

OASIS-C1

End result or consequence; the patient's health and functional status after a period of treatment.

Outcome

Which of the following is a list of organizations that have deeming authority for home health care with regard to Medicare certification and the Conditions of Participation?

The Accreditation Commission for Health Care (ACHC), the Community Health Accreditation Program (CHAP), and The Joint Commission

T/F: A home care agency that opts to be surveyed for Medicare certification by The Joint Commission would be deemed to be in compliance with the Conditions of Participation upon accreditation by the commission.

True

T/F: HIM home care positions require knowledge of finance, quality improvement, utilization review, and information systems.

True

T/F: Home Health Resource Groups (HHRGs) are based on assessment data in three areas- clinical, functional, and service utilization.

True

T/F: Medicare will only pay for home health services for persons who are homebound.

True

T/F: The Accreditation Commission for Health Care (ACHC) has deeming authority for Medicare in home health, hospice, and DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies).

True

T/F: The Outcome and Assessment Information Set (OASIS) is a data set that is used by Medicare for both payment and quality improvement purposes.

True

In-home respite care _______________________________.

allows the primary caregiver to have some free time

One of the criteria for receiving Medicare payment for home care is that the patient being served must _________________________.

be homebound

Physical therapy, occupational therapy, speech-language pathology, medical social services, and respiratory therapy are all examples of the various ___________________ that may provide services to home health patients.

disciplines

A wheelchair or hospital bed is an example of ______________________.

durable medical equipment

Under Medicare, approximately how often must a physician certify that home care is needed?

every 60 days

Medical-surgical nursing, intravenous therapy, and restorative nursing care are __________________________.

skilled nursing services

A _____________________________ is a record organized in sections according to patient care departments and/or disciplines.

source-oriented record

The rule used as a basis of comparison for measuring quantitative or qualitative value is ________________________.

standard

Labor costs and transportation costs associated with home care visits are examples of ______________________.

variable costs