True / False
A family numbering system is a simple way of organizing records because the numbers rarely change.
False
A freestanding dialysis facility that is accredited by the Joint Commission is deemed to meet federal requirements and does not have to be surveyed by the state.
False
A managed care organization that meets TJC or AAAHC standards is deemed to meet NCQA standards.
False
A per diem method of payment means that the provider is paid based on the number of persons the provider agrees to treat.
False
A person who has not been sentenced, but is incarcerated while awaiting trial is classified as a prisoner.
False
A personal health record is a paper-based health record that is protected from disclosure to those outside the facility that created it.
False
A physician assistant is a registered nurse who has had additional training in areas such as family or pediatric care.
False
All individuals eligible to receive care within the managed care organization (MCO) are referred to as residents.
False
American Association for On-Site Health Care publishes standards for some type of ambulatory health care.
False
Americans have heavily depended on hospitals for life saving health care since 1700's
False
An employee who is injuring on the job must receive care from a provider selected by the workers compensation carrier.
False
Because the federal government establishes requirements for licensure of hospitals, the requirements are the same in each state.
False
Changes in health care delivery have caused health information management professionals to focus more narrowly on acute inpatient settings.
False
Coordination of benefits (COB) allows excess reimbursement from health plans to providers to be refunded to the patient.
False
Dialysis is a procedure necessary to maintain the life of a person whose liver has failed.
False
ESRD networks treat patients by providing hemodialysis services.
False
Each dialysis patient is assigned to a primary care provider who alone is responsible for the performing a comprehensive assessment and developing a plan of care.
False
Hospital clinics are often organized by medical specialty to facilitate medical education.
False
Hospital observation services may be billed to all payers as outpatient services for observation stays up to72 hours.
False
Hospitals do not have to be licensed to admit patients.
False
Hospitals must be accredited by the Joint Commission.
False
Hospitals must have a hospitalist on staff to qualify for CMS certification.
False
Hospitals receive Medicare reimbursement for ambulatory care through an outpatient prospective payment system (OPPS) based on diagnosis related groups (DRGs).
False
In a prospective payment system, the health care provider charges and is paid for each item of service provided
False
In general, dialysis facilities have been slow to adopt electronic health records.
False
It is not necessary for an ambulatory facility to document telephone communication with patients since insurance companies will not pay for telephone consultations.
False
Often not-for-profit charging reduced fees is a characteristic of Urgent Care Centers.
False
Only clinicians, such as physicians and nurses, may become Certified Correctional Health Professionals (CCHPs); administrative health care workers, such as HIM professionals, are not eligible
False
Patient-focused care organizes care according to hospital departmental structures.
False
Patients who have kidney transplants generally have lower survival rates, a poorer quality of life, and higher overall medical costs than patients on dialysis.
False
Peritoneal dialysis uses the patient's thoracic cavity to filter out wastes.
False
Physicians private offices are required to be licensed by the state in most states.
False
Reimbursement for physicians under Medicare has changed from the resource-based relative value system to the ambulatory payment classification system.
False
Standard scheduling assigns all patients Ina large block at the same appointment time.
False
State governments operate jails and local governments operate prisons.
False
The Commission for the Accreditation of Birth Centers publishes the Accreditation Handbook for Ambulatory Health Care.
False
The Joint Commission accredits ambulatory health care facilities under the same standards as hospitals.
False
The MCO negotiates per diem rates with individual physicians.
False
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.
False
The administrative simplification provisions of HIPAA deal with insurance portability, fraud and abuse, and medical liability reform.
False
The hospital may be paid for only one APC per day per patient
False
The hospital may be paid for only one APC per patient per 72 hours.
False
The hospital may be paid for only one RBRVS per day per patient.
False
The purpose of the Hill-Burton program in the mid-twentieth century was to decrease the number of hospital beds in over-served areas.
False
The resource-based relative value scale (RBRVS) system is an example of per diem reimbursement.
False
The retention period for clinical information on dialysis patients, according to federal statute, is ten years.
False
Under HIPA{, correctional institutions must provide current inmates with a "notice of privacy practices."
False
V represents those services which are not billable under the OPPS.
False
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.
False
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.
False
A Health Information Exchange links data provided by various health care providers.
Trua
A hospital compliance officer may be concerned with avoiding fraudulent coding and billing as well as with monitoring compliance with federal regulations such as HIPAA.
True
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,
True
A hospitality is a physician who provides comprehensive care to hospitalized patients, but who does not ordinarily see patients outside of the hospital setting.
True
A partial hospitalization program is considered to be a type of hospital outpatient program.
True
A person with end-stage renal disease can become eligible for Medicare on the basis of the ESRD diagnosis.
True
A provider's panel is the group of patients who have chosen the provider as their primary care provider.
True
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.
True
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.
True
Because of their knowledge of coding, health information managers can help review, revise, and maintain the hospitals chargemaster.
True
Both dialysis and kidney transplant are forms of renal replacement therapy (RRT).
True
Capitation is the payment of a fixed dollar amount for each covered person for the provision of a predetermined set of health care services for a specific period of time.
True
Charges for ancillary services, such as laboratory and radiology charges, are usually captured through the hospital chargemaster.
True
Community health centers were designed to meet the medical needs of people who, because of their location and their inability to pay, we're not receiving the care they needed in the traditional physicians office.
True
Dialysis patients see the following caregivers at regular intervals: physicians, nyzs6s, social workers, and dietitians.
True
Documentation of telephone calls is an important element in good risk management for ambulatory care
True
Estelle v. Gamble created a right to health care for inmates which could be violated if officials showed a deliberate indifference to inmates' serious medical needs.
True
Federal and state governments jointly fund the Medicare program.
True
For referred outpatients, the hospital provides diagnostic or therapeutic services, but it does not take responsibility for evaluating or managing the patients care.
True
Hospitals must be licensed by the state in which they are located.
True
Hospitals that meet the standard of the Joint Commission, HFAP, or DNV are deemed to meet the Conditions of Participation.
True
In hemodialysis, the patient's blood circulates outside the body through an artificial kidney that removes metabolic wastes and helps to maintain homeostasis.
True
In the staff model HMO, the HMO entity owns the facilities and arranges for health care through employed physicians, who are allowed to see only the particular HMOs patients.
True
Industrial health centers provide care to employees at their places of work or at employer contracted sites.
True
Medicare certification of rural health clinics permits cost-based reimbursement as part of the effort to increase access to primary care in medically underserved rural areas.
True
Medicare managed care plans receive payments under the Medicare Advantage program for enrollee so who have both Part A and Part B coverage.
True
Medicare pays skilled nursing facilities, home health providers, inpatient rehabilitation hospitals, and long-term care hospitals under prospective payment systems.
True
NDCs list diagnosis codes that Medicare considers evidence that a particular procedure is medically necessary.
True
One of the major responsibilities of an ESRD network is to evaluate and resolve patient grievances.
True
P represents a partial hospitalization service.
True
Part A of Medicare pays for hospital inpatient care, home health care, skilled nursing care, and hospice care.
True
Physicians are considered the main caregiver in ambulatory care.
True
Potentially compensate 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.
True
Preventative care and wellness are a central focus of a health maintenance organization and most managed care organizations.
True
S represents a significant service that is not discounted when more than one APC is present on a claim.
True
T represents a significant procedure that is discounted when other procedures are performed with it.
True
Telemedicine involves transmitting medical information back and forth between patient and physician separate locations by electronic means such as video, electronic mail, telephone, or satellite.
True
The American College of Surgeons was one of the first organizations to establish standards for hospitals
True
The Clinical Laboratory Improvement Amendments (CLIA) require that every laboratory possess a certificate to operate and that laboratories that fail to meet the operational standards or proficiency testing guidelines be sanctioned.
True
The Forum of ESRD Networks has developed a medical record model outlining recommended practices for medical record documentation in ESRD facilities.
True
The Kidney Disease Outcomes Quality Initiative (KDOQI) includes the development of clinical practice guidelines and CMS has incorporated some of the outcome measures from these guidelines into their clinical performance measures projects.
True
The fee schedule is a flat rate per procedure,visit, or service. Negotiating a fee schedule allows more consistent budgeting of payment dollars by the managed care organization.
True
The hospital may be paid for more than one APC per patient visit.
True
The managed care organization (MCO) produces its revenue by selling an insurance product and must reimburse providers for services delivered to members.
True
The placement of a prison health services program under a state Department of Corrections rather than under individual prison wardens may be an indication of the perceived importance of health services.
True
Two approaches to utilization management in ambulatory care are prospective and retrospective review.
True
Under Part C, beneficiaries pay a monthly premium for the insurance plan, in addition to their Part B premium.
True
Urgent care centers arose to meet the need for care outside regular physicians office hours.
True
Voice recognition systems are becoming more common in hospital emergency departments.
True
When a provider agrees to see managed care organization (MCO) patients and to subtract a certain percentage from the regular fee-for-service rate, this is called discounted charges.
True