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