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HIT 200 Ch 5, 6, 7 Q & A

Ch 5 - Healthcare Data sets and Standards Ch 6 - Clinical Vocabulary and classification system Ch 7 - Reimbursement Methodologies Important Q&A
STUDY
PLAY
which of the following is designed to collect a Minimum set of data about inpatients?
UHDDS
which of the following is designed to collect a Minimum set of data about ambulatory care patients?
UACDS
which of the following is designed to collect a data about long-term care residents?
MDS
Which of the following provides a structured way to develop a long-term care resident plan?
MDS
which of the following is used to gather data about Medicare beneficiaries receiving home care?
OASIS - C
which of the following best describes the DEEDS data set?
collects data about hospital emergency encounters
which of the following is a set of performance measures used to compare the performance of healthcare plans?
HEDIS
which of the following was developed by Joint Commission?
ORYX
which part of the NHIN focuses on the patient entering data?
personal health dimension
The resident Assessment Protocol is triggered by the data collected by the:
MDS
the name of government agency that has led the development of basic data sets for health records and computer databases is the:
National Committee on Vital and Health Statistics
The Primary purpose of a minimum data set in healthcare is to...
recommend common data elements to be collected in health records
data that are collected on large populations of individuals and stored in databases are referred to as...
aggregate data
The patient data set that has been incorporated in federal law and is required for Medicare reporting is....
Uniform Hospital Discharge Data Set
Both HEDIS and Joint Commission's ORYX program are designed to collect data to be used for...
Performance improvement programs
A National Health Information Network is...
A network of networks.
standardizing medical terminology to avoid differences in naming various medical conditions and procedures is one purpose of ....
vocabulary standards
The federal law that directed the Secretory of Health and Human Services to develop healthcare standards governing electronic data interchange and data security is the ....
HIPAA of 1996
The number that has been proposed for use as a unique patient identification number but is controversial because of confidentiality and privacy concern...
Social Security Number
Most healthcare informatics standards have been implemented by...
consensus
A critical early step in designing and EHR is to develop a ------ in which the characteristics of each data element are defined.
data dictionary
According to the UHDDS definition, ethnicity should be recorded on a patient record as
Hispanic, non-Hispanic, unknown
Mary Smith, RHIA has been asked to work on the development of a hospital trauma data registry. which data set would be most helpful in developing this registry?
DEEDS
While the focus of the inpatient data collection is on the principal diagnosis, the focus of outpatient data collection is....
reason for encounter
In long-term care, the resident's care plan is based on data collected in the
MDS version - 2.0
reimbursement of home health services is dependent of data collected from...
OASIS
A consumer interested in comparing the performance of health plans should review data from ....
HEDIS
I need a standard that allows data to be transferred across the internet. which should be my choice?
XML
Each of the three dimension of information defined by the NHII contains specific recommendations for....
core data elements
A state cancer surveillance system is an example of which of the NHII dimensions ?
community
In order to effectively transmit healthcare data between a provider and payer, both parties must adhere to which electronic data interchange standards?
X12N
A radiology department is planning to develop a remot clinic and plans to transmit images for diagnostic purpose. the most important standard to implement in order to transmit images is ...
DICOM
A core data set development by ASTM to communicate a patient's past and current health information as the patient's transitions from one care setting to another is ....
Continuity of Care Record
Laboratory data is successfully transmitted back and forth from community hospital to three local physician clinics. this successful transmission is dependent on .....
LOINC
As many private and public standards groups promulgate health information standards, the office of the National Coordinator of health information technology has been given responsibility for ...
Harmonization of standards from multiple sources.
Which of the followint best describes SDO?
Develops standards
I work at a substance abuse center. What system should I use to code diagnose?
-DSM-IV-TR
Private, not for profit organization which accredits, assesses, and reports on quality of managed care plan
NCQA
What is the name of the program funded by the federal government to provide medical care to people on public assistance?
Medicaid
The reimbursement method which pays providers according to changes that are calculated before services are rendered?
Perspective payment
Payment method that reimburses healthcare providers in the form of lump sums for all healthcare services delivered to a patient for a specific illness
EOC = Episode Of Care (page - 317)
Term used in reference to transfer of health claims using electronic media
EDI
Covers healthcare costs and lost income when injured on the job
Worker's compensation
System for coding the clinical procedure and services..
CPT
Promote uniform reporting and statistical data collection for medical procedures, supplies, products, and services
HCPCS
Computer software programs that assist in the assignment of codes used with diagnostic procedures...
Encoder
Name of government agency that has led the development of basic data sets for healthcare records and computer databases is the
NCVHS
The federal law that directed the security of health and human services to develop healthcare standards governing electronic data interchange and data security is the
HIPAA of 1996
The standard that allows data to be transferred across the internet
XML
Consumer interested in comparing the performance of health plans should review
HEDIS
Core data set developed by ASTM(?) to communicate a patients past and current health information as the patients transitions from one care setting to another is
Continuity of care record
Federally funded program pays medical bills of spouses and dependents of persons on active duty in the uniformed services
TRICARE
Organization responsible for updating the procedure classification for ICD9 CM
CMS
Organization responsible for updating diagnosis classification for ICD9 CM
NCHS
Organization that originally published ICD9
WHO
Messaging standard for electronic data interchange in healthcare have been developed by
HL7
THE NATIONAL CENTERS FOR HEALTH STATISTICS IS RESPONSIBLE FOR UPDATING ICD-9-CM.
True
VOLUME 3 OF ICD-9-CM IS NOT PART OF THE INTERNATIONAL VERSION OF ICD-9 AND IS USED ONLY IN THE US.
True
V AND E CODES ARE REFERRED TO AS SUPPLEMENTARY CLASSIFICATIONS IN ICD-9-CM.
True
THE 3RD VOLUME OF ICD-9-CM CONTAINS THE TABULAR AND ALPHABETIC LISTS OF DISEASES.
False
ICD-10 IS USED IN THE US FOR MORBIDITY REPORTING.
True
THE ICD-O-3 IS A SYSTEM USED FOR CLASSIFYING INCIDENCES OF BENIGN DISEASE.
False
CPT IS A COMPREHENSIVE DESCRIPTIVE LISTING OF TERMS AND CODES FOR REPORTING DIAGNOSTIC AND THERAPEUTIC PROCEDURES AND MEDICAL SERVICES.
True
HCPCS CODES ARE MADE UP OF CPT AND LEVEL II (NATIONAL) CODES
True
THE APA DEVELOPED THE DSM-IV-TR AS A TOOL FOR STANDARDIZING THE DIAGNOSTIC PROCESS FOR PATIENTS WITH PSYCHIATRIC DISORDERS
True
AHIMA HAS DEVELOPED STANDARDS OF ETHICAL CODING.
True
AN ENCODER IS A TOOL THAT AIDS CODERS IN ASSIGNING DIAGNOSTIC AND PROCEDURE CODES.
True
TO AVOID FRAUDULENT BEHAVOIRS, HEALTHCARE PROVIDERS MUST DEVELOP COMPLIANCE PLANS AND ESTABLISH INTERNAL CONTROLS.
True
Providers Should base their compliance programs on the compliance programs released by the AMA
False (not very sure about this answer)
Designation of a chief compliance officer and a corporate compliance committee charged with the responsibility for operating and monitoring the compliance program and who report directly to the CEO and the governing body is required for corporate compliance.
True
We have a hotline that employees can call to report compliance issues. This is mandated by:
Seven elements of corporate compliance plan
THE DEGREE TO WHICH CODES ACCURATELY REFLECT THE PATIENT'S DIAGNOSIS AND PROCEDURES IS CALLED:
Validity
I NEED TO CODE AN AMBULATORY RECORD BUT THE PROCEDURE CODE I NEED ISN'T IN THE CPT MANUAL. HOW DO I CODE IT?
Use HCPCS level II codes
WHICH OF THE FOLLOWING WOLD BE AN ARGUMENT FOR THE TRANSITION TO ICD-10-CM/PCS?
More detail in the codes
WHICH OF THE FOLLOWING WOULD BE CLASSIFIED IN ICD-9-CM WITH AN E-CODE?
Fall from curb
WHICH OF THE FOLLOWING IS A GOAL OF ICD-10-PCS
To reduce training
which of the following plans reimburses patients up to a specified amount:

a. Health insurance

b. Coinsurance

c. Indemnity

d. Major medical plan
Indemnity
Catastrophic coverage is categorized as part of:
Major medical insurance
The number of day medicare will cover SNF inpatient care is limited to which of the following?
100
Which of the following types of care is not covered by Medicare?
Long-term nursing care
Which of the following covers prescribed preventive benefits and is subject to a deductible?
Medicare part B
Which of the following term is used for the amount charged for medical insurance policy?
Premium
Upon which criterion is Medicaid eligibility based?
Income
How many benefit periods are covered by hospital insurance during a medicare beneficiaries lifetime?
Based on a ninety-day stay
What term is used for retrospective reimbursement charges submitted by a provider for each service rendered?
Fee-for-service
What is the name of federally funded program that pays the medical bills of spouses and dependents of persons on active duty in the uniform services?
TRICARE
What is the name of the program funded by the federal government to provide medical care to people on public assistance?
Medicaid
Some services are covered and paid by Medicare before Medicaid makes payments because Medicaid is considered:
Payer of last resort
Which of the following groups of healthcare providers contracts with an employer to provide healthcare services?
Preferred Provider Organization
Which of the following is a nonprofit organization that contracts with physicians, acquires assets, and manages the business side of medical practices?
Medical Foundation
Which of the following reimbursement method pays providers according to charges that are calculated before healthcare services are rendered?
Prospective payment method.
Which of the following payment method reimburses healthcare providers in a form of lump sums for all healthcare services delivered to a patient for a specific illness?
Episode of care (page- 317)
Which of the following apply to radiological and other procedures that include professional and technical components and are paid as a lump sum to be divided between physicians and healthcare facilities?
Global Payment (page 318)
Which of the following is a state-licensed, Medicare-certified supplier for healthcare services to Medicare beneficiaries?
Ambulatory Surgery Center
Dr. Smith has received a single payment for pre-operative care, performing surgery, and post operative care for Ms. Jones's cholecystectomy. this mode of reimbursment is:
Global Surgery Payment
Condition established after study to be the reason for hospitalization
Principal Diagnosis
Categories of patients treated
Case mix
Coexisting condition
Comorbidity
Condition arising during hospitalization
Complication
Condition that was present at the time the order for admission was written
Present on admission
Provides controlled vocabulary for coding the contents of the patient record and for facilitating the development of computer-based patient record
SNOMED CT (classification system)
To document nursing care and to facilitate the capture of nursing information on computer system
Nursing vocabulary (classification system)
To provide means to record information about patients treated for substance abuse and mental disorder-
DSM - IV- TR (classification system)
(T or F) The AMA publishes the official guidelines for CPT coding in it's newsletter 'coding clinic'
False --- it is published in CPT assistant
(T or F) Codes are sequenced in the patient's health record according to AHIMA's Standards of Ethical Coding.
False
A baseline audits should include a sample of records coded by all coders for all types of services.
True
(T or F) An encoder is a computer software that assists in determining coding accuracy and reliability.
False - it helps to assign codes
An interface is a total component of screens, navigation, and input mechanism used to operate encoding software.
True
The NLP encoding system uses expert or artificial intelligence software to automatically assign code numbers.
True
Diagnosis related groups categorize patient cases that are medically similar with respect to diagnosis, treatment, and length of stay.
True
The amount of money the patient responsible for before the insurance kicks in is called:
Deductible
The term used to describe the money the insured patient pays on a claim is called:
Out-of-pocket expence
Prospective payment systems were developed by CMS to:
Manage Medicare and Medicaid costs.
To increase wartime labor during the second world war, employers began offering:
group health insurance
Major medical insurance covers:
Catastrophic illnesses and injuries
Medicare part A provides:
Hospitalization insurance
Medicare part B covers
Services in emergency department, Ambulatory surgery center services, and outpatient clinic services.
A private health insurance that pays, within limits, most of the healthcare services not covered by Medicare A and/or B
Medigap
Tital XIX of the Social Security Act Amendment of 1965 is also known as:
Medicaid
Medicaid eligibility standards are established by:
Individual states
To be eligible for the federal matching funds, each Medicaid program must offer:
Inpatient hospital services, Prenatal care, Vaccines for children
Which program provides additional federal funds to states so that medicaid eligibility can be expanded to include greater number of children
SCHIP
Which statement is true about the Veterans Health Administration
Eligibility is based on eight priority groups
A healthcare program for dependents and survivors of permanently and totally disabled veterans:
CHAMPVA
Agency responsible for providing healthcare services to American Indians and Alaskan natives
IHS
FECA covers
Federal employees.
This model of HMO is created when physicians join together in an organized group for the purpose of fulfilling a contract but retain individual practices:
Independent practice
This model of HMO employs physicians and other healthcare professionals to provide healthcare service to members ------Premiums are paid directly to this type of HMO and services are usually provided within corporate facilities
Staff
In this model, healthcare services are contracted with two or more multispecialty group practices instead of just one:
Network
In this HMO contract, providers usually agree to devote a fixed percentage of their practice time to the HMO
Group
This non-profit organization contracts with physicians to manage their practices and owns clinical/business resources that are made available to participating physicians:
Medical Foundation
This arrangement provides practice management services to individual physicians' practices:
Management service organization.
In this arrangement physician maintain their offices but share administrative services:
Group practice without walls
This organization manages ans coordinates the delivery of healthcare services performed by a number of healthcare professionals and facilities and its physicians are salaried employees:
Integrated Provider Organization
The type of payment system where the amount of payment is determine before the service is delivered
Prospective
This payment arrangements are streamlined by the use of chargemasters :
Fee-for-service
This payment is base on the amount representing reasonable compensation for the service/procedure in a specific area of the country:
UCR
The utilization control most closely associated with managed fee-for-service reimbursement:
Prospective Review
Based on per-person premiums or membership fees:
Capitation
Prospective payment system implemented in 1983:
DRG
LUPA
Low-utilization payment adjustment
which of the following patients qualify for LUPA
Patient had 3 visits in the 60-day period
Prior to implementation of the DRG prospective payment system, medicare part A payments to hospitals were based on:
Traditional FFS reimbursement methodology
The MS-DRG PPS rate is based on what type of diagnosis?
Primary
The computer software program that assigns appropriate MS-DRGs according to information provided for each episode of care is called a:
Grouper
Which of the following hospitals are excluded from Medicare acute care prospective payment system?
Children's
MS-DRGs are organized into:
Major diagnostic categories
What reimbursement system utilizes Medicare fee schedule?
RBRVS = Resource-based relative value scale = compensate according to fee schedule predicted on weights assigned on the basis of the resources needed for the service
What lagislation mandated the implementation of a skilled nursing facility PPS?
BBA = Balance Budget Act.
A tool used to collect resident assessment data to assign appropriate resource utilization group
MDS - Minimum Data Set
What reimbursement system is associated with the Medicare outpatient PPS?
APCs = Ambulatory Payment Classification
Which of the following types of organization is not reimbursed under the outpatient PPS?
Critical access hospitals
Which of the following concepts is applied when surgical procedures are furnished during the same operative sessions?
Discounting of Procedures
Data set used for patient assessments by the home health PPS:
OASIS
The inpatient psychiatric facility prospective reimbursement system is based on
Per diem rate
What tool is used to calculate the CMG (case mix group)?
IRF-PAI = Inpatient Rehabilitation Facility - Patient Assessment Instrument
The hospital needs to know how much Medicare paid on a claim so they can bill the secondary insurance, what should they refer to?
Remittance advice
A patient has two policies Medicare and Medicare supplement: which is true in this situation-
Monies made to the healthcare providers can not exceed charges.
Which of the following situation would be identified by NCCI edits
Billing for two services that are prohibited from being billed on the same day.
The purpose of the physicians query is to
Improve documentation
Medicare carrier and fiscal intermediaries serve as the financial agent between providers and federal government to locally administer Medicare part A and part B.
True
The 837P is submitted to Medicare carriers to process hospital outpatient claims.
False
The 837I is also referred to as the 837P
False
The 837I is submitted to Medicare fiscal intermediaries and 837P is submitted to Medicare carriers.
True
The abbreviation used to describe the electronic transfer of information such as claims submission is EDI
True
The OCE applies the set of logical rules
True
Fee schedules are ------------- updated by third party payers
Annually
To accept assignment means that the
Provider accepts the payment in full whatever the payer reimburses.
A fee schedule is
Developed by third-party payers and includes a list of healthcare services and procedures and charges of each.
An inaccurately generated chargemaster affects reimbursement, resulting in:
Overpayment, underpayment, and claims rejections.
The goal of coding compliance programs is to prevent:
Accusations of fraud and abuse.
The practice of assigning a diagnosis or procedure code specifically for the purpose of obtaining a higher level of payment is called:
upcoding
The essential elements of a corporate compliance program are defined by:
OIG