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reimbursement

_______ is where the largest numbers of lives are saved, usually by understanding the epidemiology of a disease – its patterns, where and how it emerges and spreads – and attacking it at its weak points.
a. surgery
b. pharmacy
c. public health
d. none of the above
c
One major focus of public health is the study of
a. epidemics
b. radiological images
c. all of the above
d. non of the above
a
A/an ___________ is a global outbreak of disease to which every individual in the world is susceptible.
a. epidemic
b. b. infectious disease
c. pandemic
d. none of the above
c
A/an __________ is “an excess in the number of cases of a given health problem.
a. epidemic
b. infectious disease
c. natural disaster
d. none of the above
a
In 2004, the US funded a plan for researchers to use computers to model diseases, which was called _______.
a. MIDAS
b. model informatics
c. computational informatics
d. none of the above
a
________ is a microbiology information stystem developed at Brigham and Womens Hospital in Massachusetts.. It is used to monitor antibacterial resistance.
a. WHERENET
b. WHYNET
c. HOWNET
d. WHONET
d
________ are the programs that create the simulations.
a. computational models
b. syndromics
c. pandemic modems
d. none of the above
a
________ refers to the study of diseases in populations by collecting and analyzing statistical data.
a. pandemiology
b. epidemiology
c. a and b
d. none of the above
b
Computers can create what-if scenarios or _________.
a. pictures
b. graphics
c. simulations
d. none of the above
c
In developing countries in Asia and Africa, _________ PDAs are used for the collection and dissemination of information, warnings, and education.
a. collection
b. reporting
c. epidemic control
d. SATTELIFE
d
Today, some reportable disease include _________.
a. smallpox
b. polio
c. SARS
d. all of the above
d
Data can be used by SPECTRUM which calculates the numbers infected with and deaths from _________.
a. smallpox
b. polio
c. AIDS
d. all of the above
c
In developing countries in Asia and Africa, SATTELLIFE PDAs are used for ___________.
a. the collection of information, warnings, education . . .
b. the dissemination of information
c. health-related education
d. all of the above
a
Global warming is already having a devasting effect on the earth and on human health; its effects include the following:
a. more intense heat waves
b. more intense storms
c. flooding of major rivers
d. all of the above
a
The EPP is used to predict __________ from surveillance data.
a. pandemic flu
b. SARS
c. HIV/AIDS
d. none of the above
c
The northeastern US has warmed over the past hundred years; the rate of this warming has been increasing over the past thirty years.
t
WHONET is a microbiology information system, used to monitor antibacterial resistance.
t
An epidemic is a global outbreak of disease to which every individual in the world is susceptible
f
On May 23, 2005, WHO approved new rules to control the global spread of disease.
t
Currently there are national standards for the collection of health statistics
f
One goal of the ONCHIT is the improvement of the health of the entire nation
t
The definition of epidemic is based on statistics.
t
An epidemic is an excess in the number of cases of a given health problem.
t
Social inequality as well as absolute poverty are important determinants of health _________.
t
Currently MIDAS is modeling polio
f
Which of the following uses sound waves and the echoes they produce when they encounter an object to create an image?
a. x-rays
b. ultrasound
c. positron emission tomography
d. magnetic resonance imaging
b
_______ study(ies) brain function by sensing small changes in oxygen levels.
a. x-rays
b. CT scans
c. ultrasound
d. functional magnetiuc resonance imaging
d
________ uses small amounts of radioactive materials to create a picture of the body in action.
a. x-ray
b. ultrasound
c. positron emission tomography
d. magnetic resonance imaging
c
________ take a series of x-rays at different angles. A computer then creates a cross-sectional image.
a. x-rays
b. CT scans
c. PETs
d. MRIs
b
________ can be used to show the functioning of the brain.
a. x-rays
b. CT scans
c. positron emission tomography
d. all of the above
c
______ can image soft tissue and the inside of bones.
a. x rays
b. CT scans
c. positron emission tomography
d. magnetic resonance imaging
d
An advantage of digital x-rays over traditional film x-rays is ______.
a. a digital x ray is available immediately.
b. a digital x ray can be enhanced
c. digital x rays use less radiation
d. all of the above
d
_________ creates images from data generated by the interaction of radio waves and the protons in hydrogen atoms in the water in the human body.
a. x ray
b. CT scan
c. positron emission tomography
d. magnetic resonance imaging
d
If you wanted to study the effect of Prozac on the brain you would use _______.
a. x ray
b. CT scan
c. positron emission tomography
d. none of the above
c
_________ is used to picture a moving fetus.
a. x rayb
b. ultrasound
c. positron emission tomography
d. magnetic resonance imaging
b
________ scanning is used to image the heart in a majority of cases.
a. SPECT
b. ultrasound
c. positron emission tomography
d. magnetic resonance imaging
a
___ ______ can be used to diagnose breast cancer in pregnant women.
a. x ray
b. ultrasound
c. positron emission tomography
d. magnetic resonance imaging
b
_________ transmits, stores, retrieves, and displays digital images and communicates the information over a network.
a. SPECT
b. MEDCIN
c. DICOM
d. PACS
d
________ has a lot in common with other industries that are outsourcing jobs… It has high labor costs, it’s growing rapidly, and it’s portable.
a. rehabilitative device
b. radiology
c. a and b
d. none of the above
b
A three year study indicates that interventional radiology may be as effective as surgery for _________.
a. early liver cancer
b. breast cancer
c. appendicitis
d. all of the above
a
PET scans can show the different activity in the brain when a person speaks correctly versus when he or she stutters.
t
Ultrasound uses radiation to create an image.
f
Traditional x rays image behind bones.
f
a disadvantage of PET scans is high cost.
t
PET scans are usually used for broken bones.
f
Interventional radiology is concerned with the treatment of disease.
t
Stereotactic radiosurgery involves removing tumors surgically.
f
A gamma knife is used to make incisions.
f
Dentists still use x rays which may be traditional or digital.
t
SPECT scans, like PET scans, show the body in motion.
t
A robot ___________.
a. can respond to speech commands
b. is a programmable machine
c. a and b
d. none of the avobe
c
__________ may be used to help train surgeons and to allow realistic practice operations.
a. virtual environment technology
b. endoscopes
c. robots
d. ZEUS
a
_______ is a robotic device used in some hip replacement operations.
a. ROBODOC
b. AESOP
C. ZUES
D. HERMES
a
An endoscope is _________.
a. a surgical instrument that cuts into the patient.
b. only used to produce the image the surgeon sees
c. a thin tube with a light source
d. b and c
d
Surgery that makes use of a computer generated images to enhance what the surgeon sees is called ___________.
a. virtual reality
b. augmented reality
c. telepresence surgery
d. none of the above
b
Among the benefits of MIS could be ________.
a. smaller scars
b. shorter recovery time
c. less trauma to healthy tissue
d. all of the above
d
The most frequently done laparoscopic procedure is ________.
a. gall bladder removal
b. open heart surgery
c. brain surgery
d. knee replacement
a
The first FDA cleared planning operatioins
b. robot was ________.
a. ZEUS
B.. HERMES
C. AESOP
D. HARRY
c
Computer technology may be involved in _________.
a. planning operations
b. assisting in the operating room
C. training surgeons
D. all of the above
d
A robot developed to assist in brain surgery is _______.
a. ZEUS
B. HERMES
C. AESOP
D.. MINERVA
d
The high bandwidth communications lines needed for distance surgery are in place.
f
Computer generated graphics can give a surgeon virtual x ray vision.
t
One of the advantages of MIS is that the surgeon looks at a monitor not at the patient.
f
A robotic device can decide whether what it is touching is a tumor or normal tissue.
t
Telepresence surgery was first conceived of by the US department of defense.
f
A disadvantage of MIS is longer hospital stays.
f
Virtual reality technology creates environments that seem real but are not.
t
Surgeons make use of computer models to plan operations.
t
Some surgical robots were originally develoed for the space program.
t
Hip replacement operations using ROBODOC cannot possible be as good as those with human surgeons only
f
In which type of HMO are the physicians employees?
a. group model
b. independent practice association (IPA) model
c. staff model
d. network model
c
Today’s managed care traces its origins to all of the following arrangements except:
a.. 1800, Congress awarding pensions for US naval personnel on the basis of death or disability during active service.
b. 1910, Western Clinic of Tacoma, Washington offering its members medical services for $0.50 per month.
c. 1929, Blue Cross of Dallas, Texas establishing schoolteachers plan of 21 days of hospitalization for $6 per year.
d. 1930s, Kaiser Construction setting up health plan for its workers.
a
Why did Congress pass the Health Maintenance organization Act of 1973?
a. to encourage the delivery of affordable, quality healthcare
b. To increase the number of physicians in primary care
c. to deter the privatization of the blue cross plans
d. to standardize the costs of healthcare across the nation
a
All of the following are characteristics of managed care organizations except:
a. coordination of care across the continuum
b. integration of finacing and delivery of health
c. management of costs and outcomes
d. freedom of choice and autonomous decision making
d
access to mental or behavioral health or medical specialists is through referral. What is the term for the individual who makes the referral?
a. primary care provider
b. gatekeeper
c. primary care physician
d. all of the above
d
All of the following are characteristics of disease management except:
a. prevention of exacerbations of chronic disease
b. promotion of healthy life choices
c. focus on single specialist for acute disease
d. monitoring of adherence to treatment plans
c
What is the term for an explicit statement that directs clinical decision making?
a. cookbook medicine
b. preauthorization
c. evidence based practice guidelines
d. withhold pool
c
all of the following are tools managed care organizations use to promote quality care in their healthcare plans except:
a. emphasis on health of populations
b. maintenance of accreditation
c. discernment in selection of providers
d. incentive to meet fiscal targets
d
All of the following are purposes of the surveys that managed care organizations send their patient/members except:
a. reasons for referral to specialists
b. perceptions of the plans’ strengths and weaknesses
c. suggestions for improvements
d. intentions regarding reenrollment
a
The member had had gastric bypass surgery three years previously. As a result of losing more than two hundred pounds loose skin hung from the member’s arms, thighs, and belly. The member, up9on referral from her general surgeon was scheduled to have a plastic surgeon remove the excess skin. The member called for prior approval as required by the plan. The clinical review resulted in a denial of the surgery as cosmetic. The member requested a peer review and submitted documentation from her physician that the excess skin was causing skin infections and exacerbating her eczema. The pper clinician denied the case. What is the members next step if she is determined to have the surgery?
a. file a law suit
b. appeal to an expert clinician in the same specialty
c. schedule the surgery with her original general surgeon as that surgeon was paid
d. disenroll from the plan and enroll with indemnity healthcare insurance
b
What is the term that means evaluating for a healthcare service, the appropriateness of its setting and its level of service?
a. coordination of service benefits
b. community rating
c. outcomes assessment
d. utilization review
d
Which of the following services is most likely to be considered medically necessary?
a. caregivers convenience or relief
b. cosmetic improvement
c. investigational cancer prevention
d. standard of care for health condition
d
All of the following sets represent criteria for medical necessity and utilization review except:
a. intensity of service, severity of illness, and discharge screens
b. appropriateness evaluation protocol
c. Robertson guidelines
d. Federal register Index and ratings
d
All of the following services are typ8ically reviewed for medical necessity and utilization except:
a. rehabilitive therapies
b. inpatient admissions
c. well baby check
d. mental health and chemical dependency care
c
gatekeepers determine the appropriateness of all of the following components except:
a. rate of capitation or reimbursement
b. healthcare service itself
c. level of healthcare personnel
d. setting in the continuum of care
a
The patient belonged to a managed care plan. Prior approval for the surgery was received. What number should the insurance analyst record?
a. social security
b. drug enforcement administration
c. credit score
d. precertification
d
The patient belonged to a managed care plan. The patient had an elective surgery. Prior approval for the elective surgery had not been obtained. What should the patient expect?
a. delay in scheduling the post operative visit
b. reduction in future coverage of surgical services
c. denial of reimbursement for the surgery
d. increase in premium for next enrollment period
c
For which one of the following healthcare services is the managed care plan least likely to require a second opinion?
a. procedures that are high cost
b. conditions for which the diagnostic evidence is equivocal
c. treatment protocols that have low risk
d. treatments for which experts’ opinions differ on efficacy
c
For what type of care should the physician practice manager expect to work with a case manager?
a. well baby check
b. pre athletics exam
c. acute appendicitis
d. workers’ compensation
d
What is the term for contracts that separate certain types of healthcare services to decrease MCOs risk?
a. cherry picking
b. sub capitation
c. carve out
d. withhold pool
c
All of the following are elements of prescription management except:
a. links to electronic banking
b. formulary
c. patient education
d. alerts for interactions
a
All of the following attributes characterize episode of care reimbursement except:
a. capitation
b. global payment
c. retrospective fee for service
d. aggregation of utilization of healthy embers and chronically ill members
c
Phil White had coronary artery bypass graft surgery. Unfortunately, during the surgery, Phil suffered a severe stroke. Phil’s recovery included several settings in the continuum of care – acute care hospital, physician office, rehabilitation center, and home health agency. This initial service and subsequent recovery lasted ten months. As a member of an MCO in an integrated delivery system how should Phil expect that his healthcare billing will be handled?
a. He will receive bills for each service from each physician, each facility, and each other health care provider from every encounter.
b.. He will receive bills for each service from each physician, each facility, and each other health care provider at the end of the ten month period.
c. He will receive consolidated billing for each encounter that includes the bills from all the physicians, facilities, and other health care providers involved in the encounter.
d. He will be billed for one fixed amount for the entire episode that is divided among all the physicians, facilities, and other healthcare providers.
d.
The primary care physician did not meet the MCOs target for counseling cardiac patients about smoking cessation. The primary care physician could expect any of the following results except:
a. bonus
b. reduction in salary
c. exemption fro the surplus withholds
d. loss of physician contingency reserve
a
A patient, who was a Medicaid recipient, asked about the types of financial incentives that the MCO used. What should the MCOs administrator do?
a. refer the Medicaid recipient to the MCOs legal counsel
b. consult with the MCOs legal counsel himself or herself and relay the counsel’s legal decision to the Medicaid recipient
c. release the summaries of the financial incentives
d. refuse to respond as this information involves proprietary and personnel data
c
The patient belongs to a managed care plan. The patient wants to make an appointment with an out of network specialist. The plan has approved the appointment as out of plan. What should the patient expect?
a. The front office of the out of network specialist will delay and obstruct the making of the appointment.
b. The patient’s out of pocket costs for the out of plan appointment will be equal to the out of pocket costs for in plan care because the prior notification was c0ompleted
c. The patient’s out of pocket costs will be increased
d. the patient can permanently transfer his or her care to the out of plan specialist because the initial appointment was approved.
c
Of the following types of MCOs, which one has the strictest procedures for control of costs?
a. preferred provider organization
b. staff model
c. group practice model
d. network model
b
What is meant by the phrase “point of service” in point of service healthcare insurance plan?
a;. charges are captured at the site and time they are incurred.
b. decision making is decentralized to the primary care providers who are empowered to determine the care across the continuum during the encounter.
c. computer linkages allow immediate decisions during an encounter regarding approvals or denials across the entire IDS.
d. members choose the reimbursement model (HMMO, PPO, fee for service) when they need healthcare services rather than during the open enrollment period.
d
What is the term for an MCO that serves Medicare beneficiaries?
a. Medicare advantage
b. social foundation
c. part a
d. exclusive provider organization
a
Integrated delivery systems use varying degrees of integration. Which degree of integration is lease binding?
a. acquisition
b. affiliation
c. consolidation
d. merger
b
In the group practice, the physicians have maintained their separate practices and offices. The individual practices share administrative systems to form a group practice. Which form of integrated delivery system does this arrangement represent?
a. closed panel
b. inclusive provider organization
c. clinic without walls
d. management service organization
c
Which of the following features is a benefit of consumer directed healthcare plans?
a. patients’ awareness of and responsibility for healthcare costs
b. no built in financial incentives
c. economies of scale based on one size fits all
d. employers can provide fewer choices
a
In the 1970s, what factors affected the Medicare Program?
a. The increase in Medicare expenditures for inpatient hospital care jeopardized Medicare’s ability to fund other health programs.
b. deductibles had remained stagnant generating insufficient income
c. Increased incomes of US citizens and concomitantly their increased payroll deductions paid into the Medicare Program, assured its financial solvency.
d. The clear and succinct cost based reporting requirements generated enthusiasm for the Medicare program in the provider community.
a
Which of the following points is a guideline for the acute hospital prospective payment system?
a. incentive for cost control because hospitals retain profits or suffer losses based on differences between payment rate and actual costs
b. retrospective, charge based payment
c. directly tied to past or current actual charges
d. partial payments with add-ons for severity of illness
a
what is the average of the sum of the relative weights of all patients treated during a specified time period?
a. case mix index
b. outlier pool
c. share
d. mean qualifier
a
the MS-DRG payment includes reimbursement for all of the following inpatient services except:
a. medications
b. progress notes
c. laboratory tests
d. dressings and other supplies
b
Select the highest level of the IPPS hierarchy:
a. multiple significant trauma
b. surgical section
c. diagnosis related group
d. major diagnostic category
d
What is the general term for software that assigns inpatient diagnosis related groups.
a. encoder
b. grouper
c. aligner
d. scrubber
b
what is the Medicare’s term for a facility with a high percentage of low-income patients?
a. disproportionate share hospital
b. financial hardship hospital
cc. percentage income payment facility
d. underserved facility
a
What condition does CMS require be met for a facility to receive the indirect medical education adjustment?
a. medical residents in an approved graduate medical education program
b. medical residents and nurses in approved educational programs
c. medical residents, nurses, and allied health personnel in approved educational programs
d. Any type of health personnel in training including the above listed types as well as other types, such as medical social workers, pharmacists, dentists, recreational and music therapists, and child and family development specialists
a
New medical technologies are often very expensive. What is the CMS position on the use of new technologies to treat Medicare beneficiaries?
a. CMS discourages the use of new technologies, even though they may substantially improve patient care, until the cost is within one standard deviation of the community rating
b. CMs encourages the use of new technologies through a regulatory process that formally identifies a status of new technology and thereby, allows a payment for the full DRG plus 50 percent of the new technology’s cost
c. CMS requires budget neutrality in that CMS will cover the cost of the ew technology only if its cost is offset by reduced costs due to shortened lengths of stay.
d. CMS takes no position on new technologies in that CMS expects patients to receive quality care and therefore, expects providers to use new technologies should the new technologies be the means to improve care.
b
What is the name of the entity that pays Medicare Part A claims?
a. Pricer
b. Medicare Administrative contractor
C. CMS
d. Medicare code editor
b
In MS DRG, for what is the case mix index a proxy?
a. risk of mortality
b. difficulty of treatment
c. consumption of resources
d. prognosis
c
In the IPS, what is the term for each hospital’s unique standardized amount based on its costs per Medicare discharge?
a. base payment rate
b. diagnosis related group
c. carrier amount
d. cost outlier
a
What is the basis of the labor related share?
a. cost of living adjustment
b. facilities costs related to payrolls benefits, and professional fees
c. market basket index
d. disproportionate share percentage
b
A Medicare patient was discharged from one acute IPPS and admitted to another acute IPPS hospital on the same day. How will the two acute IPPS hospitals be reimbursed?
a. The first hospital receives a per diem payment derived from the potential MS DRG and second hospital receives the full MS DRG
b. the same MS DRG payment is made to both hospitals based on the principal diagnosis and procedures, if applicable, at the second hospital
c. each hospital receives the same MS DRG payment based on the principal diagnosis and procedures if applicable at the first hospital
d. The appropriate and potentially different MS DRG payments are made to each hospital based on the patient’s principal diagnosis and procedures, if applicable, at each hospital.
a
15 For purposes of Medicare reimbursement, which of the following situations represents a discharge from that first acute IPPS hospital?
a. the patient is discharged from an acute IPPS hospital and is admitted to a skilled nursing facility with three days.
b. The patient is discharged from one acute IIPPS hospital and is admitted to a second acute IPPS hospital on the third day.
c. the patient is discharged from an acute IPPS hospital within a written plans for home health services that will begin within three days.
d. The patient is discharged as MS DRG 014 (specific cerebrovascular disorders except TIA) and is admitted to a long term care facility within three days.
b
Which is the correct formula for wage index adjustment?
a. (payment rate * non labor portion * WI) + (payment rate * labor portion)
b. (payment rate * labor portion * WI) + (payment rate * non labor portion)
c. (payment rate * WI)
d. (payment rate * non labor portion * WI) + (payment rate * labor portion* COLA)
b
Which reimbursement scheme is used in the Inpatient facility prospective payment system?
a. case rate
b. retrospective cost based
c. case rate with exclusions
d. per diem rate
d
which of the following is not a provision of the IPPS
a. high cost outlier
b. indirect medical education
c. length of stay outlier
d. disproportionate share hospital adjustment
c
under the IPF PPS which states are included in the cost of living adjustment (COLA)?
a. Alaska and Hawaii
b. California and Alaska
c. California and Hawaii
d. Hawaii and New York
a
which of the following is not a patient level adjustment used in the IPF PPS?
a. length of stay
b. comorbidity
c. MS DRG
d. Full service emergency department
d
Medicare inpatient reimbursement levels are based on:
a. CPT codes reported during the encounter
b . MSDRG calculated for the encounter
c. charges accumulated during the episode of care
d. usual and customary charges reported during the encounter
b
Which Congressional act called for the creation of a PPS for the psychiatric inpatient setting?
a. Omnibus Consolidated and emergency supplemental appropriations act of 1999
b. Medicare, Medicaid and SCHIP benefits improvement act of 2000
c. balanced budget act of 1997
d. balanced budget refinement act of 1999
d
It is the year 20XX. The federal government is determined to lower the overall payments to physicians. To incur the least administrative work, which of the following elements of the physician payment system would the government reduce?
a. conversion factor
b. RVU
c. GPCI
d. weighted discount
a
What is the term for an index based on relative differences in the cost of a market basked of goods across areas?
a. bundle
b. CPI
c. GPCI
d. cost to charge
c
3All of the following elements are used to calculate a Medicare payment under RBRVs excedpt:
a. work value
b. malpractice expenses
c. extgent of the physical exam
d. practice expenses
c
Which one of the following statements characterizes the RBRVS payment system?
a.
5Which researcher is associated with the RBRVs payment system?
a. Fetter
b. Hsaio
c. Thompson
d. Weed
b
6Which university is associated with the development of the RBRVS payment system?
a. Harvard
b. Yale
c. Princeton
d. Johns Hopkins
a
which of the following sites is considered a facility in the RBRVS payment system?
a. physician office
b. dialysis center
c. independent laboratory
d. abulance
d
Which element of the RVU accounts for the costs of the medical practice, such as office rent, wages of non physician personnel, and supplies and equipment?
a. work value
b. malpractice expenses
c. extent of the physical exam
d. practice expenses
d
All of the following items are packaged under the Medicare Hospital outpatient prospective payment system (OPPS), except:
a. recovery room
b. supplies, other than pass through
c. anesthesia
d. medical visits
d
Under the OPPS, outpatient services that are similar both clinically and in use of resources are assigned to separate groups called _______.
a. DRGs
b. APCs
c. APR-DRGs
d. APGs
b
Which of the following statements is true about APCs?
a. APCs are based solely on the patient’s principal diagnosis.
b. ICD-9-CM procedure codes are used to group patients.
c. Severity of illness is taken into consideration when grouping APCs
d. APCs are based on the CPT or HCPCS codes reported.
d
In the APC system, an outlier payment is paid when which of the following occurs?
a. the cost of the service is greater than the APC payment by a fixed ratio and exceeds the APC payment plus a threshold amount.
b. The LOS is greater than expected
c. The charges for the services provided are greater than the expected payment
d. The total cost of all services is greater than the sum of APC payments by a fixed ratio and exceeds the sum of APC payments plus a threshold amount
a
Which of the following status indicators indicates that the APC payment is reduced when multiple procedures with this status are reported together?
a. V – medical visit
b. X – ancillary service
c. T – surgical service
d. S – significant procedure
e. G – pass through drug
c
What is the maximum number of APCs that may be assigned per encounter?
a. 1
b. 5
c. 10
d. 15
e. unlimited
e
The prospective payment system used by hospitals for the majority of services provided to Medicare hospital outpatients is called ______ and became effective on _____ .
a. laboratory fee schedule; October 1, 2000
b. ambulatory patient groups; January 1, 2000
c. ambulatory payment classifications; august 1, 2000
d. Medicare fee schedule; august 1, 2000
b
This PPS has been adopted for use by many third party payers, that is Medicaid) for reimbursement of outpatient visits. It is not the methodology used by Medicare.
a. ASC (ambulatory surgery centers) groups
b. APGs (ambulatory patient groups)
c. DRGs (diagnosis related groups)
d. APCs (ambulatory payment classifications
b
These are financial protections that were created to ensure that certain types of facilities (that is, cancer hospitals and small rural hospitals) recoup losses incurred due to payment differences between the OPPS and pre-OPPS (reasonable cost) payments.
a.
b.
c.
d.
c
The OPPS encompasses a variety of PPSs. All of the following are OPPS systems except:
a. percent of billed charges
b. fee schedule
c. APCs
d. ASP (average sale price) for drugs
a
Several acts influenced the creation and establishment of the current OPPS (APCs). Which of the following acts did not influence the creation and establishment of OPPS?
a.
b.
c
Which Medicare fee schedule uses a five year transition period to switch from a reasonable cost/reasonable charge based system to a PPS?
a. RBRVS
b. laboratory
c. ambulance
d. ambulatory surgical center
c
What term is used to indicate that an ambulance service entity is associated with a medical facility?
a. supplier
b. contractor
c. provider
d. associate
c
Which act of congress added a new section to the SSA calling for the creation of a PPS for ambulance services?
a. HIPAA of 1996
b. Balanced budget act of 1997
c. balanced budget refinement act of 1999
d. benefits improvement act of 2000
b
The ambulance fee schedule was implemented on:
a. October 1, 2001
b. January 1, 2002
c. April 1, 2002
d. July 1, 2002
c
Under the ambulance fee schedule, the ________ is used to determine the level of service for ground transport.
a. patient’s medical condition using ICD 9 CM diagnosis code
b. length of the transport in miles
c. EMS provider skill set used during the transport
d. type of transport vehicle
c
Which of the following is not an adjustment provided under the ambulance fee schedule?
a. multiple patient transport adjustment
b. urban area service adjustment
c. regional variation adjustment
d. rural area service adjustment
b
When a patient is pronounced dead prior to an ambulance being called, which of the following payment provisions is followed under the ambulance fee schedule?
a. no payment is made to the ambulance supplier/provider
b. a BLS base rate for ground transport will be paid
c. payment rules are the same as if the patient were alive
d. 50 percent of the payment rate is paid
a
The omnibus budget reconciliation act of 1980 amended the SSA to specify which procedures would be covered under the prospective payment system for ambulatory surgical centers. This PPS is officially named:
a. The ASC List of Covered procedures
b. The ASC List of Covered surgeries
c. The ASC fee schedule
d. The ASC PPS
a
Which is the correct formula for wage index adjusting a payment?
a. (payment rate * non-labor portion * WI) + (Payment rate * labor portion)
b. (payment rate * labor portion * WI) + (Payment rate * non-labor portion)
c. (payment rate * WI)
d. (payment rate * non-labor portion * WI) + (Payment rate * labor rate * COLA)
b
Under the ASC list multiple procedures performed during the same surgical session are reimbursed at which of the following rates?
a. All procedures receive full (100 percent) payment
b. The procedure in the highest level group receives full payment and the remaining procedures receive half (50%) payment.
c. The procedure in the lowest level group receives full payment and the remaining procedures receive half (50%) payment
d. The procedure in the highest level group receives full payment and the remaining procedures receive one-third(33%) payment
b
The Medicare modernization act of 2003 mandated the creation of a new PPS for ASC services because:
a. physicians do not like the ASC list
b. ASC facilities requested one
c. There is disparity between ambulatory surgical center and hospital outpatient facility payments for the same services
d. CMS believes that there should be more disparity between ambulatory surgical center and hospital outpatient facility payments for the same services
c
Medicare certified ASCs must accept assignment meaning:
a. An ASC can balance-bill the patient after medicare has paid their portion of the bill
b. an ASC can charge a Medicare patient more than other patients.
c. An ASC bills the Medicare patient for a 40% copayment and any deductible that is required.
d. An ASC must accept Medicare payment as payment in full.
d
The Medicare modernization act of 2003 mandated the creation of a new PPS for ASC services:
a. between 2006 and 2008
b. between 2007 and 2009
c. between 2008 and 2010
d. between 2009 and 2011
a

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