Ch 17: True and False

Question 1

T/F: Medicare patients are not included in the PPS system

Answer 1

False

Question 2

T/F: Prospective payment rates are set at a level intended to cover operating costs for treating a typical inpatient in a given DRG

Answer 2

True

Question 3

T/F: Under Medicare’s PPS, hospitals are paid a set fee for treating patients in a single DRG category, regardless of the actual cost of care for the individual

Answer 3

True

Question 4

T/F: The established payment rate for all services that a patient in an acute care hospital receives during an entire stay is based on a predetermined payment level that is selected on the basis of averages

Answer 4

True

Question 5

T/F: The biggest challenge in developing an RVS-based payment schedule was patient diversity

Answer 5

False

Question 6

T/F: The Affordable Care Act eliminated patient cost-sharing requirements (coinsurance and deductible) for most Medicare-covered preventive services

Answer 6

True

Question 7

T/F: DRGs are used for reimbursement in the PPS of the Medicare and Medicaid healthcare insurance systems

Answer 7

True

Question 8

T/F: DRGs adopted by CMS are defined by diagnosis and procedure codes used in the coding manuals

Answer 8

True

Question 9

T/F: A patient’s DRG categorization depends on the coding and classification of the patient’s medical information using only the CPT coding system

Answer 9

False

Question 10

T/F: Each DRG is assigned a relative weight (RW) and an average length of stay (ALOS)

Answer 10

True

Question 11

T/F: When patients are admitted to either a residential healthcare facility or a nursing home, physicians are required to prepare a written plan of care for treatment

Answer 11

True

Question 12

T/F: Activities of daily living are behaviors related strictly to mental health

Answer 12

False

Question 13

T/F: Medicare payment rules are established by Congress

Answer 13

False

Question 14

T/F: The Medicare program is administered mainly at the local and regional level by private insurance companies that contract with CMS to handle day-to-day billing and payment matters

Answer 14

True

Question 15

T/F: One of the chief objectives in creating the PPS was to monitor the quality of hospital services for Medicare beneficiaries

Answer 15

True

Question 16

T/F: Being a successful health insurance professional stops with knowing how to complete and submit insurance claims

Answer 16

False

Question 17

T/F: CMS uses the same PPS for reimbursement to acute inpatient hospitals, hospital outpatient services, and skilled nursing facilities

Answer 17

False

Question 18

T/F: Not all peer review organizations (PROs) deal with healthcare

Answer 18

True

Question 19

T/F: Non-PARs not accepting assignment can change beneficiaries no more than 115% of the Medicare allowance

Answer 19

True

Question 20

T/F: Contractual write-offs and bad-debt write-offs are basically the same

Answer 20

False

Question 21

T/F: A computerized practice management system can alleviate potential administrative problems a healthcare practice may encounter in complying with the HIPAA Privacy Rules

Answer 21

True

Question 22

T/F: The HHS mandates that all medical facilities use the same format for submitting electronic health transactions

Answer 22

False

Question 23

T/F: The VBPM applies only to physician payments under the Medicare PFS

Answer 23

True

Question 24

T/F: Many different patient accounting systems are available today that are capable of performing comparable patient accounting information

Answer 24

True

Question 25

T/F: If a medical practice contracts with a “business associate,” the practice should ensure that the agreement includes certain protections defined by HIPAA

Answer 25

True