Ch 18: Review Test

Question 1

The construction of today’s modern hospital is regulated by ____?

Answer 1

• Federal and state laws
• State health department policies
• City ordinances

Question 2

Today’s hospitals mainly offer what?

Answer 2

Private and semiprivate rooms

Question 3

Hospitals that provide all levels of care are referred to as what?

Answer 3

Vertically integrated hospitals

Question 4

A popular designation given to today’s healthcare patients is what?

Answer 4

Customers

Question 5

A single building or campus, typically having a large number or beds, specialized facilities for various medical care types, and an emergency department, is called a ____

Answer 5

General hospital

Question 6

A medical facility smaller than a hospital is typically referred to as what?

Answer 6

Clinic

Question 7

A healthcare facility that is equipped and staffed to respond immediately to critical situations and provide continuous care to patients with “worst-case” scenarios is a(n) ____?

Answer 7

Acute care facility

Question 8

A facility designed for patients who have had acute events as a result of an illness, injury, or exacerbation of a disease process is a(n) ____?

Answer 8

Subacute care facility

Question 9

The type of facility in which patients have the advantage of constant access to nursing care as they more toward recovery and return to their home is a(n) ____?

Answer 9

Subacute care facility

Question 10

A facility that is licensed or approved under state or local law that is primarily engaged in providing experienced nursing care and related services is a(n) ____?

Answer 10

Skilled nursing facility

Question 11

Temporary relief for an individual providing healthcare to a family member is commonly called what?

Answer 11

Respite care

Question 12

The type of care facility provided for adults who are chronically ill or disabled and are no longer able to manage in independent living situations is referred to as what?

Answer 12

Long-term care

Question 13

What is the acronym for the federal act the ensures public assess to emergency services regardless of ability to pay?

Answer 13

EMTLA (emergency medical treatment & labor act)

Question 14

The voluntary process through which an organization is able to measure the quality of its services and performance against nationally recognized standards is called ____?

Answer 14

Accreditation

Question 15

The independent, nonprofit organization that performs quality-oriented accreditation reviews on HMOs and similar types of managed care plans is ____?

Answer 15

NCQA (national committee for quality assurance)

Question 16

What is the acronym for the organization formed in 1979 to assist ambulatory healthcare organizations in improving the quality of care provided to patients?

Answer 16

AAHC (association of academic health centers)

Question 17

What is the independent, nonprofit organization that promotes continuous improvement in the quality and efficiency of healthcare delivery through the establishment of standards, education, and communication?

Answer 17

URAC (Utilization review accreditation commission)

Question 18

How any organization is run, in its simplest definition, is referred to as ____?

Answer 18

Governance

Question 19

Moral principles that govern the practice of medicine by physicians and other healthcare practitioners are commonly referred to as medical ____?

Answer 19

Ethics

Question 20

Medicare hospital claims are processed by contracted nongovernment organizations or agencies that are commonly referred to as ____?

Answer 20

• Medicare administrative contractors (MACs)
• Fiscal intermediaries
• Medicare carriers

Question 21

Medicare Part A pays toward what?

Answer 21

Hospital charges

Question 22

Medicare’s acute care payment system is called the ____?

Answer 22

Prospective payment system (PPS)

Question 23

What is the abbreviation for an inpatient hospital coding system that groups related diagnoses and their associated medical/surgical treatment?

Answer 23

DRGs

Question 24

Many Medicaid programs adjust payments to reflect such things as patient demographics, diagnostic and treatment information, and total charges, which is referred to as ____?

Answer 24

A case mix

Question 25

If a military treatment facility is unavailable, TRICARE patients, in many cases, must obtain a ____?

Answer 25

Nonavailability statement (NAS)

Question 26

Most third-party payers' reimbursement rates are subject to change how often?

Answer 26

Annually

Question 27

Most hospitals in the United States contract with Blue Cross and Blue Shield and are referred to as ____?

Answer 27

Member hospitals

Question 28

The designated spaces on the UB-04 are called what?

Answer 28

Form locators

Question 29

The universal claim form for current use in inpatient hospital claims is what?

Answer 29

UB-04

Question 30

The process by which a patient can participate in choices about his or her healthcare's commonly referred to as what?

Answer 30

Informed consent

Question 31

An individual who has the legal authority to speak on a patient's behalf is called what?

Answer 31

Surrogate

Question 32

What manual is currently used for inpatient diagnostic coding?

Answer 32

ICD-10-CM

Question 33

What manual is now used for inpatient procedural coding?

Answer 33

ICD-10-PCS

Question 34

Coders must distinguish key elements or words in the patient's hospital health record that identify the ____?

Answer 34

Principal diagnosis

Question 35

What is the electronic equivalent to the UB-04 paper claim form?

Answer 35

837I

Question 36

The overall data stream of the electronic UB-04 file is known as a(n) ____?

Answer 36

Transaction set

Question 37

The total number of codes in the ICD-10-PCS system is approximately ____?

Answer 37

12,500

Question 38

"That condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care" defines the ____?

Answer 38

Principal diagnosis

Question 39

The payment system implemented in 2000 and used by the Centers for Medicare and Medicaid Services (CMS) to reimburse for hospital outpatient services is called the ____?

Answer 39

Hospital outpatient prospective payment system

Question 40

OPPS (or HOPPS) allows for temporary payment of new technologies, drugs, devices, and biologies for which no ambulatory payment classification (APC) payment rate is available, which is called ____?

Answer 40

Pass-throughs

Question 41

A computer application interface commonly used in hospitals to send and retrieve data for grouping, editing, and reimbursement outcomes is called the ____?

Answer 41

Grouper software system

Question 42

Identify the program implemented by CMS in 1996 to control improper coding that leads to inappropriate increased payment for healthcare services

Answer 42

National Correct Coding Initative

Question 43

Impatient acute care hospitals that are paid under the DRG payment system are required to report a specific indicator for every diagnosis on inpatient acute care hospital claims called ____?

Answer 43

Present on admission (POA)

Question 44

Identify the congressional act that stipulates that hospitals cannot charge uninsured patients more for the same treatment than what those with health insurance are billed

Answer 44

The Affordable Care Act

Question 45

The process of verifying that the diagnosis and procedure codes used on claims comply with all current coding guidelines and rules is called ____?

Answer 45

Coding compliance

Question 46

According to the textbook, the implementation date for the ICD-10 coding system is ____?

Answer 46

October 1, 2015

Question 47

ICD-10-PCS codes are composed of ____ characters

Answer 47

7

Question 48

Regardless of the coding system used, diagnosis codes must be supported by ____?

Answer 48

Medical documentation

Question 49

Identify the number of significant procedures other than the principal procedure that may be reported on the UB-04 claim form

Answer 49

5