QUESTIONS AND CORRECT ANSWERS| ALREADY
GRADED A+||BRAND NEW VERSION!!
Quality improvement is based on - CORRECT ANSWER ✔✔ - Developing and
enforcing standards through surveillance, Measuring and improving outcomes of
care, Educating healthcare providers about quality improvement opportunities,
Educating beneficiaries to make good health care choices.
CMS - CORRECT ANSWER ✔✔ - Responsible for implementing federal quality
assurance standards in laboratories, nursing homes, hospitals, home health
agencies and ambulatory surgical centers.
4 - CORRECT ANSWER ✔✔ - Parts of Medicare
60 days - CORRECT ANSWER ✔✔ - Many of days after a Medicare patient's
discharge from an inpatient hospital or skilled nursing facility does the benefit
period end (providing that the patient has not been readmitted to a facility during
that time).
100 days - CORRECT ANSWER ✔✔ - Days Medicare will pay for in a participating
skilled nursing facility when medically necessary.
Medicare Part B - CORRECT ANSWER ✔✔ - Component of Medicare helps pay for
ambulance transportation.
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,Medicaid - CORRECT ANSWER ✔✔ - is funded and administered through a State-
federal partnership to provide health care coverage for certain low income
people.
Medicare Part B - CORRECT ANSWER ✔✔ - Patient must have to be eligible for
Tricare For Life.
Insurance Eligibility, Authorization/Pre certification requirements, and deductible
and Co-pay amounts - CORRECT ANSWER ✔✔ - The verification of benefits
process determines _________________________.
NAIC - CORRECT ANSWER ✔✔ - In an effort to standardize the Coordination of
Benefits rules.
HMO's - CORRECT ANSWER ✔✔ - Insurance plans that strive to control health
care cost by requiring members to receive services at designated facilities.
Body Language & Visual Behavoir - CORRECT ANSWER ✔✔ - Non verbal
communication clues.
HIPAA - CORRECT ANSWER ✔✔ - Patient privacy protections are part of this act.
Staff Empathy - CORRECT ANSWER ✔✔ - According to a Press-Ganey study,
____________________ has a major impact on a patient's impression of a
hospital.
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,Documented - CORRECT ANSWER ✔✔ - If it's not _________________________ ,
it didn't happen
Clinical Prerequisites - CORRECT ANSWER ✔✔ - Part of this is reviewing service
and procedure information with the patient.
Financial Pre - Determination - CORRECT ANSWER ✔✔ - The method through
which the provider identifies actual payment sources and assists the patient in
determining expected reimbursement, their out of pocket expenses and
alternative funding sources.
Point of Service Collection - CORRECT ANSWER ✔✔ - Collecting the patient's
portion of the bill at the time service is rendered.
EMTALA - CORRECT ANSWER ✔✔ - Federal law enacted in 1986 by CMS to protect
patients against discrimination based on his or her economic status and mandates
patients receive a screening exam and stabilizing treatment when seeking
emergency medical care of when in active labor.
Secretary of the DHHS - CORRECT ANSWER ✔✔ - Validates Joint Commission
findings.
Office of Civil Rights (OCR) - CORRECT ANSWER ✔✔ - responsible for the
enforcement of HIPAA regulations.
MPI - CORRECT ANSWER ✔✔ - Will store at least all medical record numbers
associated with that entity's patients.
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, Policyholder/ Subscriber - CORRECT ANSWER ✔✔ - Person who contracts with the
insurance company for health care coverage.
CMS - CORRECT ANSWER ✔✔ - Created on March 9, 1977 to consolidate into one
agency the responsibility for administering Medicare and Medicaid.
Prospective Payment System (PPS) - CORRECT ANSWER ✔✔ - Legislated in 1983.
Reduced the growth rate of Medicare outlays for hospital inpatient services.
DRG - CORRECT ANSWER ✔✔ - System that pays hospitals a fixed amount per
patient based on diagnosis.
APG's or APC's - CORRECT ANSWER ✔✔ - Outpatient payment system that covers
episodes of care for a particular medical diagnosis (excludes Behavior Health)
rather than the current system of payments for individual services.
Fiscal Intermediaries - CORRECT ANSWER ✔✔ - With certain exceptions
______________________ perform bill processing and pay benefits for Medicare
Part A.
Internal and external - CORRECT ANSWER ✔✔ - Patient access service's customers
are_____________________.
External Customers - CORRECT ANSWER ✔✔ - is Vital to ensure a positive
healthcare experience for patients.
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