HIM 370 Exam 2 Questions with Correct Answers Solved 100% Graded A+

HIM 370 Exam 2 Questions with Correct Answers Solved 100% Graded A+ Documentation required in an ambulatory surgery record that outlines all the risk with the procedure is known as what? - Answers informed consent Documentation required in an ambulatory surgery record that contains the discharge instructions? - Answers discharge diagnosis T/F: managed care organizations do not monitor the documentation of providers so licensure & certification are all that is required to joint - Answers False Do physicians offices have a problem list? what does the problem list contain? - Answers Yes, every provider has one & it contains active &/or resolved problems, resolve problems show the dates Branches of the OIG, what does OIG stand for? - Answers Office of Inspector General how long does a corporate integrity agreement last? - Answers 5 years PPO - Answers preferred provider organization What are the types of managed care plans - Answers HMO, PPO, PSP Whats a point of service plan? - Answers Start w/ primary care -- gatekeeper outlines where they go next Can you pay a fine, admit liability, & be kept off of the exclusion list? - Answers Yes Whats coordination of benefits? - Answers When youre looking at 2 insurance plans & determining which one is primary What is it when you are paid a flat rate based on the services provided ? - Answers fee schedules What if we where paid for each day the patient is in the facility? - Answers per diem Who would be the individual responsible for providing return to work physical exams; what type of outpatient freestanding ambulatory is going to do that? - Answers industrial/ Occupational health clinic What do you call a clinic located on college campus ? what kind of facility is it? - Answers - university health center - freestanding ambulatory Your facility is paid a fixed amount for each covered person, is that capitation or fee schedule? - Answers capitalization Evaluates proficiency of laboratory staff , what accreditation association ? - Answers CMS & they do a CLIA survey OIG - Answers Office of Inspector General Role is to protect the integrity of DHHS as well as the program beneficiaries - majority of resources goes towards program monitoring - Answers OIG - Medicare & Medicaid payments/ documentation 6 components that make up OIG - Answers a. Office of Inspector General b. Office of Audit Services c. Office of Evaluation & Inspections d. Office of Management & Policy e. Office of Investigations f. Office of counsel to the Inspector General administering the OIG plan & overall monitoring of enforcement & adherence to the OIG plan - Answers office of Inspector General - largest civilian audit agency in the federal government - conduct individual audits of health & human services programs - Answers Office of Audit services - work to prevent fraud, waste & abuse - Oversee the state Medicaid fraud control units/patient abuse & neglect - Answers Office of Evaluation and Inspections - focuses on customer satisfaction & information - budget formulation, execution of the programs, & funding of the State Medicaid Fraud control unit - human capital planning. Including recruiting, staffing, training & performance management, emergency preparedness - Answers Office of Management and Policy - conducts criminal & civil & administrative investigations of fraud & misconduct related to HHS (health & human services) - operate the OIG hotline - coordinate with the DOJ & other law enforcement authorities to leverage resources against fighting fraud - Answers Office of Investigations - legal advocate for the IG - lawyer for the OIG - Answers Office of Counsel to the Inspector General What are the ramifications & consequences of a failed OIG investigative audit - Answers exclusion, civil monetary penalties, corporate integrity agreement - no participation in federal programs - no Medicaid or Medicare reimbursement - if your facility hires a nurse or physician on the exclusion list, the facility is subjected to civil monetary penalties - Answers Ramifications & consequences of a failed OIG investigative audit: exclusion how do you prevent an exclusion if failed an OIG investigative audit? - Answers run a background check with the NPDB (national practitioner databank) - monetary settlement with denied liability - facilities & provides can still participate in the CMS program - Answers Ramifications & consequences of a failed OIG investigative audit: civil monetary penalties - arises after investigations reveal false claims violations - facility &/or provider are not excluded from CMS program but are under highly intense scrutiny of all services & payments for at least 5 year - Answers Ramifications & consequences of a failed OIG investigative audit: corporate integrity agreement what happens if you go under a corporate integrity agreement? - Answers facility &/or provider are not excluded from CMS program but are under highly intense scrutiny of all services & payments for at least 5 year Medicare part A eligibility requirements - Answers - 65 or older - disability (do not have to be 65 yrs of age) as determined by the social security administration & physician documentation - ESRD-end stage renal disease (do not have to be 65 yrs of age) - federal & state funded health insurance program for low income individuals & families