HIMT 1200 FINAL EXAM REVIEW
QUESTIONS AND ANSWERS 100% PASS
In a ____ system the health care provider charges and is paid for each item of service provided -
ANS fee-for-service
Under this type of program, reimbursement may be awarded or penalized based upon the
provider's ability to meet pre-established targets for delivery of health care services -
ANS pay-for-performance (P4P)
this law, passed in 2010, expanded Medicaid eligibility requirements - ANS Children's Health
Insurance Program (CHIP)
true or false - In a prospective payment system, the health care provider charges and is paid for
each time of service provided - ANS false
Under this care model, the primary care physician acts as a "gatekeeper" to coordinate the
patient care across providers by addressing preventive, acute, and chronic care needs and by
providing the patient with access to electronic tools - ANS Patient- centered medical home
model
Which of the following is NOT one of the administrative simplification provisions of HIPAA? -
ANS PPS (prospective payment system)
True or False - Medicare pays skilled nursing facilities, home health providers, inpatient
rehabilitation hospitals, and long-term care hospitals under prospective payment systems. -
ANS true
@COPYRIGHT ALL RIGHTS RESERVED PAGE 1 OF 24
,A(n) _________ links data provided by various health care providers. - ANS HIE
organization/RHIO
This program was developed by The Joint Commission to help accredited health care institutions
focus upon specific patient safety concerns. - ANS National Patient Safety Goals (NPSG)
This part of Medicare is also known as Medicare Advantage. - ANS Part C
Which audit initiative resulted in many teaching hospitals having to repay millions of dollars to
the Medicare program because they lacked documentation to substantiate Medicare payments
to faculty physicians who supervised residents? - ANS PATH
As required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003,
CMS has replaced past claims processing contractors known as fiscal intermediaries and
Medicare carriers with ________________________. - ANS Medicare Administrative
Contractors (MACs)
The physician sends the patient to the hospital for a radiological examination. The patient
returns to the physician's office for follow-up of test results. From the point of view of the
hospital, what type of hospital patient is this? - ANS Referred outpatient
HCPCS "Level II" or national codes refer to . - ANS codes that CMS developed
Under EMTALA, hospitals that offer emergency services ___________________. - ANS must
screen and stabilize, if necessary, any patient who arrives in the emergency department
Medicare payments to long-term acute-care hospitals (LTACHs) are based on ___________. -
ANS LTC-DRGs
Which of the following statements is FALSE in relation to APC status indicators?
Option A:
@COPYRIGHT ALL RIGHTS RESERVED PAGE 2 OF 24
, "S" represents a significant service that is not discounted when more than one APC is present
on a claim.
Option B:
"T" represents a significant procedure that is discounted when other procedures are performed
with it.
Option C:
"P" represents a partial hospitalization service.
Option D:
"V" represents those services which are not billable under the OPPS. - ANS Option D
Which of the following statements is TRUE?
Option A:
Hospitals must be accredited by The Joint Commission.
Option B:
Hospitals must be licensed by the state in which they are located.
Option C:
Hospitals must have a hospitalist on staff to qualify for CMS certification.
Option D:
Hospitals do not have to be licensed to admit patients. - ANS Option B
The standard form for submitting information to third-party payers when filing claims for
hospital services is the ______________. - ANS UB-04
For certain categories of encounterbased hospital outpatient services, "Composite APCs" result
in _______________________. - ANS only a single payment for certain common combination
services provided on the same day of service
true or false - Industrial health centers provide care to employees at their places of work or at
employer contracted sites. - ANS true
@COPYRIGHT ALL RIGHTS RESERVED PAGE 3 OF 24
QUESTIONS AND ANSWERS 100% PASS
In a ____ system the health care provider charges and is paid for each item of service provided -
ANS fee-for-service
Under this type of program, reimbursement may be awarded or penalized based upon the
provider's ability to meet pre-established targets for delivery of health care services -
ANS pay-for-performance (P4P)
this law, passed in 2010, expanded Medicaid eligibility requirements - ANS Children's Health
Insurance Program (CHIP)
true or false - In a prospective payment system, the health care provider charges and is paid for
each time of service provided - ANS false
Under this care model, the primary care physician acts as a "gatekeeper" to coordinate the
patient care across providers by addressing preventive, acute, and chronic care needs and by
providing the patient with access to electronic tools - ANS Patient- centered medical home
model
Which of the following is NOT one of the administrative simplification provisions of HIPAA? -
ANS PPS (prospective payment system)
True or False - Medicare pays skilled nursing facilities, home health providers, inpatient
rehabilitation hospitals, and long-term care hospitals under prospective payment systems. -
ANS true
@COPYRIGHT ALL RIGHTS RESERVED PAGE 1 OF 24
,A(n) _________ links data provided by various health care providers. - ANS HIE
organization/RHIO
This program was developed by The Joint Commission to help accredited health care institutions
focus upon specific patient safety concerns. - ANS National Patient Safety Goals (NPSG)
This part of Medicare is also known as Medicare Advantage. - ANS Part C
Which audit initiative resulted in many teaching hospitals having to repay millions of dollars to
the Medicare program because they lacked documentation to substantiate Medicare payments
to faculty physicians who supervised residents? - ANS PATH
As required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003,
CMS has replaced past claims processing contractors known as fiscal intermediaries and
Medicare carriers with ________________________. - ANS Medicare Administrative
Contractors (MACs)
The physician sends the patient to the hospital for a radiological examination. The patient
returns to the physician's office for follow-up of test results. From the point of view of the
hospital, what type of hospital patient is this? - ANS Referred outpatient
HCPCS "Level II" or national codes refer to . - ANS codes that CMS developed
Under EMTALA, hospitals that offer emergency services ___________________. - ANS must
screen and stabilize, if necessary, any patient who arrives in the emergency department
Medicare payments to long-term acute-care hospitals (LTACHs) are based on ___________. -
ANS LTC-DRGs
Which of the following statements is FALSE in relation to APC status indicators?
Option A:
@COPYRIGHT ALL RIGHTS RESERVED PAGE 2 OF 24
, "S" represents a significant service that is not discounted when more than one APC is present
on a claim.
Option B:
"T" represents a significant procedure that is discounted when other procedures are performed
with it.
Option C:
"P" represents a partial hospitalization service.
Option D:
"V" represents those services which are not billable under the OPPS. - ANS Option D
Which of the following statements is TRUE?
Option A:
Hospitals must be accredited by The Joint Commission.
Option B:
Hospitals must be licensed by the state in which they are located.
Option C:
Hospitals must have a hospitalist on staff to qualify for CMS certification.
Option D:
Hospitals do not have to be licensed to admit patients. - ANS Option B
The standard form for submitting information to third-party payers when filing claims for
hospital services is the ______________. - ANS UB-04
For certain categories of encounterbased hospital outpatient services, "Composite APCs" result
in _______________________. - ANS only a single payment for certain common combination
services provided on the same day of service
true or false - Industrial health centers provide care to employees at their places of work or at
employer contracted sites. - ANS true
@COPYRIGHT ALL RIGHTS RESERVED PAGE 3 OF 24
