What factor is medical necessity based on?

Question 1 (1 point)

 

What factor is medical necessity based on?

Question 1 options:

A)

The beneficial effects of a service for the patient’s physical needs and quality of life

 

B)

The cost of a service compared with the beneficial effects on the patient’s health

 

C)

The availability of a service at the facility

 

D)

The reimbursement available for a given service

 

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Question 2 (1 point)

The first prospective payment system (PPS) for inpatient care was developed in 1983. The newest PPS is used to manage the costs for

Question 2 options:

A)

medical homes.

 

B)

assisted living facilities.

 

C)

home health care

 

D)

inpatient psychiatric facilities

 

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Question 3 (1 point)

The category “Commercial payers” includes private health information and

Question 3 options:

A)

employer-based group health insurers.

 

B)

Medicare/Medicaid.

 

C)

TriCare

 

D)

Blue Cross and Blue Shield

 

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Question 4 (1 point)

LCDs and NCDs are review policies that describe the circumstances of coverage for various types of medical treatment. They advise physicians which services Medicare considers reasonable and necessary and may indicate the need for an advance beneficiary notice. They are developed by the Centers for Medicare and Medicaid Services (CMS) and Medicare Administrative Contractors. LCD and NCD are acronyms that stand for

Question 4 options:

A)

local contractor’s decisions and national contractor’s decisions.

 

B)

list of covered decisions and noncovered decisions.

 

C)

local covered determinations and noncovered determinations.

 

D)

local coverage determinations and national coverage determinations.

 

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Question 5 (1 point)

A Medicare patient was seen by Dr. Zachary, who is a nonparticipating physician. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The Medicare Fee Schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termed as “balance billing,” which means that the patient is

Question 5 options:

A)

financially liable for charges in excess of the Medicare Fee Schedule, up to a limit.

 

B)

financially liable for the Medicare Fee Schedule amount.

 

C)

financially liable for only the deductible.

 

D)

not financially liable for any amount.

 

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Question 6 (1 point)

CMS adjusts the Medicare Severity DRGs and the reimbursement rates every

Question 6 options:

A)

quarter

 

B)

calendar year beginning January 1

 

C)

month

 

D)

fiscal year beginning October 1

 

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Question 7 (1 point)

The prospective payment system used to reimburse hospitals for Medicare hospital outpatients is called

Question 7 options:

A)

MS-DRGs

 

B)

APGs

 

C)

RBRVS

 

D)

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