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24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] What happens in the "Log phase"? [Answer]
Cells double at regular intervals
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] What happens in the "Stationary phase"? [Answer]
Cells maintain cell number but do not continue to grow because of nutrient depletion
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] What happens in the "Decline phase"? [Answer]
Cells because to die because of lack of energy and nutrients
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] Define "autolysis" [Answer]
The breakdown or an orgaism because of it's own purpose or mechanism
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] Why may a bacterium autolyse? [Answer]
Some bacteria autolyse in order to spread and enhance growth of survivors
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] How can the number of viable cells in a culture be determined? [Answer]
by performing dilutions at each time point, spreading aliquots on petri dishes, and countingthe number of colonies that grow
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] What is the meaning of CFU? [Answer]
Colony Forming Unit, Each viable cell that can grow into a colony on a petri plate is a CFU.
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] What information does a turbimimetric assay yield? [Answer]
A turbidimetric assay determines how many bacterial cells, living or dead, are present by use of a spectrophotometer. The number differs from CFU numbers, because CFU numbers only reflect viable cells.
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] Define "anabolism" [Answer]
The use of energy and building blocks to make new cellular materials
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] Define "catabolism" [Answer]
The breakdown of complex materials that cells use for making more cells.
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] Define "metabolism" [Answer]
All the chemical processes occurring in a cell.
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] Define "enzymes" [Answer]
Protien catalysts that cells use to convert some molecules into others
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] Some enzymatic reactions are controlled by negative feedback. What happens when the product of a given reaction becomes high in concentration? [Answer]
When the cell is in an environment with ample amino acids, for instance, the cell gets the signal to save energy and not make its own amino acid.
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] What is activation energy? [Answer]
Activiation energy refers to the amount of heat neccessary to cause a chemical reaction. Enzymes can dramatically reduce the activation energy.
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] List the 3 major pathways of catabolism in organisms [Answer]
glycolysis, the Krebs cycle and electron transport
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] Name the starting compund of glycolysis [Answer]
glucose
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] How many ATP's are produced by the following processes: a. glycolysis b. TCA cycle/electron transport [Answer]
a: glycolysis produces two ATPs b: TCA cycle/electron transport produces thirty ATPs
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] Name the final electron acceptor in aerobic respiration [Answer]
oxygen
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] Name two possible final acceptors in anaerobic respiration [Answer]
nitrate and sulfate
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] List six commercially valuable products produced by fermentation [Answer]
cheese, yogurt, vinegar, acetone, butyl alcohol, beer and wine
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
24cf5fe0_cards_about_Micro_Unit_5_of_14__Answer
[Question] Name three types of macromolecules for which building blocks, or precursor molecules, are required [Answer]
DNA, RNA, and amino acids
[]
Flashcards about Micro Unit 5 of 14
Answer
http://www.studystack.com/flashcard-15244
1/1438042987127.36_20150728002307-00282-ip-10-236-191-2_747763189_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In the US, what is healthcare insurance? [Answer]
Reduction of a person's or a group's exposure to risk for unknown healthcare costs by the assumption of that risk by an entity
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The physician's office sent a request for payment to Able Insurance. The term used in the HC industry for this request for payment is a(n): [Answer]
Claim
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In which type of reimbursement methodology, do HC insurance companies reimburse providers after the costs have been incurred? [Answer]
Retrospective payment
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In the HC industry, what is the term for receiving compensation for HC services? [Answer]
Reimbursement
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] To which of the following factors in health insurance status most closely linked? [Answer]
Employment
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In which type of HC payment method does the HC plan pay for each service that a provider renders? [Answer]
Fee-for-service reimbursement
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In the HC industry, what is another term for "charge"? [Answer]
Fee
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In the accounting system of the physician office, the account is categorized as "self pay". How should the insurance analyst interpret this category? [Answer]
The guarantor will pay the entire bill
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] What is the term for a predetermined list of charges? [Answer]
Fee schedule
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In which type of HC payment method does the HC plan recompense providers with a fixed rate for each day a covered member is hospitalized? [Answer]
Per diem
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The coding system that is used primarily for reporting Dx for hospital inpatients is known as: [Answer]
ICD-9-CM
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which coding system was created for reporting procedures and services performed by physicians in clinical practice? [Answer]
CPT
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Under MS-DRGs, all of the following factors influence a facility's case mix index except for: [Answer]
The productivity standard for coders
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following is NOT a reason to perform case mix analysis? [Answer]
Determine the correct MS-DRG assignment for an encounter
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The practice of under coding can affect a hospital's MS-DRG case mix in which of the following ways? [Answer]
Makes it lower than warranted by the actual service/resource intensity of the facility
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following is the correct format for HCPCS Level II codes? [Answer]
A1234
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which govt. fraud/abuse effort focused on recouping lost funds for Medicare due to inaccurate coding/billing & recovered $188 Mil. in first 2 years? [Answer]
Operation Restore Trust
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The 6th scope of Work for QIO introduced which of the following? [Answer]
Payment Error Prevention Program
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The policies and procedures section of coding compliance plan should include: [Answer]
Unbundling
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] MS-DRG relationships comparing with CC to without CC DRGs for the same clinical condition should be reviewed because: [Answer]
CCs can be over-coded by coders and CCs can be under-coded by coders
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] All of the following entities are voluntary insurance except: [Answer]
Medicare
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following entities is also known as a group plan? [Answer]
Employer based HC insurance plan
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following characteristics is the greatest advantage of group health care insurance? [Answer]
Greater benefits for lower premiums
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In regards to healthcare insurance the percentage that the guarantor pays is called the...? [Answer]
Coinsurance
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following services has the highest likelihood of being a covered service? [Answer]
Medically necessary
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] What is the term for the contract between the HC insurance company and the individual or group for whom the company is assuming the risk? [Answer]
Policy
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which part of the medicare program was created under the medicare modernization act of 2003? [Answer]
Part D
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] This program formerly CHAMPUS Provides coverage for the dependents of active members of the armed forces: [Answer]
Tricare
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which government sponsored programs replaced the aid to families with dependent children AFDC program in 1996? [Answer]
Temporary assistance for needy families program TANF
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following is not a function of the indian health service IHS? [Answer]
Provides only inpatient healthcare services
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The civilian health medical program of the department of veterans affairs CHAMPVA is available for: [Answer]
spouse or widow of a veteran meeting specific criteria and children of a veteran meeting specific criteria
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] which of the following is/are true of SCHIP? [Answer]
Is a federal/state program and varies from state to state
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The medicare program is divided into how many parts? [Answer]
4
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Medicare part c is a ______ option known as medicare advantage: [Answer]
managed care
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] All of the following are true of state medical programs except: [Answer]
services offered to beneficiaries are the same in each state
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which TRICARE Program offers services to active duty family members (ADFMs) With no enrollment, deductible, or copayment fees for covered services? [Answer]
TRICARE Prime
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] All of the following are characteristics of managed care organizations except: [Answer]
Freedom of choice and autonomous decision making
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Access to mental or behavioral health medical specialists is through referral. What is the term for the person who makes the referral? [Answer]
PCP, gatekeeper, primary care provider (all of these)
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] What is the term that means the evaluating, for a healthcare service, the appropriateness of its setting and it's level of service? [Answer]
Utilization review
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following services is most likely to be considered medically necessary? [Answer]
Standard of care for health condition
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] All of the following sets represent criteria for medical necessity and utilization review except: [Answer]
Federal Register Index and Ratings
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] All of the following services are typically reviewed for medical necessity and utilization except: [Answer]
Well-baby check
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Gatekeepers determine the appropriateness of all of the following components except: [Answer]
Rate of capitation or reimbursement
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The patient belonged to a managed care plan. Prior approval for the surgery was received. What number should the insurance analyst record? [Answer]
Precertification
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The patient belonged to a managed care plan. The patient had an elective surgery. Prior approval for it had not been obtained. What should the patient expect? [Answer]
Denial of reimbursement for the surgery
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] What is the term for an MCO that serves Medicare beneficiaries? [Answer]
Medicare Advantage
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In the 1970s, how did factors affect the Medicare Program? [Answer]
The increase in Medicare expenditures for inpatient hospital care jeopardized Medicare's ability to fund other health programs.
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following points is a guideline for the acute hospital prosective payment system? [Answer]
Incentive for cost control because hospitals retain profits or suffer losses based on differences between payment rate and actual costs
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] What is the average of the sum of the relative weights of all patients treated during a specified time period? [Answer]
Case mix index
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The MS-DRG payment includes reimbursement for all of the following inpatient services except: [Answer]
Progress notes
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] What is the general term for software that assigns inpatient diagnosis related groups? [Answer]
Grouper
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] What is Medicare's term for a facility with a high percentage of low income patients? [Answer]
Disproportionate share hospital
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In MS-DRGs, for what is the case mix index a proxy? [Answer]
Consumption of resources
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In the IPPS, what is the term for each hospital's unique standardized amount based on its costs per Medicare discharge? [Answer]
Base payment rate
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following is not a patient level adjustment used in the IPF PPS? [Answer]
Full service emergency department
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Medicare inpatient reimbursement levels are based on _____ [Answer]
MS-DRG calculated for the encounter
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following sites is considered a facility in the RBRVS payment system? [Answer]
Ambulance
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following statements is true about APCs? [Answer]
d. APCs are based on the CPT or HCPCS code(s) reported.
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] the APC system, an outlier payment is paid when which of the following occurs? [Answer]
The cost of the service is greater than the APC payment by a fixed ratio and exceeds the APC payment plus a threshold amount
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The prospective payment system used by hospitals for the majority of services provided to Medicare hospital outpatients is called ______ and became effective on ______. [Answer]
Ambulatory Payment Classifications August 1, 2000
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] This PPS has been adopted for use by many third party payers (that is, Medicaid) for reimbursement of outpatient visits. It is not the methodology used by Medicare. [Answer]
APGs (Ambulatory Patient Groups)
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Under the Ambulance Fee Schedule, the _______________ is used to determine the level of service for ground transport. [Answer]
EMS provider skill set used during the transport
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] When a patient is pronounced dead prior to an ambulance being called, which of the following payment provisions is followed under the Ambulance Fee Schedule? [Answer]
no payment is made to the ambulance supplier/provider
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Under the ASC List multiple procedures performed during the same surgical session are reimbursed at which of the following rate? [Answer]
The procedure in the highest level group receives full payment and the remaining receive half (50%) payment
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The Medicare Modernization Act of 2003 mandated the creation of a new PPS for ASC services because ___________________. [Answer]
There is disparity between ambulatory surgical center and hospital outpatient facility payments for the same services
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Medicare-certified ASCs must accept assignment, meaning [Answer]
an ASC must accept Medicare payment as payment in full
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In which of the PAC payment systems, is the unit of payment the 60-day episode of care? [Answer]
Home health agency
[]
Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Generally, what is the average length of stay of long-term care hospitals? [Answer]
≥ 25 days
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Patients with all the following conditions are appropriate for LTCHs except: [Answer]
Acute myocardial infarction
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In terms of grouping and reimbursement, how are the MS-LTC-DRGs and acute care MS-DRGs similar? [Answer]
Based on principal diagnosis
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] All of the following elements are part of the IRF PPS except: [Answer]
Major diagnostic category
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] All of the following types of diagnoses are used in the IRF PPS except: [Answer]
Principal
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In the IRF PPS, what is the tool for data collection that drives payment? [Answer]
Patient Assessment Instrument
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] All of the following services are consolidated into a single payment under the HHPPS except: [Answer]
Durable medical equipment
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In which of the PAC payment systems, is the adjusted rate multiplied by the patient’s number of Medicare days to determine the reimbursement amount? [Answer]
Long term care hospital
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] What is the term used in a rehabilitation facility to mean “a patient’s ability to perform activities of daily living”? [Answer]
functional status
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] Which of the following is the definition of revenue cycle management? [Answer]
Coordination of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] The term “hard coding” refers to: [Answer]
CPT codes that appear in the hospital’s charge master
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json
7f0e4ea9_ards_about_Reimbursement_Final__Answer
[Question] In healthcare settings, the record of the cash the facility will receive for the services it has provided is known as which of the following terms? [Answer]
Accounts receivable
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Flashcards about Reimbursement Final
Answer
http://www.studystack.com/flashcard-606074
1/1438042987127.36_20150728002307-00008-ip-10-236-191-2_715580459_3.json