Exam (elaborations) CHAA3120

Medicare Two-midnight rule - ANSWER What is the CMS rule that states that an inpatient stay must cross two midnights to be paid for under Medicare part A? OIG - ANSWER Which program is responsible for protecting the integrity of the Hospital and Human Services (HHS) program by detecting and preventing fraud? 7 - ANSWER An effective compliance level has a minimum of how many levels? Creating standards of privacy - ANSWER Part of an effective compliance program Not being treating in an emergency due to lack of ability to pay - ANSWER EMTALA is a regulations that protects patients from what? Financial Assistance Brochure - ANSWER What is not an example of PHI? Increase the adoption of qualified electronic health records - ANSWER Meaningful Use is an incentive program to what? MOON - ANSWER This document is provided to Medicare beneficiaries who are admitted as outpatients receiving observation status that they may have a co-payment and co-insurance Unknowingly billing for services at a higher complexity - ANSWER What is not an example of fraud or abuse? CHAMPVA - ANSWER Which government healthcare program is provided for surviving spouses of veterans killed in the line of duty? Civilians working in a military treatment facility - ANSWER Who does Tricare not provide healthcare to? Veterans Choice - ANSWER When a veteran's local VA healthcare center cannot provide service in a timely manner, this program allows the veteran to seek care from the community. When an individual has medical coverage through an employer GHP, that plan is the primary payer during the 30 month COB period. Medicare is the secondary during this time. - ANSWER Is Medicare the primary or secondary payer if a patient has ESRD and is in their 30 month period? If there are other sources of payment primary to Medicare - ANSWER The MSP requires that we ask pertinent questions to determine what? ABN - ANSWER What is the form given to Medicare beneficiaries informing them of potential non-coverage of out-patient services? It enhances community confidence in the quality and safety of care - ANSWER Which of the following is a reason that organizations seek Joint Commission accreditation? That if this inpatient stay is deemed experimental they will be responsible - ANSWER The important Message from Medicare (IMM) informs the patient of the following except? MAGI - ANSWER Method used to determine financial eligibility for Medicaid, CHIP, and Marketplace cost sharing is called PPACA - ANSWER What is the name of the program also known as Obamacare? EMTALA - ANSWER Name of the statute created to ensure all people have access to emergency treatment regardless of their ability to pay. Condition Code 44 - ANSWER What is the tracking code for patients admitted as inpatients to the hospital but do not meet the criteria? BCBS - ANSWER Who is the primary payer when the Medicare patient is under the age of 65 and is covered by their spouses BCBS plan through the Federal Government?