Through what document does a hospital establish compliance standards?
ANSWER : code of conduct
What is the purpose OIG work plant?
ANSWER : Identify Acceptable compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day ...
Through what document does a hospital establish compliance standards?
ANSWER : code of conduct
What is the purpose OIG work plant?
ANSWER : Identify Acceptable compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
window rule?
ANSWER : Non-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do?
ANSWER : Report a specific circumstance that affected a procedure or service
without changing the code or its definition
IF outpatient diagnostic services are provided within three days of the admission of a
Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what
must happen to these charges
, Deeagles - Stuvia US
ANSWER : They must be billed separately to the part B Carrier
what is a recurring or series registration?
ANSWER : One registration record is created for multiple days of service
What are nonemergency patients who come for service without prior notification to the
provider called?
ANSWER : Unscheduled patients
Which of the following statement apply to the observation patient type?
ANSWER : It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient
ANSWER : Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what?
ANSWER : Complete the scheduling process correctly based on service requeste
The Time needed to prepare the patient before service is the difference between the
patients arrival time and which of the following?
ANSWER : Procedure time
, Deeagles - Stuvia US
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include:
ANSWER : Documentation of the medical necessity for the test
What is the advantage of a pre-registration program
ANSWER : It reduces processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry
ANSWER : The responsible party's full legal name, date of birth, and social
security number
Which of the following statements is true about third-party payments?
ANSWER : The payments are received by the provider from the payer responsible
for reimbursing the provider for the patient's covered services.
Which provision protects the patient from medical expenses that exceed the pre-set
level
ANSWER : stop loss
what documentation must a primary care physician send to HMO patient to authorize a
visit to a specialist for additional testing or care?
ANSWER : Referral
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