CMS
Process Understanding
ELLiE
Compliance
Random
100

If a Medicare pt in OBS status is refusing to discharge what form must they receive?

ABN

100

What does VIDA stand for?

Very Important Discharge Appointment (DCs prior to 11A)

100

What is the name of the column where you can view DCP updates?

Expected Disch Comment

100

When do DCAs have to be completed by, with the exception of the weekend?

Within 24-hrs of admission.

100

When is Course Compass to be completed by?

12.15.22

200

When does discharge planning begin?

Day of admission

200

What is the relative value that is assigned to a diagnosis-related group (DRG) of patients in a medical environment?

Case Mix Index (CMI)

200

What order has to be entered for medically cleared Baker Act patients?

Referral to Behavioral Health

200

When is it okay to review charts of family members, friends, or neighbors?

Never

200

The form that OBS non-Medicare patient's receive on admission

HOON

300

If a Medicare pt appeals a DC outside of the window to appeal, what form do they receive while waiting to hear from KEPRO?

HINN 12

300

When is the appropriate time to request auth for SNF?

24-48 hrs prior to DC.

300

How are BPCI-A patients identified in ELLiE?

2 asterisks (**) in front of "DCAD, H/NN"

300

Which patient's qualify as a CJR Bundle?

THA & TKA (DRG 469 & 470) who are MC FFS

300

An inpatient Medicare recipient has appealed their discharge to KEPRO. What is KEPRO?

Quality Improvement Organization (QIO)

400

Public access to emergency services regardless of ability to pay

EMTALA

400

At what time do we make contact with the NOM/ANM to discuss VIDAs for the next day & where is this documented?

3PM & Under Expected Disch Comment

400

Where are UR Avoidable Days documented?

Payor Comm -> Bed Days

400

We do not use the terminology 'Preferred Provider List' because we want to ensure we are abiding by which act?

IMPACT Act

400

AIDET Stands for:

Acknowledge, Introduce, Duration, Explain, Thank

500

In order to participate in Medicare reimbursement a hospital must follow federal regulations, what are these called according to CMS?

Conditions of Participation (CoP)

500

What is the patient satisfaction metric utilized within the health care industry?

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

500

Updating ADT Codes so ELLiE & CarePort don’t mismatch

Event Mgt -> Update -> DC Disposition

500

What is PPS (full name + meaning)

Prospective Payment System | 

Fixed amount of reimbursement based off DRG

500

What is the ADT Code for GIP / IPU?

51

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