CMS
Utilization Review
Revenue Cycle
Discharge Planning
Patient Safety
100

Medicare patients receive this letter at least 2 days prior to an inpatient admission and up to 48 hours before a discharge order is placed

What is the Important Message of Medicare

100

What should be a patients admission time?

When care begins in the ED or on a unit

100

What status is utilized to evaluate if a possible inpatient admission is warranted?

Observation

100

AIDET Stands for:

Acknowledge, Introduce, Duration, Explain, Thank

100

Explain the RAACE procedure for a fire

R - Remove everyone from the immediate area

Alarm - Activate the alarm by pulling the nearest pull station

Alert - call out 'Code Red' to your co-workers and make sure someone calls the emergency number for your facility

Confine - Close all of the doors in the area affected

Extinguish - If safe initiate PASS from a safe distance and leave yourself a way to escape

200

Medicare patients receive this notification when they are placed in Observation status

What is the Medicare Outpatient Observation Notice (MOON)?

200

If we have a patient that is a Medicare recipient with an inpatient status, but the patient does not meet IP criteria, has not discharged, the attending is in agreement, and the Utilization Review committee/PA agrees, what condition code do we apply in order to convert to observation?

What is Condition Code 44?

200

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

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

200

BPCI is an initiative that is linking payment reimbursement to quality outcomes and the shared responsibility of patient care. What does BPCI stand for?

Bundle Payments for Care Improvement

200

Explain how to use a fire extinguisher

P - Pull the pin

A - Aim at the base of the fire

S - Squeeze the handle

S - Sweep from side to side

300

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

What is Quality Improvement Organization (QIO)?

300

What list do we utilize in order to determine if we are eligible to receive Medicare Part A reimbursement for certain procedures?

What is the CMS Inpatient Only List?

300

What is the rule required for all diagnostic or outpatient services observed the day of and three days prior to an admission (with related DRG) to be bundled within the inpatient services for Medicare billing?

DRG 3 Day Window OR 72 Hour Rule

300

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

IMPACT Act

300

Where is the fire alarm pull in your area?

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400

A Medicare recipient has appealed their discharged to KEPRO and KEPRO has agreed with the Hospital. The patient must be delivered a letter. What's the letter called and what's the numbers following it?  


What is Hospital Issued Notice of Non-Coverage (HINN) 12

400

Are inpatient discharges in the denominator or the numerator of the Observation equation?

Denominator

400

Outpatient, non-diagnostic services during the payment window, for Medicare patients, that are unrelated (and not on the day of admission), are reimbursed through what?

Medicare Part B (outpatient reimbursement)

400

Which law is in place in an effort to ensure all patients are provided emergent care in the EDs? Abbreviation and title.

Emergency Medical Treatment and Active Labor (EMTALA) law.

400

What do you do before you start CPR on a person

Assess scene safety

Check for responsiveness

Look for normal breathing

Call 9-1-1

500

A patient enters the hospital and is being treated for PNA with pneumonitis due to toxoplasmosis. The attending MD orders a PET scan due to patient request to determine if the patient has breast cancer. What letter should be ordered and delivered to the patient?

What is the Hospital Issued Notice of Non-Coverage (HINN) 11?

500

What is the relative value that is assigned to a diagnosis-related group (DRG) of patients in a medical environment? (HINT: We want this to be higher, which means we're being reimbursed more for managing more clinically dense patients)

Case Mix Index (CMI)

500

In healthcare, we assign a medical code that reports medical, surgical, and diagnostic services. We primarily focus on these when we are doing UR for the ortho unit...what are these called? Acronym and what does it stand for.

Current Procedural Terminology (CPT)

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

While performing CPR - what is the ratio between compressions to breaths for all patients?

30/2