health services billing
What are the two types of forms used for health services billing?
Describe how Medicaid payments to providers are limited by the federal government.
What is charge explosion?
How does the False Claims Act (FCA) impact providers of health care services?
What are the elements that should be present, at a minimum, in all charge masters?
Prosecution under the FCA requires that specific intent to defraud the government was present.
What is the objective in a managed-care environment that often leads to conflict between hospitals and doctors?
Increased emphasis on which of the following by both Medicare and Medicaid have also provided a strong incentive for hospitals and nursing homes to either merge or establish affiliation arrangements?
What factors contribute to the complexity of the revenue cycle in health care?
What type of physician alignment is most appealing to physicians because their control is maximized in this type of organizational setting?
Most of the major coverage provisions of the Affordable Care Act went into effect in what year and gave millions of people coverage under the law?
Governmental healthcare organizations are able to raise funds through equity investments.
What piece of legislation prohibits a person from receiving income from a pattern of activity, including committing an enumerated act (such as mail or wire fraud), at least twice in 10 years?
The financial manager’s main responsibility is to acquire and use funds so as to maximize the firm s value. Their main functions may include: forecasting and planning, making major investment financing decisions, coordinating and controlling, dealing with the financial markets, and managing public opinion.
For what reason is physician expenditures increasing?
__________ is often referred to as the antidumping law because it prohibits hospitals from transferring an emergency patient to another hospital simply because of the patient’s inability to pay.
The earnings of an investor-owned corporation can be subject to double taxation
Providing medically unnecessary care to a patient and then billing Medicare for it is an example Medicare fraud.
What are primary uses of financial information
Should hospitals and physicians undercode Medicare patient stays and patient visits in order to reduce the possibility of being charged under the False Claims Act?
In order for integration with other physicians to be successful, what person is needed to arrange the financing of capital needs and to provide administrative leadership?
FCA charges against providers can be brought by individuals under a qui tam action.
One of the advantages of a nonprofit organization compared with an investor-owned company is that the investor-owned company is subject to federal income taxes.
EMTALA allows a hospital to transfer an emergency patient to another hospital because of the patient’s inability to pay.
What are the six stages of the revenue cycle?
What is the difference in ownership between a sole proprietorship, a partnership, and a corporation?
How does the Stark Law impact physicians?
Hospital emergency room personnel are permitted to query the patient regarding his or her financial or insurance status at any time as long as the patient initiates such a discussion.
Which of the following covers nearly 100% of hospital service charges but is subject to a 20% coinsurance payment for most physician services?
Assume that an ambulance brought Cindy Roe to the emergency department of Grace Medical Center. She decides to leave the hospital without receiving treatment. The attending physician and the hospital staff offer Cindy medical examination and treatment within the hospital before she leaves. Cindy refuses treatment and refuses to sign an informed consent, and they let her go. The physician/hospital most likely has violated EMTALA.