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DOD
A. Diagnostic and statistical manual
B. Department of Defense
C. Disproportionate share hospital (adjustment)
D. Diagnosis related groups
Answer: B
NEW QUESTION # 162
EMC
A. Explanation of Benefits
B. Exclusive provider organization
C. Electronic Media Claim
D. Electronic Medical Record
Answer: C
NEW QUESTION # 163
Allowable Charge
A. Adopted by Medicare in 2008 to reimburse hospitals for inpatient care provided to Medicare beneficiaries; expanded original DRG system (based on intensity of resources) to add two subclasses to each DRG that adjusts Medicare inpatient hospital reimbursement rates for of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.
B. DRG system adapted for use by thirdparty payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross Blue Shield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.
C. The Maximum amount the payer will reimburse for each procedure or service, according to the patients policy.
D. See limiting charge; maximum fee a physician may charge.
Answer: D
NEW QUESTION # 164
CLIA
A. UB04 Claim used by institutional and other selected providers to bill payers
B. Centers of Medicare and Medicaid Services
C. Competitive Medical Plan
D. Clinical Laboratory Improvement Act
Answer: D
NEW QUESTION # 165
Amendment to the HMO Act of 1973 is legislation that allowed federally qualified HMOs to permit members to occasionally use non HMO physicians and be partially reimbursed.
A. TRUE
B. FALSE
Answer: A
NEW QUESTION # 166
......
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