WGU C810 Data Management & Reimbursement (5)

What does the daily inpatient census represent? | A. Total annual discharges | B. Number of patients present at census-taking time | C. Number of emergency department visits | D. Number of outpatient encounters

B. Number of patients present at census-taking time

What hospital statistic is calculated by dividing total inpatient days by total discharges? | A. Bed occupancy rate | B. Average daily census | C. Average length of stay (ALOS) | D. Case-mix index

C. Average length of stay (ALOS)

What statistic measures the relative costliness and complexity of a hospital's patient population? | A. ALOS | B. Bed occupancy rate | C. Case-mix index (CMI) | D. Mortality rate

C. Case-mix index (CMI)

Diagnosis-related groups (DRGs) are primarily associated with which reimbursement system? | A. Fee-for-service | B. Prospective payment system (PPS) | C. Capitation | D. RBRVS

B. Prospective payment system (PPS)

What reimbursement methodology pays a predetermined amount based on diagnosis? | A. Fee-for-service | B. Capitation | C. Prospective payment system (PPS) | D. Cost-based reimbursement

C. Prospective payment system (PPS)

Which reimbursement methodology pays providers for each service rendered? | A. Capitation | B. Fee-for-service | C. PPS | D. DRGs

B. Fee-for-service

What payment system is used for outpatient prospective payment? | A. APCs | B. DRGs | C. RBRVS | D. MEDPAR

A. APCs

Resource-based relative value scale (RBRVS) is primarily used for reimbursement of which setting? | A. Inpatient hospitals | B. Physician services | C. Long-term care facilities | D. Home healthcare

B. Physician services

Which organization processes Medicare claims and provides payment to healthcare organizations? | A. MACs | B. CMS Conditions of Participation | C. Joint Commission | D. AHIMA

A. MACs

What database contains Medicare inpatient utilization and payment information? | A. MPI | B. MEDPAR | C. UHDDS | D. OASIS

B. MEDPAR

Coordination of benefits determines what? | A. Which insurance plan pays first | B. Which diagnosis is primary | C. Which physician receives reimbursement | D. Which DRG applies

A. Which insurance plan pays first

Which reimbursement system pays providers a fixed amount per member per month regardless of services used? | A. Fee-for-service | B. PPS | C. Capitation | D. RBRVS

C. Capitation

What statistic measures the percentage of available beds occupied during a period? | A. Average daily census | B. Bed occupancy rate | C. ALOS | D. Mortality rate

B. Bed occupancy rate

What type of statistics measure the frequency of disease? | A. Mortality statistics | B. Utilization statistics | C. Morbidity statistics | D. Financial statistics

C. Morbidity statistics

What type of statistics measure deaths? | A. Mortality statistics | B. Morbidity statistics | C. Census statistics | D. Utilization statistics

A. Mortality statistics

Which statistic represents the average number of patients receiving care each day? | A. Average daily census | B. Bed occupancy rate | C. Mortality rate | D. Case-mix index

A. Average daily census

Which type of care is reimbursed using DRGs? | A. Ambulatory surgery | B. Physician office visits | C. Acute inpatient hospital care | D. Home healthcare

C. Acute inpatient hospital care

Which reimbursement methodology encourages efficiency because payment is predetermined? | A. Fee-for-service | B. PPS | C. Cost reimbursement | D. Per diem reimbursement

B. PPS

What type of reimbursement pays a fixed amount for each day of hospitalization? | A. Capitation | B. Per diem reimbursement | C. PPS | D. RBRVS

B. Per diem reimbursement

What organization administers Medicare and Medicaid programs? | A. AHIMA | B. CMS | C. Joint Commission | D. MACs

B. CMS

Which database is often used to analyze Medicare utilization trends? | A. OASIS | B. MEDPAR | C. DEEDS | D. MDS

B. MEDPAR

What factor contributes most directly to a higher case-mix index? | A. Increased outpatient visits | B. More complex and resource-intensive cases | C. Reduced census | D. Lower mortality rates

B. More complex and resource-intensive cases

Which reimbursement methodology is associated with managed care organizations? | A. Capitation | B. Fee-for-service | C. Cost reimbursement | D. DRGs

A. Capitation

Which system groups outpatient services for reimbursement? | A. APCs | B. DRGs | C. MEDPAR | D. RBRVS

A. APCs

What statistic is useful for measuring hospital utilization and efficiency? | A. Average length of stay | B. Mortality rate | C. Morbidity rate | D. Birth rate

A. Average length of stay

What data set provides a standardized minimum set of data elements for acute care hospital discharges? | A. MDS | B. OASIS | C. UHDDS | D. DEEDS

C. UHDDS

What does UHDDS stand for? | A. Uniform Hospital Diagnostic Data System | B. Uniform Hospital Discharge Data Set | C. Universal Health Data Distribution Standard | D. United Healthcare Data Delivery System

B. Uniform Hospital Discharge Data Set

What statistic is calculated by dividing the total number of inpatient service days by the total number of discharges? | A. Bed occupancy rate | B. Average daily census | C. Average length of stay | D. Gross death rate

C. Average length of stay

Which statistic measures deaths occurring among hospitalized patients? | A. Morbidity rate | B. Gross death rate | C. Bed occupancy rate | D. Average daily census

B. Gross death rate

Which death rate excludes deaths occurring within the first 48 hours of admission? | A. Gross death rate | B. Morbidity rate | C. Net death rate | D. Crude death rate

C. Net death rate

Which statistic measures the proportion of hospital deaths that underwent autopsy? | A. Gross autopsy rate | B. Net autopsy rate | C. Mortality rate | D. Bed occupancy rate

A. Gross autopsy rate

Which statistic excludes unautopsied coroner's cases from the denominator? | A. Gross autopsy rate | B. Net autopsy rate | C. Gross death rate | D. Net death rate

B. Net autopsy rate

What type of statistic compares one number to another and is expressed as a quotient? | A. Percentage | B. Average | C. Ratio | D. Rate

C. Ratio

What type of statistic expresses a value out of 100? | A. Ratio | B. Percentage | C. Average | D. Index

B. Percentage

What is the average daily census calculated from? | A. Inpatient service days divided by the number of days in the period | B. Total discharges divided by inpatient days | C. Bed count divided by patient days | D. Admissions divided by discharges

A. Inpatient service days divided by the number of days in the period

Which statistic measures the percentage of beds occupied during a given period? | A. Average daily census | B. Gross death rate | C. Bed occupancy rate | D. Morbidity rate

C. Bed occupancy rate

What type of data is used to measure frequency of disease? | A. Mortality data | B. Morbidity data | C. Census data | D. Financial data

B. Morbidity data

Which type of data is used to measure deaths? | A. Utilization data | B. Morbidity data | C. Mortality data | D. Census data

C. Mortality data

Which reimbursement system groups inpatient stays into categories based on diagnoses and procedures? | A. APCs | B. DRGs | C. RBRVS | D. Capitation

B. DRGs

Which reimbursement system groups outpatient services for payment purposes? | A. DRGs | B. APCs | C. Capitation | D. Fee-for-service

B. APCs

Which reimbursement methodology pays providers a fixed amount regardless of the number of services rendered? | A. Fee-for-service | B. Capitation | C. Per diem reimbursement | D. Cost reimbursement

B. Capitation

Which reimbursement method pays based on physician work, practice expense, and malpractice expense? | A. DRGs | B. APCs | C. RBRVS | D. Capitation

C. RBRVS

Which organization processes Medicare claims on behalf of CMS? | A. Joint Commission | B. AHIMA | C. Medicare Administrative Contractors (MACs) | D. OIG

C. Medicare Administrative Contractors (MACs)

What is the purpose of coordination of benefits? | A. To determine which insurer pays first | B. To assign DRGs | C. To determine physician reimbursement | D. To calculate ALOS

A. To determine which insurer pays first

Which database contains Medicare inpatient utilization and payment information? | A. MPI | B. MEDPAR | C. MDS | D. OASIS

B. MEDPAR

What does a high case-mix index indicate? | A. Lower patient complexity | B. Higher patient complexity and resource use | C. Reduced mortality | D. Increased occupancy

B. Higher patient complexity and resource use

Which reimbursement methodology encourages providers to manage resources efficiently because payment is predetermined? | A. Fee-for-service | B. PPS | C. Cost reimbursement | D. Per diem reimbursement

B. PPS

Which type of statistic is used to compare values and is often expressed as one number divided by another? | A. Ratio | B. Percentage | C. Average | D. Index

A. Ratio

Which statistic is calculated by dividing inpatient service days by total days in the period? | A. Average daily census | B. Average length of stay | C. Bed occupancy rate | D. Mortality rate

A. Average daily census

Which type of care is most commonly reimbursed under the inpatient prospective payment system? | A. Physician office visits | B. Home healthcare | C. Acute inpatient hospital stays | D. Ambulatory surgery

C. Acute inpatient hospital stays