A.False Claims Act

B.Fair Debt Collection Practices Act

C.Federal Employment Compensation Act

D.First Look Analysis for Hospital Outlier Monitoring

A.TRUE

B.FALSE

A.DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross BlueShield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.

B.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 severity of illness (SOI) (extent of physiological decompensation or organ system loss of function) and risk of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.

A.Electronic Healthcare Network Accreditation Commission

B.Electronic Health Record

C.Employer group health plan

D.Evaluation and Management

A.Competitive Medical Plan

B.Centers of Medicare and Medicaid Services

C.Insurance claim used by noninstitutional providers and supplier to bill payers

D.UB04 Claim used by institutional and other selected providers to