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Through what document does a hospital establish compliance standards? - ANSWER-Code of Conduct
What is the purpose of the OIG work plan? - ANSWER-Communicate Issues that will be reviewed during
the year for compliance with Medicare Regulations
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? -
ANSWER-Diagnostic services and related charges provided on Wednesday, Thursday and Friday before
admission.
What does a modifier allow a provider to do? - ANSWER-Report a specific circumstance that affected a
procedure or service without changing the code or its definition
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these
charges? - ANSWER-They must be combined with the inpatient bill and paid under the MS-DRG
(diagnosis related group) system.
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these
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