Health Service Management 340 Final

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1. Question : (TCO 4) Your hospital has just been told that all of your cardiovascular surgeons are transferring their practice to a competitive hospital beginning next year. How would this affect a forecast of volume?

Student Answer: First and foremost, if a hospital is suddenly lost all of its cardiovascular surgeons...heads will roll. However, if there are a major lost of service such as the cardiovascular surgeon...there will be a decrease in the volume due to the lost of services. Thus when the hospital have a reduce in the total volume it will also have a reduce in total cost. If the hospital is operating under statistics the long run, through the development or discontinuation of certain programs volume may be
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OCE designed to processes claims for all outpatient institutional providers including hospitals that are subject to the Outpatient Prospective Payment System (OPPS) as well as hospitals that are NOT (Non-OPPS). Each OCE results in one of six different dispositions. The dispositions help to ensure that all fiscal intermediaries are following similar procedures. There are four claim-level dispositions: Rejection, Claim must be corrected and resubmitted; denial, claim cannot be resubmitted but can be appealed; return to provider, problems must be corrected and claim resubmitted; and suspension, claim requires further information before it can be processed. There are two line item–level dispositions: rejection, claim is processed but line item is rejected and can be resubmitted later; and denial, claim is processed but line item is rejected and cannot be resubmitted. (Essentials of Health Care Finance, 7th Edition. Jones & Bartlett Publishers p. 26).

4. Question : (TCO 1) How could a hospital legally avoid being covered by the Emergency Medical Treatment and Labor Act (EMTALA)?

Student Answer: The Emergency Medical Treatment and Active Labor Act (EMTALA) passed in 1986 and it requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. It further stated Participating
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