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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