A Client Is Admitted with Chest Pain

question 22

Multiple Choice

A client is admitted with chest pain.A series of diagnostic tests are ordered,and the client undergoes coronary artery bypass grafting.The cost of care for this client is increased because of a four-pack-per-day smoking history that resulted in extension of the client's intensive care unit (ICU) stay by 3 days because of respiratory problems.The case manager realizes that under the terms of the diagnosis-related group (DRG) payment system for this diagnosis that the client's past history and present care needs will have what affect on reimbursement?

• A) The cost of caring for this client was $5000 greater than the DRG reimbursement fee,and the hospital will be allowed to collect the additional fees from the insurance company.
• B) Although the cost of care for this client was greater than the DRG reimbursement amount,the hospital will be reimbursed only at the set fee.
• C) The client will be required to pay back the insurance company for the extra fees incurred because smoking is a modifiable health risk for heart disease.
• D) The primary care provider who admitted the client will receive a reduced payment to cover the loss incurred by the hospital.

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Definitions:

Not-for-profit Accountant

A finance professional specializing in managing the finances of organizations that do not seek to make a profit.

Financial Transactions

The process of exchanging one asset for another, typically involving the transfer of money between parties in the business or financial context.

Financial Statements

Official records that outline the financial activities and condition of a business, including the balance sheet, income statement, and cash flow statement.

Government Accountant

A financial expert who works within the public sector, managing and auditing the accounts of government agencies and ensuring compliance with legal requirements.