Review

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.

Help!

Question

Answer

A person can live without a spleen

True

🗑

The mediastinum is located between the lungs

True

🗑

The stem cell harvesting in 38205 is the collection of stem cells from the bone marrow

False

🗑

The upper jugular group of lymph nodes are located in the groin

False

🗑

The diaphragm is a wall of muscle that separates the thoracic and abdonimal cavities

True

🗑

There is more chance for advancement working in a hospital facility than in a private physician's office

True

🗑

Because of the divrsity in reimbursement methods; it is very important that the insurance billing specialist have basic knowledge if insurance programs

True

🗑

When a managed care patient is admitted for a nonemergency to a hospital without a managed care contract, the managed care program needs to be notified by the hospital within 48 hours

False

🗑

Emergency department charges are billed along with the inpatient stay on the CMS-1500 claim form

False

🗑

When admitted as a worker's compensation case, the patient will not have an insurance card

True

🗑

The physician's office uses ICD-9-CM Volumes 1,2 and 3 to code diagnoses and procedures

False

🗑

Surgical procedures performed in the hospital operating room are billed by the hospital billing department

False

🗑

Elective surgeries are deferrable

True

🗑

A patient has a right to request an itemized bill from a hospital stay with no cost to the patient

True

🗑

On the UB-40 claim form, the patient's date of birth should be entered using 6 digits in block 14

False

🗑

On the UB-04 claim form in Field 17, code 20 (expired) is used to indicate the patient's discharge status

True

🗑

Information such as "condition is employed related" (Code 02), listed in Fields 18 through 28 the UB-04 claim form, is called condition code

True

🗑

The DRG is assigned using an automated system called the DRG selector

False

🗑

The purpose of the DRG-based system is to hold down rising health care costs

True

🗑

The grouper differentiates between chronic and acute conditions

False

🗑

The ambulatory payment classifications (APCs) are based on diagnoses

False

🗑

Th --- manufactures most blood cells

bone marrow

🗑

The spleen is composed of this material that also surrounds veins and arteries

lymph tissue

🗑

---- is a malignant disease of the bone marrow in which excessive white blood cells are produced

Leukemia

🗑

Mediastinum codes are identified by which factor

surgical approach

🗑

This type of lymphadenectomy is the removal of the lymph nodes, glands, and surrounding tissues

radical

🗑

The lymph node excision category codes are based on what two things

method and location

🗑

How many categories are located in the Mediastinum subheading

🗑

A diaphragmatic hernia is also known as a(n)

esophageal hiatal hernia

🗑

This bone marrow is taken from a close relative, so there is a genetic similarity

allogenic

🗑

This bone marrow is collected from the patient and later transplanted or reinfused back into the patient from whom it came

autologenic

🗑

What word describes a lymphadenectomy in which only the lymph nodes are removed

limited

🗑

What is it called when the diaphragm is out of normal position and has moved up farther into the thoracic cavity

eventration

🗑

Confidential information about patients should never be discussed with

any of the above

🗑

When criteria are used by the review agency for admission screening, this is referred to as

AEPs

🗑

One criterion that needs to be met to certify severity of illness (SI) in an admission is

active, uncontrolled bleeding

🗑

One criterion that needs to be met for intensity of service (IS) in an admission is

administration and monitoring of intravenous medications

🗑

A patient is considered an inpatient to the hospital on admission

for an overnight stay

🗑

When a patient who has managed care contract is admitted to a hospital for an emergency, the managed care program needs to be notified within

48 hours

🗑

The rule stating that when a patient receives outpatient services within 72 hoursof admission, then all outpatient services are combined with inpatient services and become part of the diagnostic-related group rate for admission, is called the

72 hour rule

🗑

What organization is responsible for admission review, readmission review, procedure review, day and cost outlier review, DRG validation, and transfer review

QIO

🗑

Readmission review occurs if the patient is readmitted within

7 days of discharge

🗑

The significant reason for which a patient is admitted to the hospital is coded using the

principal diagnosis

🗑

Classifications of surgical and nonsurgical procedures and miscellaneous therapeutic and diagnostice procedures are found in

ICD-9-CM Volume 3

🗑

ICD-9-CM procedure codes contain

Both A and C

🗑

The codebook used to list procedures on outpatient hospital claims is

CPT

🗑

The person who interviews the patient and obtains personal and insurance information and the admittin diagnosis is a/an

admitting clerk

🗑

Daily progress notes are entered on the patient's medical record by a/an

nurse

🗑

The claim form transmitted to the insurance carrier for reimbursement for inpatient hospital services is a called a

UB-04

🗑

The form that accompanies the billing claim form for inpatient hospital services is called a

detail statement

🗑

The hospital insurance claim form must always be reviewed by the

insurance billing editor

🗑

Professional services billed by the physician include

All of the above

🗑

If a patient is being admitted to a hospital and refuses all preadmission testing but a bill is sent to the insurance carrier for these anway, this ia called

phantom charges

🗑

A tentative DRG is based on

admission diagnosis, scheduled procedures, age and secondary diagnosis

🗑

How many major diagnostice categories (MDCs) are there in the DRG-based system

🗑

On the UB-04 claim form, code 6 (transfer from another health care facility) in Field 15 is used to indicate

source of admission

🗑

The claim form used for outpatient hospital services is

UB-04

🗑

Laparoscopic splenectomy

38120

🗑

Bone marrow biopsy by needle aspiration

38221

🗑

Biopsy of a lymph node by fine needle aspiration without image guidance

10021

🗑

Excision of a mediastinal tumor

39220

🗑

The mediastinum category code range is

39000-39499

🗑

Suprahyoid lymphadenectomy

38700

🗑

The physician performs a complete axillary lymphadenectomy

38745

🗑

Imbrication of the diaphragm for eventration, transabdomina, nonparalytic

39545

🗑

The physician repairs a large laceration of the diaphragm that occurred during a car accident from the seat belt the patient was wearing though a transabdominal approach

39501

🗑

The physician performs an extensive drainage of a lymph node abscess

38305

🗑

PAT is an abbreviation for

Pre-admission testing

🗑

The hospital department that conducts an admission and concurrent review on all cases and prepares a discharge plan to determine whether admissions are justified is called the ---- department

Utilization review

🗑

The --- coding system is used to list procedural codes for Medicare patients on hospital insurance claims that are not in the CPT book

HCPCS

🗑

The --- is the clinical resume for final progress note

discharge summary

🗑

The Uniform Bill claim form is considered a --- statement

summary

🗑

Medicare provides stop loss called --- in its regulations

outliers

🗑

The abbreviation of the phrase that indicates when claims are submitted electronically is ---

EDI

🗑

On the UB-04 claim form, the second digit of the four-digit bill code in Field 4 indicates the type of

facility

🗑

On the UB-04 claim form, 1553 listed as the hour of admission indicates that the patient was admitted at ---

3:53 pm

🗑

A four-digit code corresponding to each narrative description or standard abbreviation that identifies a specific accomodation, ancillary service, or billing calculation related to services billed is called a/an ---- code

revenue

🗑

The DRG-based system changed hospital reimbursement from a fee-for-service to a lump sum, fixed-fee payment based on the --- rather than on time or services rendered.

diagnosis

🗑

Cases that cannot be assigned an appropriate DRG because of atypical situations are called ----

cost outliers

🗑

An unethical practice of upcoding a patient's DRG category for a more severe diagnosis to increase reimbursement is called ---

DRG creep

🗑

---- is a preexisting condition that will, because of its effect on the specific principal diagnosis, require more extensive therapy or cause an increase in length of stay by at least 1 day in approximately 75% of cases

Comorbidity

🗑

Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.

To hide a column, click on the column name.

To hide the entire table, click on the "Hide All" button.

You may also shuffle the rows of the table by clicking on the "Shuffle" button.

Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

Normal Size Small Size show me how

Created by: bgarneau