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A Fordney 16

Confidential information about patients should never be discussed with Coworkers, family, or friends
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 is admitted who has a managed care contract for an emergency to a hospital, the managed care program needs to be notified within 48 hours
The rule stating that when a patient recives outpatient services within 72 house of 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 PRO
Readmission review occurs if the patient is readmitted within 7 days of discharge
A review for additional Medicare reimbursement is called day outlier review
The significant reason for which a patient is admitted to the hospital is coded using the princial diagnosis
Classifications of surgical and nonsurgical procedures and miscellaneous therapeutic and diagnostic procedures are found in ICD-9-CM volume 3
ICD-9-CM procedure codes contain at least two digits, and two to four digits
The code book used to list procedures on outpatient hospital claims is CPT
The person who interviews the patient and obtains personal and insurance information and the admitting diagnosis is a/an admitting clerk
Daily progress notes are entered on the patient's medical record by a nurse
The claim form sent to the insurance carrier for reimbursement for inpatient hospital services is called the UB-92
The form that accompanies the billing claim form for inpatient hospital services is called a detailed statement
The hospital insurance claim form must always be reviewed by the insurance billing editor
Professional services billed by the physician include hospital consultations, hospital visits and emergency department visits
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 services anyway, this is called double billing
A tentative DRG is based on admission diagnosis, scheduled procedures, age, and secondary diagnosis
How many major diagnostic categories (MDCs) are there in the DRG-based system 25
On the UB-92 claim form, code 6 (transfer from another health care facility) in block 20 is used to indicate source of admission
The claim form used for outpatient hospital services is the UB-92 claim form
PAT is an abbreviation for preadmission 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 Healthcare Common Procedure
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 electronic data interchange
On the UB-92 claim form, the first digit of the three-digit bill code in block 4 indicates the type of ____ facility
On the UB-92 claim forn, the number of inpatient days is indicated in block 7; these are referred to as ___ days covered
On the UB-92 claim form, 15:53 listed as the hour of admission indicates that the patient was admitted at 3:53 pm
A three- or four-digit code corresponding to each narrative description or standard abbreviation that identifies a specific accommodation, ancillary service, or billing calculation related to services billed is called a ___ code revenue
The DRG-based system changed hospital reimbursement from a fee-for-service system 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 pratice 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 intensive therapy or cause an increase in length of stay by at least 1 day in approximately 75% of cases comorbidity
Created by: leemiller
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