Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
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
Normal Size Small Size show me how
MED112 CODE/BILL
MED112 CH 17 HOSPITAL BILING AND REIMBURSEMENT
| Question | Answer |
|---|---|
| MED112 CH 17 | |
| What type of healthcare facilities are equipped for patients to stay overnight? A. Outpatient B. Inpatient C. Urgent care D. Ambulatory care | B. Inpatient |
| How does emergency care differ from urgently needed care? A. Emergency care is for conditions that must be treated right away and are life threatening. B. Emergency care requires the patient to be admitted as an inpatient for treatment. C. Urgent care is less convenient for the patient to receive healthcare services. D. Emergency care is for minor illnesses. | A. Emergency care is for conditions that must be treated right away and are life threatening. |
| When healthcare providers from various specialties and healthcare facilities work together to provide patient services, it is called a(n) A. Integrated delivery system B. Ambulatory care center C. Preferred provider network D. Participating provider network | A. Integrated delivery system |
| Which of the following are the major steps during a patient’s hospital stay from the insurance perspective? (MAY BE MORE THAN ONE) A. Billing B. Treatment C. Admission D. Discharge | B. Treatment C. Admission D. Discharge |
| How may the stay be measured? A. By the number of patients B. By the number of beds C. By the number of physician visits D. By the average days of the stay | B. By the number of beds |
| Hospitals are classified in which of the following ways? (MAY BE MORE THAN ONE) A. By the type of facility B. By the size of the staff C. By the services they provide D. By the types of insurance plans accepted E. By their geographic location | A. By the type of facility C. By the services they provide |
| When a patient is admitted into the hospital, the process is called A. Admission B. Discharge C. Registration D. Release of information | A. Admission |
| What facility provides custodial care for patients with chronic disabilities and prolonged illnesses? A. Hospice care facility B. Long-term care facility C. Ambulatory care facility D. Rest home | B. Long-term care facility |
| In the event that a patient cannot make healthcare decisions, a(n) ________ will determine how a patient wants to receive care. A. Notice of privacy practices B. Release of information C. Assignment of benefits D. Advance directive | D. Advance directive |
| An or ________ involves a situation in which the delay in treatment may lead to a significant increase in the threat to a patient’s life or body part. A. Urgent visit B. Emergency C. Checkup D. Well visit | B. Emergency |
| When more than one insurance policy is in effect for a patient, the health plans require A. Release of information B. Coordination of benefits C. Assignment of benefits D. Notice of privacy practices | B. Coordination of benefits |
| What is the focus of an integrated delivery system? A. To focus on the acute care the patient needs B. To offer services in the ambulatory setting C. To provide the continuum of care the patient needs D. To provide services in the patient’s home | C. To provide the continuum of care the patient needs |
| A hospital-issued notice of noncoverage (HINN) protects a patient from receiving uncovered Medicare services and serves to reserve the right to bill the beneficiary for the service. A. Hospital-issued notice of noncoverage (HINN) B. Advance notice of noncoverage (ANP) C. Hospital beneficiary notice (HBN) D. Advanced beneficiary notice (ABN) | A. Hospital-issued notice of noncoverage (HINN) |
| Which hospital department is responsible for creating or updating the patient’s medical record and securing consent for release of information? A. Admission department B. Patient accounting department C. Nursing department D. Discharge department | A. Admission department |
| When does the collection of information into the patient’s medical record typically begin? A. At billing B. At discharge C. At time of treatment D. At admission | D. At admission |
| Which of the following are types of consents used in hospitals? (MAY BE MORE THAN ONE) A. Responsibility for payment B. Coordination of benefits C. Medical treatment D. Advance directive | A. Responsibility for payment C. Medical treatment D. Advance directive |
| What is the classification when Medicare is the secondary payer? A. HSP B. MPI C. COB D. MSP | D. MSP |
| When does the collection of pretreatment payment plans begin? A. After services are rendered B. At the time services are received C. Before admission and treatment D. After the claim has been paid by the health plan | C. Before admission and treatment |
| Which of the following services does federal law require? (MAY BE MORE THAN ONE) A. Services that are preventive or routine B. Services that are not reasonable and necessary C. Services that are customary in nature D. Services that may be provided in another, lower-costly setting | B. Services that are not reasonable and necessary C. Services that are customary in nature D. Services that may be provided in another, lower-costly setting |
| Which services may be covered in a hospital inpatient account for treatment and care? (MAY BE MORE THAN ONE) A. Nursing notes B. Physical exam notes C. Payment records D. Consent forms | A. Nursing notes B. Physical exam notes D. Consent forms |
| For each inpatient patient, what does the master patient index (MPI) contain? (MAY BE MORE THAN ONE) A. Birth date B. Admission date C. Last name D. Diagnosis E. Attending physician | A. Birth date B. Admission date C. Last name E. Attending physician |
| In most hospitalization cases, the goal is to file a claim or bill within ________ days after discharge. A. Twenty-eight B. Fourteen C. Two D. Seven | D. Seven |
| What data set is the basis for sequencing diagnoses and reporting procedures for inpatient coding? A. UHDDS B. UACDS C. CRYX D. OASIS | A. UHDDS |
| Which of the following types of payment may be collected in advance? (MAY BE MORE THAN ONE) A. Private room fees B. LTC day amounts C. Contractual write-offs D. Deductibles | A. Private room fees B. LTC day amounts D. Deductibles |
| The condition established after study to be chiefly responsible for admission to a hospital is called the ________ diagnosis. A. Surgical B. Admitting C. Principal D. Primary | C. Principal |
| When the patient is admitted for tests to uncover the cause of a problem, inpatient medical coders can use which of the following conditions if a diagnosis is not made before discharge? (MAY BE MORE THAN ONE) A. Suspected B. Unconfirmed C. Determined D. Confirmed | A. Suspected B. Unconfirmed |
| Which of the following influence the standards for hospital patient medical records? (MAY BE MORE THAN ONE) A. National Committee of Quality Assurance B. The Joint Commission C. Hospital bylaws D. Medicare regulations | B. The Joint Commission C. Hospital bylaws D. Medicare regulations |
| What is the hospital’s list of codes and charges called? A. CMS-1500 B. Encounter form C. Charge master D. Data dictionary | C. Charge master |
| Conditions that develop as problems related to surgery or other treatments are coded as A. Systems B. Complications C. Comorbidities D. Incentives | B. Complications |
| Which of the following groups are responsible for ICD-10 guidelines? (MAY BE MORE THAN ONE) A. American Health Information Management Association (AHIMA) B. Centers for Medicare & Medicaid Services (CMS) C. National Center for Health Statistics (NCHS) D. Department of Health and Human Services (HHS) E. American Hospital Association (AHA) | A. AHIMA B. CMS C. NCHS E. AHA |
| As mandated by HIPAA, as of October 1, 2015, the ________ code set must be used for inpatient procedural reporting for hospitals and payers. A. DRG B. ICD-10-PCS C. CPT-4 D. HCPCS Level II | B. ICD-10-PCS |
| What is the condition identified by the physician at admission to represent injury? A. Primary diagnosis B. Admitting diagnosis C. Secondary diagnosis D. Principal diagnosis | B. Admitting diagnosis |
| How often is the code set for ICD-10-PCS updated? A. Biannually B. Quarterly C. Monthly D. Annually | D. Annually |
| What codes may inpatient coders use for a diagnosis that may not match the principal diagnosis once a final decision has been made? A. Suspected or unconfirmed diagnosis B. Primary diagnosis only C. Complication diagnosis D. Only a confirmed diagnosis can be coded | A. Suspected or unconfirmed diagnosis |
| What is the next step after a coder locates the index entry for ICD-10-PCS? A. The coder turns to the correct table. B. The coder refers to the GEMs. C. The coder consults the index to build an ICD-10-PCS code. D. The coder selects values from the columns. | A. The coder turns to the correct table. |
| Patients are charged according to the type of ________ and service they receive. A. Accommodation B. Documents C. Supplies D. Equipment | A. Accommodation |
| What ICD-10-PCS code may be assigned to surgery to perform? A. No procedure code is assigned. B. Incidental procedure code C. Therapeutic procedure code D. Secondary procedure code | C. Therapeutic procedure code |
| What are conditions called when they coexist with the primary diagnosis? A. Comorbidities B. Complications C. Symptoms D. Incidental | A. Comorbidities |
| Which of the following are considered never events? (MAY BE MORE THAN ONE) A. Pressure ulcer, Stage III B. Congestive heart failure C. Severe sepsis following cardiac surgery D. Urinary tract infection associated with a catheter | A. Pressure ulcer, Stage III D. Urinary tract infection associated with a catheter |
| What does the UHDDS require significant procedures to be reported along with? (MAY BE MORE THAN ONE) A. Complications B. Principal diagnosis C. Occupational therapy D. Comorbidities | A. Complications B. Principal diagnosis D. Comorbidities |
| Which CMS payment system was authorized by the Balanced Budget Act of 1997? A. OPPS B. PPS C. RBRVS D. DRG | A. OPPS |
| ICD-10-PCS has a ________ code structure, meaning that a table format is used to present options for building a code. A. Multiaxial B. Multi-step C. Multifield D. Multidimensional | A. Multiaxial |
| Private payers have established the standard number of days allowed for various conditions, called ________. A. GLOS B. ELOS C. ALOS D. VLOS | B. ELOS |
| Which of the following is listed in the index of the ICD-10-PCS? A. Admitting diagnosis B. Common procedures C. Comorbidities D. Body systems | B. Common procedures |
| The ________ transaction has sections requiring data elements for the billing and the pay-to provider, the subscriber and patient, and the payer in addition to claim and service details. A. 837I B. UB-04 C. CMS-1500 D. 837P | A. 837I |
| In the inpatient setting, the code that is most closely related to the treatment of the principal diagnosis is the ________ code. A. Primary procedure B. Admitting diagnosis C. Comorbidity D. Principal procedure | D. Principal procedure |
| What is a preventable medical error resulting in serious consequences for the patient called? A. Never event B. Case mix C. Complication D. Comorbidity | A. Never event |
| What reimbursement system was implemented for Medicare ambulatory surgical facilities? A. APGs B. MS-DRGs C. DRGs D. ARGs | A. APGs |
| What is the name of the CMS paper claim form used by inpatient facilities? A. UB-92 B. UB-04 C. 837I D. HCFA-1500 | B. UB-04 |
| The OIG issues are ________ to help direct proper coding for institutional providers. A. Restrictive Advice B. Work Plan C. Audit Evaluations D. Explanation of Coverage | B. Work Plan |
| A HMO may negotiate a ________, which is a flat rate to pay for each day the patient is in the hospital regardless of the specified services. A. Per diem B. Capitation C. DRG D. Discounted fee | A. Per diem |
| What is the name for the electronic CMS claim form used by physicians? A. 837P B. CMS-1450 C. CMS-1500 D. UB-04 | A. 837P |
| When payments are transmitted by payers to a hospital, the hospital receives a(n) A. Notice of payment B. Remittance advice C. Explanation of benefits D. Assignment of benefits | B. Remittance advice |
| Both CMS and many health plans have announced they will no longer pay hospitals for treating complications caused by avoidable conditions, also called A. Never events B. Comorbidities C. Systemic conditions D. Skipped events | A. Never events |
| How many data fields are on the UB-04? A. 150 B. Fifty-two C. Eighty-one D. Thirty-four | C. Eighty-one |
| Who oversees fraud and abuse for Medicare Part A payments? A. CMS B. QIO C. OIG D. DOJ | C. OIG |
| Private payers have established the standard number of days allowed for various conditions, called A. ELOS B. ALOS C. VLOS D. GLOS | A. ELOS |
| Which hospital departments are involved in checking that appropriate payments have been received? (MAY BE MORE THAN ONE) A. Accounting B. HIM C. Registration D. Patient Accounts | B. HIM D. Patient Accounts |
| What does ELOS stand for? A. Estimated Length of Service B. Expected Length of Stay C. Extended Length of Service D. Established Length of Stay | B. Expected Length of Stay |
| Which hospital department oversees the collection, maintenance, and security of patient medical records? A. Patient Accounts B. Health Information Management (HIM) C. Admissions D. Accounting | B. Health Information Management (HIM) |
| Which payment system is used for hospital inpatient reimbursement under Medicare? A. APGs B. OPPS C. MS-DRGs D. RBRVS | C. MS-DRGs |
| Which payment system is used for hospital outpatient reimbursement under Medicare? A. OPPS B. DRGs C. APGs D. RBRVS | A. OPPS |
| What does ALOS stand for? A. Allowed Length of Stay B. Average Length of Stay C. Authorized Length of Service D. Average Length of Service | B. Average Length of Stay |
| What does MPI stand for? A. Medical Provider Index B. Master Patient Index C. Medical Patient Information D. Managed Provider Information | B. Master Patient Index |
| What does HINN stand for? A. Hospital Insurance Notice of Necessity B. Hospital-Issued Notice of Noncoverage C. Health Insurance Notification Notice D. Hospital Inpatient Notice of Need | B. Hospital-Issued Notice of Noncoverage |
| What does MSP stand for? A. Medicare Service Payment B. Medical Services Program C. Medicare Secondary Payer D. Managed Service Plan | C. Medicare Secondary Payer |
| What does OPPS stand for? A. Outpatient Patient Payment System B. Outpatient Prospective Payment System C. Organized Provider Payment System D. Outpatient Procedure Payment Schedule | B. Outpatient Prospective Payment System |
| What does APG stand for? A. Ambulatory Payment Group B. Approved Procedure Group C. Authorized Payment Group D. Ambulatory Procedure Guideline | A. Ambulatory Payment Group |
| What does DRG stand for? A. Diagnostic Reporting Group B. Diagnosis-Related Group C. Disease Reporting Guideline D. Diagnostic Reimbursement Guideline | B. Diagnosis-Related Group |
| When the hospital staff collects data on a patient who is being admitted for services, the process is called A. Precertification B. Health information management C. MSP D. Registration | D. Registration |
| Which of the following hospital departments has different procedures for collecting patients’ personal and insurance information? A. Collections department B. Accounting department C. Surgery department D. Emergency department | D. Emergency department |
| Patient charges in hospitals vary according to A. Their services only B. Their accommodations and services C. Their age and gender D. Their accommodations only | B. Their accommodations and services |
| Which of these rules governs the reporting of hospital inpatient services on insurance claims? A. HIM B. APC C. ASC D. UHDDS | D. UHDDS |
| Conditions that arise during the patient’s hospital stay as a result of surgery or treatments are called A. Correlates B. Comorbidities C. Complications D. Admitting diagnoses | C. Complications |
| In inpatient coding, the initials CC mean A. Comorbidities and complications B. Cubic centimeters C. Convalescent center D. Chief complaint | A. Comorbidities and complications |
| The code 02103D4 is an example of which type of code? A. HCPCS B. ICD-10-PCS C. CPT D. ICD-10-CM | B. ICD-10-PCS |
| Under a prospective payment system, payments for services are A. Not required from most patients B. Based on the provider’s fees C. Discounts to the provider’s usual fees D. Set in advance | D. Set in advance |
| The UB-04 form locator 4 requires the A. Revenue code B. Admission hour C. Patient status D. Type of bill | D. Type of bill |
| Under Medicare rules for patients in car accidents, the automobile insurance is A. Tertiary B. Secondary C. Primary D. Supplemental | C. Primary |
| The clinician primarily responsible for the care of the patient from the beginning of the hospital episode | Attending physician |
| The condition that after study is established as chiefly responsible for a patient’s admission to a hospital | Principal diagnosis |
| A hospital’s list of the codes and charges for its services | Charge master |
| A person admitted to a hospital for services that require an overnight stay | Inpatient |
| A system of analyzing conditions and treatments for similar groups of patients used to establish Medicare fees for hospital inpatient services | Diagnosis-related groups (DRGs) |
| Conditions in addition to the principal diagnosis that the patient had at hospital admission that affect the length of the hospital stay or course of treatment | Comorbidities |
| The patient’s condition identified by the physician at admission to the hospital | Admitting diagnosis |
| The main service performed for the condition listed as the principal diagnosis for a hospital inpatient | Principal procedure |
| Outpatient care | Ambulatory care |
| HIPAA standard transaction for the facility claim | 837I |
Created by:
C to the C
Popular Medical sets