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Mod 150 Unit 3 Revie
Review
| 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 | 4 |
| 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 | 25 |
| 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 |
Created by:
bgarneau