Terms

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Question

Answer

Ancillary charges include:

Medical, surgical and central supplies.

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Routine charges include:

Oxygen

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Which of the following is not a business office function:

Discharge planning

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Patient statements are generated after:

RA's are posted. (Remittance Advice)

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The payment method in which hospitals are paid based on the actual costs of treating each patient is:

Cost-based reimbursement

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Supports & shapes the body, protects the internal organs, forms some blood cells & store minerals:

Skeletal System

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True or False: Acute care facilities provide services for patients who do not require an overnight stay treatment:

False

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True or False: An Ambulatory surgery center treats in patients:

False

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True or False: CMS is the Abbreviation for Centers for Medicare and Medicaid Services:

True

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True or False: Clinics are outpatient facilities:

True

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True or False: The attending Physician is the doctor who is primarily responsible for the care of the patient from the hospital admission through discharge or transfer:

True

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True or False: The admitting physician is the doctor who is primarily responsible for the care of the patient from the hospital admission through discharge or transfer:

False

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CDM is the abbreviation for change description monitor:

False

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True or False: The charge description master is a facility's list of the codes and charges for its services:

True

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True or False: A charge explode occurs when the charge description master is updated each year:

False

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True or False: The daily coinsurance rate is equal to 75% of the inpatient hospital deductible:

False

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True or False: Medicare Part B pays for Coinsurance days:

False

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True or False: COB is the abbreviation for Coordination of benefits:

True

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True or False: Local Medical review policies (LMRPS) contain information about Medicare services:

True

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True or False: Medicare Part A Covers hospitalization but not hospice care:

False

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True or False: Medicare Administrative Contractors are gradually replacing fiscal Intermediaries and carriers:

True

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True or False: MAC is the abbreviation for Medicare Administrative Contractor:

True

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True or False: A modifier is a 10-digit number that can be added to CPT procedure codes:

False

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True or False: Unlisted procedure codes are used for new services or procedures that haven't been assigned a CPT code yet:

True

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True or False: HCPCS is the abbreviation for Health Care Common Product Coding System:

False

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True or False: The HCPCS code set has two levels, CPT codes Level I and supply codes (Level II):

True

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True or False: The ICD 10 CM is a listing of diagnosis codes used to classify diseases and injuries:

True

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Which of the following tasks is not performed by patient account specialist:

Transcription of medical records.

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Which type of facility provides continuous Professional Medical care for patients:

Acute care facility

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Which type of facility provides daily care for Inpatients who require medical care or rehabilitation services:

Skilled Nursing facility

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The Champva Program primarily covers:

Veterans with permanent service related disabilities.

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True or False: A medical EMS is a situation in which delaying treatment of the patient would lead to a significant increase in the threat to life or body part:

True

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True or False: In Medicare, when beneficiary who is working is covered by an employer's group health plan, the medicare secondary payer rules do not apply:

False

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In FL 8, which is the correct format for entering a patient's name that has a prefix, such as Van Buren:

VanBuren

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True or False: CORF is the abbreviation for comprehensive outpatient rehabilitation facility.

True

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True or False: A patient's admission date may or may not be the same as the from date in the statement covers period field.

True

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True or False: The purpose of a patient control number is to make locating a patient account quicker when posting payments:

True

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Inpatient status:

23 or more hours

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Outpatient status:

23 or less

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Birth day rule

The parent with the earliest birthday is the primary insurance.

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List the right order for Insurance, Doctor and Patient:

Patient, Doctor or Provider and then Insurance

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True or False: Hospital payment for a DRG is calculated by Multiplying the DRG weight by the hospital's base rate:

True

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Which of the following is not a level of severity:

Minor CC

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Number assigned to a patient that is used for multiple episodes of care at a facility:

Medical Record Number

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In FL 8, which is the correct format for entering a patient's name that has an apostrophe, such as O'connor:

OConnor

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To correctly report the dates of service in FL 6, the MMDDYY for is required. Which of the following is an example of a correct entry:

010206

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True or False: A patient control number is permanently assigned to a patient and used for all episodes of care at that facility:

False

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The Outpatient Prospective Payment System (OPPS) is used for outpatient services including most Medicare Part B,C and D services:

False

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On a pater UB-04, if the patient's complete date of birth has not been obtained, FL (Patient Birth Date) should be completed with whatever information is available:

False

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Which payer action calls for a corrected and resubmitted claim:

Claim rejection

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True or False: Medicare's portion of the APC payment is equal to the APC payment amount minus the patient's coinsurance/copayment:

True

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True or False: The TOB code had five Digits

False

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True or False: A clean claim must be paid or denied by Medicare by the thirtieth day after its receipt:

True

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True or False: Elective Admissions are often scheduled in advance:

True

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True or False: The Outpatient Code editor used for Medicare Outpatient claims edits the patient's age to ensure it is consistent with the diagnosis:

True

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DRG Weight Reflects:

How resource-intensive the DRG is relative to other DRGs

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True or False: If the patient's Insurance Identifier is not the same as the insured's the patient's Insurance Identifier is entered in FL 8a:

True

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True or False: The date a patient is admitted for impatient care or the start of care date for home health services is called the admission date:

True

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True or False: TOB is the abbreviation for type of bill:

True

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True or False: A denied claim cannot be appealed:

False

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True or False: A sole community hospital is the only source of inpatient services in a given geographic area:

True

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True or False: An elective admission is usually a medical Emergency:

False

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True or False: The term working aged person in Medicare means a patient who is the age range 40-65:

False

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In which type of admission is the health of the patient not in jeopardy:

Elective

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True or False: A continuing claim is the first in a series of claims to be submitted:

False

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Which type of admission indicates the patient's condition is severe, life threatening, or potentially disabling:

Emergency

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True or False: APC is the abbreviation for Ambulatory Payment Classification:

True

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Which software program is used to calculate payments:

Pricer

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True or False:Condition Code 10 (Patient and/or spouse is employed but No EGHP Coverage Exists) is used to report that either the patient or spouse has group health Insurance:

False

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Condition code 18 (Maiden Name Retained) is an example of which group of condition codes:

Patient condition codes

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True or False: When a continuing claim is submitted, the provider expects that subsequent bills will be sent:

True

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True or False: CORF's are designed to provide inpatient care under a physician's supervision:

False

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Created by: rochelle1977

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