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A Fordney 16

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
Confidential information about patients should never be discussed with   Coworkers, family, or friends  
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When criteria are used by the review agency for admission screening, this is referred to as   AEPs  
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One criterion that needs to be met to certify severity of illness (SI) in an admission is   active, uncontrolled bleeding  
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One criterion that needs to be met for intensity of service (IS) in an admission is   administration and monitoring of intravenous medications  
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A patient is considered an inpatient to the hospital on admission   for an overnight stay  
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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  
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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  
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What organization is responsible for admission review, readmission review, procedure review, day and cost outlier review, DRG validation, and transfer review   PRO  
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Readmission review occurs if the patient is readmitted within   7 days of discharge  
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A review for additional Medicare reimbursement is called   day outlier review  
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The significant reason for which a patient is admitted to the hospital is coded using the   princial diagnosis  
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Classifications of surgical and nonsurgical procedures and miscellaneous therapeutic and diagnostic procedures are found in   ICD-9-CM volume 3  
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ICD-9-CM procedure codes contain   at least two digits, and two to four digits  
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The code book used to list procedures on outpatient hospital claims is   CPT  
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The person who interviews the patient and obtains personal and insurance information and the admitting diagnosis is a/an   admitting clerk  
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Daily progress notes are entered on the patient's medical record by a   nurse  
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The claim form sent to the insurance carrier for reimbursement for inpatient hospital services is called the   UB-92  
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The form that accompanies the billing claim form for inpatient hospital services is called a   detailed statement  
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The hospital insurance claim form must always be reviewed by the   insurance billing editor  
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Professional services billed by the physician include   hospital consultations, hospital visits and emergency department visits  
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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  
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A tentative DRG is based on   admission diagnosis, scheduled procedures, age, and secondary diagnosis  
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How many major diagnostic categories (MDCs) are there in the DRG-based system   25  
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On the UB-92 claim form, code 6 (transfer from another health care facility) in block 20 is used to indicate   source of admission  
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The claim form used for outpatient hospital services is the   UB-92 claim form  
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PAT is an abbreviation for   preadmission testing  
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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  
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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  
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The ___ is the clinical resume for final progress note   discharge summary  
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The Uniform Bill claim form is considered a ___ statement   summary  
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Medicare provides stop loss called ___ in its regulations   outliers  
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The abbreviation of the phrase that indicates when claims are submitted electronically is   EDI electronic data interchange  
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On the UB-92 claim form, the first digit of the three-digit bill code in block 4 indicates the type of ____   facility  
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On the UB-92 claim forn, the number of inpatient days is indicated in block 7; these are referred to as ___ days   covered  
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On the UB-92 claim form, 15:53 listed as the hour of admission indicates that the patient was admitted at   3:53 pm  
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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  
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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  
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Cases that cannot be assigned an appropriate DRG because of atypical situations are called ___   cost outliers  
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An unethical pratice of upcoding a patient's DRG category for a more severe diagnosis to increase reimbursement is called ___   DRG creep  
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___ 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  
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