Reimbursement Test
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Under SNF PPS which one of the following healthcare services is excluded from the consolidated payment? a)Labs b)Routine c)Meds d)Radiation | show 🗑
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| show | Per Diem
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| show | Resource Utilization Groups
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| All of the following are consolidated into a single payment under the HHPPS except a)Home Health Visits b)Routine and non-routine Medical Supplies c) Nursing and therapy equipment. | show 🗑
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| Being discharged from a Long Term Care facility to an acute care facility then back to a Longterm Care within 10 days is considered what? | show 🗑
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| show | True
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| Use of the charge description master has made manual coding by HIM coder obsolete. (T or F) | show 🗑
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| What is used to collect charges for healthcare at all of the points of service and electronically report to patients acct. for entry of provider claims? | show 🗑
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| show | Coordination of all functions that contribute to the capture, management, and collection of revenue.
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| show | Medicare
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| show | Focus on single specialist for diseases
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| Which part of Medicare program was created under the Medicare Modernization Act of 2003 (MMA)and covers prescription drugs? (A, B, C or D) | show 🗑
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| show | Utilization Review
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| Which of the following characteristics is the greatest advantage of group healthcare insurance? a)smaller risk pool b) higher out of Pocket c)Greater benefits for lower premiums d) More stringent preexisting condition | show 🗑
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| show | Policy
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| show | Managed Care
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| show | Benefits
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| show | TRICARE Prime
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| (T or F)Treatment protocols that have a low risk are most likely to need a second opinion | show 🗑
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| (T or F) Services offered to Medicaid beneficiaries are the same in each state. | show 🗑
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| Why did Congress pass the Health Maintenance Organization Act of 1973? | show 🗑
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| All of the following attributes characterize episode-of-care reimbursement except: a)capitation b)Global Payment c) fee-for-service d)Prospective Payment | show 🗑
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| Which would typically not require review for medical necessity and utilization: a)Rehab b)Inpatient c)Well-Baby d)Mental Health | show 🗑
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| show | Links to Electronic Billing
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| show | Transplant
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| When a physicians office sent a request for payment to an Insurance company. What is this request called? | show 🗑
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| In the Accounting system of the physician office, the account is categorized as "Self-Pay" How should this insurance designation be interpreted? | show 🗑
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| Which healthcare payment method does the healthcare plan over see both the costs of healthcare and the outcomes of care? | show 🗑
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| show | Retrospective Payment
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| show | Fee Schedule
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| show | Reimbursement
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| In which type of reimbursement methodology does the health insurance company have the greatest risk? | show 🗑
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| show | Fee-for-Service
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| What system was created for reporting procedures and services performed by physicians in clinical practice? | show 🗑
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| show | ICD-9-CM
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| In which type of healthcare payment method does the healthcare plan pay provides with a fixed rate for each day a covered member is hospitalized. | show 🗑
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| What does NEC mean in ICD-9-CM | show 🗑
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| show | Not Otherwise Specified
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| show | Deeper detailed code you code use as will be inside of the brackets. ex. 100.2[794.94]
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| In a typical acute care setting, Charge Entry is located in which revenue cycle area? | show 🗑
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| In a typical acute care setting, Admitting is located in which revenue cycle area? | show 🗑
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| What data set provides the underpinning of the HHPPS? | show 🗑
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| How many HHRGs are there? | show 🗑
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| show | Labor Portion
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| Aging of accounts is the practice of counting the days, generally in _____ increments from time bill was SENT to the current day. | show 🗑
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| show | >25days
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| show | CPT codes that are coded by the coders
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| show | Paper-based
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| show | Compliance violations may occur and reimbursement may be lost through claim denial.
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| What are the 4 names for Charge Description Master | show 🗑
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| show | A regular income and repeating set of events that produces it.
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| show | False
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| show | The average of the sum of the relative weight of all the patients treated during a specific time period.
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| show | Physician Work, Practice Expenses and Malpractice
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| Is the status indicator C for inpatient, outpatient or both? | show 🗑
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| show | The High percentage of low income patients
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| show | CPT
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| show | LOS, MS-DRG w/principle dx mental illness, Co-morbid condition, Age of Patient, Electro therapy
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| List the 5 facility-Level Adjustments | show 🗑
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| show | High cost of drugs and devices
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| Skilled Professionals get paid on a ______ basis | show 🗑
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| What is OASIS | show 🗑
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| _________ is used to measure patients outcomes in outcome based quality improvement | show 🗑
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| What is OASIS based on? | show 🗑
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| show | in 1997 by the Balance Budget Act for Medicare beneficiaries
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| Types of MCOs | show 🗑
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| What is HMO | show 🗑
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| show | Preffered Provider Organization- This contracts with employers and insurers to render services to a group of members it also contracts with providers for healthcare services at a fixed or discounted rate
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| show | Point-of-Service: Members choose how to recieve service at the time they need the service (Gatekeepingm Cost Sharing,Out-of-networks, prescriptions)
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| What is EPO | show 🗑
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| What are three types of Episode of Care? | show 🗑
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Created by:
mrskater