Question 1

ICD-10-CM diagnosis and procedures codes are used to derive the DRG by following the flowchart in a ___________.

Accepted Answer

The answer of ICD-10-CM diagnosis and procedures codes are used...

Question 2

All of the following statements about APCs are true EXCEPT:

Accepted Answer

A)  Patients may be assigned to more than one APC for an encounter. 
B)  APC assignment is based on ICD-10-CM principal diagnosis and secondary codes. 
C)  There are over 1,000 APCs. 
D)  APCs apply only to ambulatory care. 
A)  Patients may be assigned to more than one APC for an encounter. 
B)  APC assignment is based on ICD-10-CM principal diagnosis and secondary codes. 
C)  There are over 1,000 APCs. 
D)  APCs apply only to ambulatory care.

Question 3

A patient presented to a hospital three times in one month: one visit was for a throat culture in the clinic. One visit was for a suture of a laceration in the emergency department. One visit was for a same-day stay for a hernia repair. The hospital would submit:

Accepted Answer

A)  One bill at the end of the month totaling all charges under one account number and one medical record number; a new account number would be assigned next month 
B)  One bill for the throat culture under one account number, and another bill with another account number for the suture and hernia repair, because these were surgical procedures to be grouped together; both bills would have the same medical record number 
C)  A separate bill for each visit with a new medical record number and new account number 
D)  A separate bill for each visit with the same medical record number but different account numbers 
A)  One bill at the end of the month totaling all charges under one account number and one medical record number; a new account number would be assigned next month 
B)  One bill for the throat culture under one account number, and another bill with another account number for the suture and hernia repair, because these were surgical procedures to be grouped together; both bills would have the same medical record number 
C)  A separate bill for each visit with a new medical record number and new account number 
D)  A separate bill for each visit with the same medical record number but different account numbers

Question 4

Periodic payments to an insurance company for coverage (an insurance policy) are called _________.

Accepted Answer

The answer of Periodic payments to an insurance company for...

Question 5

One major difference between a PPO and an HMO is:

Accepted Answer

A)  Under PPOs, patients can choose any health care provider without penalty 
B)  HMOs require co-pays 
C)  HMOs do not typically reimburse for out-of-network providers 
D)  PPOs require co-pays 
A)  Under PPOs, patients can choose any health care provider without penalty 
B)  HMOs require co-pays 
C)  HMOs do not typically reimburse for out-of-network providers 
D)  PPOs require co-pays

Question 6

Payments calculated based on the number of days are called ____________.

Accepted Answer

The answer of Payments calculated based on the number of...

Question 7

List and describe the four types of reimbursement.

Accepted Answer

· Fee for service reimburses the provide

Question 8

Prospective payment for acute care is based on ____________.

Accepted Answer

diagnosis

Question 9

The process of evaluating medical interventions against established criteria, based on the patient's known or tentative diagnosis, is called ____________.

Accepted Answer

The answer of The process of evaluating medical interventions against...

Question 10

The type of insurance that assumes the payment for all or part of certain, specified services, but requires out-of-pocket deductibles and frequently caps total covered payments is called _____________.

Accepted Answer

The answer of The type of insurance that assumes the...

Question 11

If a facility is to receive reimbursement for an item such as an aspirin, the item and the cost of the item must be included in the facility's:

Accepted Answer

A)  Chargemaster 
B)  Codemaster 
C)  Medical record 
D)  Encounter form 
A)  Chargemaster 
B)  Codemaster 
C)  Medical record 
D)  Encounter form

ICD-10-CM diagnosis and procedures codes are used to derive the DRG by following the flowchart in a ___________.

All of the following statements about APCs are true EXCEPT:

A patient presented to a hospital three times in one month: one visit was for a throat culture in the clinic. One visit was for a suture of a laceration in the emergency department. One visit was for a same-day stay for a hernia repair. The hospital would submit:

Periodic payments to an insurance company for coverage (an insurance policy) are called _________.

One major difference between a PPO and an HMO is:

Payments calculated based on the number of days are called ____________.

List and describe the four types of reimbursement.

Prospective payment for acute care is based on ____________.

The process of evaluating medical interventions against established criteria, based on the patient's known or tentative diagnosis, is called ____________.

The type of insurance that assumes the payment for all or part of certain, specified services, but requires out-of-pocket deductibles and frequently caps total covered payments is called _____________.

If a facility is to receive reimbursement for an item such as an aspirin, the item and the cost of the item must be included in the facility's:

Health Care Delivery Systems

Collecting Health Care Data

Electronic Health Records

Acute Care Records

Health Information Management Processing

Code Sets

Health Information Management Issues in Other Care Settings

Managing Health Records

Statistics

Quality and Uses of Health Information

Confidentiality and Compliance

Him Department Management

Training and Development

Filters

Exam 7: Reimbursement

ICD-10-CM diagnosis and procedures codes are used to derive the DRG by following the flowchart in a ___________.

All of the following statements about APCs are true EXCEPT:

A patient presented to a hospital three times in one month: one visit was for a throat culture in the clinic. One visit was for a suture of a laceration in the emergency department. One visit was for a same-day stay for a hernia repair. The hospital would submit:

Periodic payments to an insurance company for coverage (an insurance policy) are called _________.

One major difference between a PPO and an HMO is:

Payments calculated based on the number of days are called ____________.

List and describe the four types of reimbursement.

Prospective payment for acute care is based on ____________.

The process of evaluating medical interventions against established criteria, based on the patient's known or tentative diagnosis, is called ____________.

The type of insurance that assumes the payment for all or part of certain, specified services, but requires out-of-pocket deductibles and frequently caps total covered payments is called _____________.

If a facility is to receive reimbursement for an item such as an aspirin, the item and the cost of the item must be included in the facility's:

Health Care Delivery Systems

Collecting Health Care Data

Electronic Health Records

Acute Care Records

Health Information Management Processing

Code Sets

Health Information Management Issues in Other Care Settings

Managing Health Records

Statistics

Quality and Uses of Health Information

Confidentiality and Compliance

Him Department Management

Training and Development

Filters