Question 1

One AEP criterion that needs to be met for intensity of service (IS) in an admission is

Accepted Answer

A)  sudden onset of unconsciousness. 
B)  administration and monitoring of intravenous medications. 
C)  pulse rate less than 50 or greater than 140. 
D)  sudden onset of loss of sight or hearing. 
A)  sudden onset of unconsciousness. 
B)  administration and monitoring of intravenous medications. 
C)  pulse rate less than 50 or greater than 140. 
D)  sudden onset of loss of sight or hearing. B

Question 2

Insurances from different states have the same standards for reimbursement.

Accepted Answer

A) True 
 B)False  False

Question 3

Match the type of reimbursement method with the correct description below.

-A reduction in charges for total bed days per year with incremental increases in the discount up to a maximum percentage.

Accepted Answer

A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems 
A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems O

Question 4

On the CMS 1450 (UB-04) claim form in Field 17, code 20 (patient expired) is used to indicate the patient's discharge status.

Accepted Answer

A) True 
 B)False

Question 5

When admitted as a workers' compensation case, the patient will not have an insurance card.

Accepted Answer

A) True 
 B)False

Question 6

The MS-DRG is assigned using an automated system called the DRG selector.

Accepted Answer

A) True 
 B)False

Question 7

Match the type of reimbursement method with the correct description below.

-A single charge per hospital admission paid by the managed care plan.

Accepted Answer

A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems 
A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems

Question 8

MS-DRGs are weighted to reflect the average costs for inpatient care.

Accepted Answer

A) True 
 B)False

Question 9

A patient has a right to request an itemized bill from a hospital stay with no cost to the patient.

Accepted Answer

A) True 
 B)False

Question 10

In an effort to reduce the processing time for each health insurance claim submitted and to reduce costs related to health care delivery, Medicare uses a ______________ prospective payment system on which hospital fee reimbursements are based.

Accepted Answer

diagnosis-

Question 11

ICD-10-PCS codes are used to identify

Accepted Answer

A)  outpatient surgery. 
B)  inpatient surgery. 
C)  outpatient diagnosis. 
D)  inpatient diagnosis. 
A)  outpatient surgery. 
B)  inpatient surgery. 
C)  outpatient diagnosis. 
D)  inpatient diagnosis.

Question 12

The Uniform Bill claim form is considered a ____________________ statement.

Accepted Answer

The answer of The Uniform Bill claim form is considered...

Question 13

When criteria are used by the hospital's review agency for admission screening, this is referred to as

Accepted Answer

A)  DRGs. 
B)  AEPs. 
C)  APCs. 
D)  PIPs. 
A)  DRGs. 
B)  AEPs. 
C)  APCs. 
D)  PIPs.

Question 14

Preauthorization is needed for patients who are

Accepted Answer

A)  covered by an HMO. 
B)  covered by a PPO. 
C)  covered by a managed care organization. 
D)  none of the above. 
A)  covered by an HMO. 
B)  covered by a PPO. 
C)  covered by a managed care organization. 
D)  none of the above.

Question 15

Daily progress notes are entered on the patient's medical record by a/an

Accepted Answer

A)  admitting clerk. 
B)  ward clerk. 
C)  insurance billing clerk. 
D)  nurse. 
A)  admitting clerk. 
B)  ward clerk. 
C)  insurance billing clerk. 
D)  nurse.

Question 16

The MS-DRG system is designed to increase reimbursement for sicker patients.

Accepted Answer

A) True 
 B)False

Question 17

A 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/an _____________________ code.

Accepted Answer

The answer of A four-digit code corresponding to each narrative...

Question 18

The MS-DRG-based system is a complex _________________-tiered system.

Accepted Answer

The answer of The MS-DRG-based system is a complex _________________-tiered...

Question 19

Match the type of reimbursement method with the correct description below.

-Type of arrangement in which the hospital receives a flat per-admission reimbursement for the service to which the patient is admitted.

Accepted Answer

A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems 
A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems

Question 20

A patient is considered an inpatient to the hospital on admission

Accepted Answer

A)  to the emergency department. 
B)  for an overnight stay. 
C)  for an outpatient surgical procedure. 
D)  both b and c 
A)  to the emergency department. 
B)  for an overnight stay. 
C)  for an outpatient surgical procedure. 
D)  both b and c

One AEP criterion that needs to be met for intensity of service (IS) in an admission is

Insurances from different states have the same standards for reimbursement.

Match the type of reimbursement method with the correct description below. -A reduction in charges for total bed days per year with incremental increases in the discount up to a maximum percentage.

On the CMS 1450 (UB-04) claim form in Field 17, code 20 (patient expired) is used to indicate the patient's discharge status.

When admitted as a workers' compensation case, the patient will not have an insurance card.

The MS-DRG is assigned using an automated system called the DRG selector.

Match the type of reimbursement method with the correct description below. -A single charge per hospital admission paid by the managed care plan.

MS-DRGs are weighted to reflect the average costs for inpatient care.

A patient has a right to request an itemized bill from a hospital stay with no cost to the patient.

In an effort to reduce the processing time for each health insurance claim submitted and to reduce costs related to health care delivery, Medicare uses a ______________ prospective payment system on which hospital fee reimbursements are based.

ICD-10-PCS codes are used to identify

The Uniform Bill claim form is considered a ____________________ statement.

When criteria are used by the hospital's review agency for admission screening, this is referred to as

Preauthorization is needed for patients who are

Daily progress notes are entered on the patient's medical record by a/an

The MS-DRG system is designed to increase reimbursement for sicker patients.

A 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/an _____________________ code.

The MS-DRG-based system is a complex _________________-tiered system.

Match the type of reimbursement method with the correct description below. -Type of arrangement in which the hospital receives a flat per-admission reimbursement for the service to which the patient is admitted.

A patient is considered an inpatient to the hospital on admission

Role of an Insurance Billing Specialist

Compliance, Privacy, Fraud, and Abuse in Insurance Billing

Basics of Health Insurance

Medical Documentation and the Electronic Health Record

Diagnostic Coding

Procedural Coding

The Paper Claim: Cms-1500 02-12

The Electronic Claim

Receiving Payments and Insurance Problem Solving

Office and Insurance Collection Strategies

The Blue Plans, Private Insurance, and Managed Care Plans

Medicare

Medicaid and Other State Programs

Tricare and Veterans Health Care

Workers Compensation

Disability Income Insurance and Disability Benefit Programs

Seeking a Job and Attaining Professional Advancement

Filters

Exam 17: Hospital Billing

One AEP criterion that needs to be met for intensity of service (IS) in an admission is

Insurances from different states have the same standards for reimbursement.

Match the type of reimbursement method with the correct description below. -A reduction in charges for total bed days per year with incremental increases in the discount up to a maximum percentage.

On the CMS 1450 (UB-04) claim form in Field 17, code 20 (patient expired) is used to indicate the patient's discharge status.

When admitted as a workers' compensation case, the patient will not have an insurance card.

The MS-DRG is assigned using an automated system called the DRG selector.

Match the type of reimbursement method with the correct description below. -A single charge per hospital admission paid by the managed care plan.

MS-DRGs are weighted to reflect the average costs for inpatient care.

A patient has a right to request an itemized bill from a hospital stay with no cost to the patient.

In an effort to reduce the processing time for each health insurance claim submitted and to reduce costs related to health care delivery, Medicare uses a ______________ prospective payment system on which hospital fee reimbursements are based.

ICD-10-PCS codes are used to identify

The Uniform Bill claim form is considered a ____________________ statement.

When criteria are used by the hospital's review agency for admission screening, this is referred to as

Preauthorization is needed for patients who are

Daily progress notes are entered on the patient's medical record by a/an

The MS-DRG system is designed to increase reimbursement for sicker patients.

A 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/an _____________________ code.

The MS-DRG-based system is a complex _________________-tiered system.

Match the type of reimbursement method with the correct description below. -Type of arrangement in which the hospital receives a flat per-admission reimbursement for the service to which the patient is admitted.

A patient is considered an inpatient to the hospital on admission

Role of an Insurance Billing Specialist

Compliance, Privacy, Fraud, and Abuse in Insurance Billing

Basics of Health Insurance

Medical Documentation and the Electronic Health Record

Diagnostic Coding

Procedural Coding

The Paper Claim: Cms-1500 02-12

The Electronic Claim

Receiving Payments and Insurance Problem Solving

Office and Insurance Collection Strategies

The Blue Plans, Private Insurance, and Managed Care Plans

Medicare

Medicaid and Other State Programs

Tricare and Veterans Health Care

Workers Compensation

Disability Income Insurance and Disability Benefit Programs

Seeking a Job and Attaining Professional Advancement

Filters