Exam 17: Hospital Billing

Match the type of reimbursement method with the correct description below. -An outpatient classification system developed by Health Systems International is ambulatory payment classifications (APCs).

What does the abbreviation CC indicate when used with DRGs?

Match the type of reimbursement method with the correct description below. -A single charge for a day in the hospital regardless of actual charges or costs incurred.

Match the type of reimbursement method with the correct description below. -A classification system that categorizes inpatients who are medically related with respect to diagnosis and treatment and are statistically similar in length of hospital stay.

A patient who is covered under an HMO plan must have authorization prior to admission unless the patient is admitted for an emergency.

The hospital insurance claim form must always be reviewed by the

Elective surgeries are deferrable.

Match the type of reimbursement method with the correct description below. -Dollar amount owed to a participating provider for health care services rendered to a plan member according to a fee schedule set by the managed care plan.

Match the type of reimbursement method with the correct description below. -Reimbursement to the hospital on a per-member, per-month basis to cover costs for the member of the plan.

A review for additional Medicare reimbursement is called

Medicare's Inpatient Prospective Payment System has approximately _________ MS-DRGs.

Match the type of reimbursement method with the correct description below. -Term for the first day of a hospital stay being paid at a higher rate.

What is QIO an abbreviation for?

Information such as "condition is employment related" (code 02), listed in Fields 18 through 28 of the CMS 1450 (UB-04) claim form, is called a condition code.

Match the type of reimbursement method with the correct description below. -Method by which part of the plan's payment to the hospital may be withheld or set aside in a bonus pool.

All of the following are considered computer security safeguards EXCEPT:

Ambulatory payment classifications (APCs) are based on the principal diagnosis.

On the CMS 1450 (UB-04) claim form, code 6 (transfer from another health care facility) in Field 15 is used to indicate

On the CMS 1450 (UB-04) claim form, 1553 listed as the hour of admission indicates that the patient was admitted at ____________________.

The ____________________ is the clinical résumé for final progress notes.