Exam 17: Hospital Billing

Which organization is responsible for admission review, readmission review, procedure review, day and cost outlier review, DRG validation, and transfer review?

PAT is an abbreviation for ____________________.

Surgical procedures performed in the hospital operating room are billed by the hospital billing department.

When a patient who has a managed care contract is admitted to a hospital for an emergency, the managed care program needs to be notified within

Match the type of reimbursement method with the correct description below. -Methods in which the plan advances cash to cover expected claims to the hospital.

What is the document that needs to be completed and signed by the physician after a patient leaves the hospital, before the hospital can receive reimbursement?

The person who interviews the patient and obtains personal and insurance information and the admitting diagnosis is a/an

Match the type of reimbursement method with the correct description below. -Term for a managed care plan that leases beds from a facility.

Match the type of reimbursement method with the correct description below. -A comprehensive listing of charges based on procedure codes that states fee maximums paid by the health plan.

______________________ 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.

Medicare provides stop-loss called _____________________ in its regulations.

Match the type of reimbursement method with the correct description below. -An averaging after a flat rate has been given to certain categories of procedures.

Match the type of reimbursement method with the correct description below. -A form of reinsurance in which the hospital buys insurance to protect against lost revenue and receives less of a capitation fee, and the amount the hospital does not receive helps pay for the insurance.

The claim form transmitted to the insurance carrier for reimbursement for inpatient hospital services is called the

The claim form used for outpatient hospital procedure billing is the

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

Emergency department charges are billed along with the inpatient stay on the CMS-1500 claim form.

ICD-10-PCS codes contain

The rule stating that when a patient receives outpatient services within 72 hours 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

The Administrative Simplification provisions of the Health Information Portability and Accountability Act of 1996 prohibit the submission of most _____________________.