Question 1

A number that designates a particular service or procedure and is used to generate a charge on a patient bill is called a ____.

Accepted Answer

A) chargemaster 
B) charge description number 
C) department number 
D) revenue code 
A) chargemaster 
B) charge description number 
C) department number 
D) revenue code B

Question 2

The condition that,after study,is established as chiefly responsible for occasioning the admission of the patient to the hospital is a ____.

Accepted Answer

A) primary diagnosis 
B) complication 
C) provisional diagnosis 
D) principal diagnosis 
A) primary diagnosis 
B) complication 
C) provisional diagnosis 
D) principal diagnosis D

Question 3

Which of the following is a characteristic of MS-DRGs?

Accepted Answer

A) Each MS-DRG has a relative weight 
B) All hospitals have the same payment rate 
C) MS-DRGs are updated every 2 years 
D) All of the above are correct 
A) Each MS-DRG has a relative weight 
B) All hospitals have the same payment rate 
C) MS-DRGs are updated every 2 years 
D) All of the above are correct A

Question 4

A patient is admitted with a cough and hemoptysis and is diagnosed with lung cancer.The patient's lung cancer is present on admission.

Accepted Answer

A) True 
 B)False

Question 5

____ is the manipulation of codes to receive maximum reimbursement without the supporting documentation in the medical record or with disregard for the coding conventions,guidelines,and UHDDS definitions.

Accepted Answer

A) Comorbidity 
B) Complication 
C) Maximization 
D) Optimization 
A) Comorbidity 
B) Complication 
C) Maximization 
D) Optimization

Question 6

Match the following terms to the correct definitions.
-It works with consumers and healthcare providers and hospitals to make sure that patients are getting the "right care at the right time"

Accepted Answer

A) Complication 
B) Comorbidity 
C) Quality Improvement Organization (QIO) 
D) PEPPER-Program for Evaluating Payment Patterns Electronic Report 
E) Postacute Transfer Policy 
A) Complication 
B) Comorbidity 
C) Quality Improvement Organization (QIO) 
D) PEPPER-Program for Evaluating Payment Patterns Electronic Report 
E) Postacute Transfer Policy

Question 7

SOW stands for ____.

Accepted Answer

A) surgery of whitlows 
B) scars of weight 
C) scope of work 
D) scope of weight 
A) surgery of whitlows 
B) scars of weight 
C) scope of work 
D) scope of weight

Question 8

Clinical documentation specialists would perform a concurrent review of a patient's health record for any missing or incomplete nursing documentation.

Accepted Answer

A) True 
 B)False

Question 9

MS-DRG stands for __________.

Accepted Answer

Medicare S

Question 10

The ____________________ is the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.

Accepted Answer

The answer of The ____________________ is the condition established after...

Question 11

Quality improvement organizations (QIO) work with consumers,____________________,and ____________________ to make sure that patients are getting the "right care at the right time."

Accepted Answer

healthcare providers

Question 12

Match the following terms to the correct definitions.
-This program is an electronic report that is sent to a hospital;it contains hospital-specific information for 13 target areas

Accepted Answer

A) Complication 
B) Comorbidity 
C) Quality Improvement Organization (QIO) 
D) PEPPER-Program for Evaluating Payment Patterns Electronic Report 
E) Postacute Transfer Policy 
A) Complication 
B) Comorbidity 
C) Quality Improvement Organization (QIO) 
D) PEPPER-Program for Evaluating Payment Patterns Electronic Report 
E) Postacute Transfer Policy

Question 13

Which of these are factors that can determine MS-DRG assignment?

Accepted Answer

A) Patient's sex 
B) Presence or absence of MCC/CC 
C) Patient's discharge status 
D) All of the above 
A) Patient's sex 
B) Presence or absence of MCC/CC 
C) Patient's discharge status 
D) All of the above

Question 14

DRGs were developed at Yale University in the late 1960s to ____________________ and ____________________.

Accepted Answer

monitor quality of c

Question 15

Which one of these is NOT a commonly missed CC (complication/comorbidity) for MS-DRGs?

Accepted Answer

A) Atrial flutter 
B) Hypokalemia 
C) Hyponatremia 
D) Malnutrition 
A) Atrial flutter 
B) Hypokalemia 
C) Hyponatremia 
D) Malnutrition

Question 16

A condition that arises during a patient's hospitalization and may lead to increased resource use is a ____.

Accepted Answer

A) comorbidity 
B) complication 
C) provisional diagnosis 
D) morbidity 
A) comorbidity 
B) complication 
C) provisional diagnosis 
D) morbidity

Question 17

Medicare is a health coverage program for all of the following EXCEPT those ____.

Accepted Answer

A) 65 or older 
B) younger than 65 with certain disabilities 
C) 62 or older 
D) of all ages with end-stage renal disease 
A) 65 or older 
B) younger than 65 with certain disabilities 
C) 62 or older 
D) of all ages with end-stage renal disease

Question 18

Medicare was established in what year?

Accepted Answer

A) 1995 
B) 1935 
C) 1965 
D) 1945 
A) 1995 
B) 1935 
C) 1965 
D) 1945

Question 19

All of the following are TRUE of the individual hospital payment rate EXCEPT _____.

Accepted Answer

A) a regional- or national-adjusted standardized amount that considers type of hospital affects payment 
B) the individual hospital payment rate never changes 
C) whether the hospital is designated as a large urban or a rural hospital is a factor in payment 
D) the wage index for the geographic area where the hospital is located is a factor in payment 
A) a regional- or national-adjusted standardized amount that considers type of hospital affects payment 
B) the individual hospital payment rate never changes 
C) whether the hospital is designated as a large urban or a rural hospital is a factor in payment 
D) the wage index for the geographic area where the hospital is located is a factor in payment

Question 20

How do you calculate case-mix index?

Accepted Answer

Add the relative weight for pa

Exam 26: Reimbursement Methodologies

A number that designates a particular service or procedure and is used to generate a charge on a patient bill is called a ____.

The condition that,after study,is established as chiefly responsible for occasioning the admission of the patient to the hospital is a ____.

Which of the following is a characteristic of MS-DRGs?

A patient is admitted with a cough and hemoptysis and is diagnosed with lung cancer.The patient's lung cancer is present on admission.

____ is the manipulation of codes to receive maximum reimbursement without the supporting documentation in the medical record or with disregard for the coding conventions,guidelines,and UHDDS definitions.

Match the following terms to the correct definitions. -It works with consumers and healthcare providers and hospitals to make sure that patients are getting the "right care at the right time"

SOW stands for ____.

Clinical documentation specialists would perform a concurrent review of a patient's health record for any missing or incomplete nursing documentation.

MS-DRG stands for __________.

The ____________________ is the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.

Quality improvement organizations (QIO) work with consumers,____________________,and ____________________ to make sure that patients are getting the "right care at the right time."

Match the following terms to the correct definitions. -This program is an electronic report that is sent to a hospital;it contains hospital-specific information for 13 target areas

Which of these are factors that can determine MS-DRG assignment?

DRGs were developed at Yale University in the late 1960s to ____________________ and ____________________.

Which one of these is NOT a commonly missed CC (complication/comorbidity) for MS-DRGs?

A condition that arises during a patient's hospitalization and may lead to increased resource use is a ____.

Medicare is a health coverage program for all of the following EXCEPT those ____.

Medicare was established in what year?

All of the following are TRUE of the individual hospital payment rate EXCEPT _____.

How do you calculate case-mix index?

The Rationale for and History of Coding

The Health Record As the Foundation of Coding

ICD-10-Cm Format and Conventions

Basic Steps of Coding

General Coding Guidelines for Diagnosis

General Coding Guidelines for Medical and Surgical Procedures

General Coding Guidelines for Other Medical- and Surgical-Related Procedures and Ancillary Procedures

Symptoms, Signs, and Abnormal Clinical and Laboratory Findings Not Elsewhere Classified, and Z Codes

Certain Infectious and Parasitic Diseases

Neoplasms

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism

Endocrine, Nutritional, and Metabolic Diseases

Mental, Behavioral, and Neuro developmental Disorders

Diseases of the Nervous System,Diseases of the Eye and Adnexa,and Diseases of the Ear and Mastoid Process

Diseases of the Circulatory System

Diseases of the Respiratory System

Diseases of the Digestive System

Diseases of the Skin and Subcutaneous Tissue

Diseases of the Musculoskeletal System and Connective Tissue

Diseases of the Genitourinary System

Pregnancy, Childbirth, and the Puerperium

Certain Conditions Originating in the Perinatal Period and Congenital Malformations, deformations, and Chromosomal Abnormalities

Injuries and Certain Other Consequences of External Cases and External Causes of Morbidity

Burns, adverse Effects, and Poisonings

Complications of Surgical and Medical Care

Out patient Coding

Filters

Quality improvement organizations (QIO) work with consumers,,and to make sure that patients are getting the "right care at the right time."

DRGs were developed at Yale University in the late 1960s to and .