Exam 12: Hospital Medical Billing

Software that is used to calculate the Diagnosis Related Group (DRG) payment group is called a(n): A)claims processing system. B)grouper. C)accounts receivable system. D)database.

(Short Answer)

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Question 41

In determining payment for hospital services, diagnoses and treatments are categorized into groups called __________ Groups.

(Short Answer)

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Question 42

Why is comorbidity important in coding?

(Essay)

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Question 43

The type of care provided in a hospital that does NOT require the patient to stay overnight is known as outpatient or __________ care.

(Short Answer)

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Question 44

The prospective payment system (PPS) is NOT widely used as a reimbursement method for inpatient care.

(True/False)

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Question 45

An emergency room physician who admits a patient to the hospital and has no further involvement in the patient's care is referred to as the attending physician.

(True/False)

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Question 46

What does the process of admitting a patient to the hospital involve?

(Essay)

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Question 47

In form locator 15 on the UB-04 claim form, the codes for Physician Referral, HMO Referral, and Transfer from a skilled nursing facility (SNF) represent: A)admission source codes. B)discharge status codes. C)admission type codes. D)condition codes.

(Short Answer)

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Question 48

Ambulatory payment classifications are applied to outpatient services that include chemotherapy, implants, and preventive screenings.

(True/False)

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Question 49

What are the three basic reimbursement methods for inpatient hospital services?

(Essay)

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Question 50

Hospice care, billed using a UB-04 claim form, can be delivered as: A)inpatient only. B)outpatient only. C)either inpatient or outpatient. D)ambulatory care.

(Short Answer)

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Question 51

On the UB-04, codes that identify the department that supplied the services are the: A)CPT codes. B)ICD-9-CM codes. C)revenue codes. D)value codes.

(Short Answer)

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Question 52

If a patient were admitted to the hospital because of an auto accident, an occurrence code would be used to describe the accident.

(True/False)

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Question 53

Codes that identify special circumstances, events, or room accommodations that may affect the payer's processing of the bill are called: A)condition codes. B)occurrence codes. C)value codes. D)revenue codes.

(Short Answer)

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Question 54

What information is included in a charge description master (CDM)?

(Essay)

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Question 55

A case that cannot be assigned an appropriate Diagnosis Related Group (DRG) because of an atypical situation is called a(n): A)misdiagnosis. B)cost differential. C)cost outlier. D)unsubstantiated claim.

(Short Answer)

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Question 56

The majority of hospital reimbursement comes from: A)bank loans. B)insurance companies. C)patients. D)private donations.

(Short Answer)

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Question 57

Most major diagnostic categories (MDCs) are based on: A)a particular organ system. B)number of diagnoses. C)age of the patient. D)health status of the patient.

(Short Answer)

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Question 58

On form locator 1 of the UB-04 form, the provider name, address, and telephone number is: A)optional. B)required. C)not applicable. D)not required.

(Short Answer)

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Question 59

The computerized comprehensive list of codes for all services and items provided to hospital patients is known as the __________ .

(Short Answer)

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Question 60

Showing 41 - 60 of 90

Software that is used to calculate the Diagnosis Related Group (DRG) payment group is called a(n): A)claims processing system. B)grouper. C)accounts receivable system. D)database.

In determining payment for hospital services, diagnoses and treatments are categorized into groups called __________ Groups.

Why is comorbidity important in coding?

The type of care provided in a hospital that does NOT require the patient to stay overnight is known as outpatient or __________ care.

The prospective payment system (PPS) is NOT widely used as a reimbursement method for inpatient care.

An emergency room physician who admits a patient to the hospital and has no further involvement in the patient's care is referred to as the attending physician.

What does the process of admitting a patient to the hospital involve?

In form locator 15 on the UB-04 claim form, the codes for Physician Referral, HMO Referral, and Transfer from a skilled nursing facility (SNF) represent: A)admission source codes. B)discharge status codes. C)admission type codes. D)condition codes.

Ambulatory payment classifications are applied to outpatient services that include chemotherapy, implants, and preventive screenings.

What are the three basic reimbursement methods for inpatient hospital services?

Hospice care, billed using a UB-04 claim form, can be delivered as: A)inpatient only. B)outpatient only. C)either inpatient or outpatient. D)ambulatory care.

On the UB-04, codes that identify the department that supplied the services are the: A)CPT codes. B)ICD-9-CM codes. C)revenue codes. D)value codes.

If a patient were admitted to the hospital because of an auto accident, an occurrence code would be used to describe the accident.

Codes that identify special circumstances, events, or room accommodations that may affect the payer's processing of the bill are called: A)condition codes. B)occurrence codes. C)value codes. D)revenue codes.

What information is included in a charge description master (CDM)?

A case that cannot be assigned an appropriate Diagnosis Related Group (DRG) because of an atypical situation is called a(n): A)misdiagnosis. B)cost differential. C)cost outlier. D)unsubstantiated claim.

The majority of hospital reimbursement comes from: A)bank loans. B)insurance companies. C)patients. D)private donations.

Most major diagnostic categories (MDCs) are based on: A)a particular organ system. B)number of diagnoses. C)age of the patient. D)health status of the patient.

On form locator 1 of the UB-04 form, the provider name, address, and telephone number is: A)optional. B)required. C)not applicable. D)not required.

The computerized comprehensive list of codes for all services and items provided to hospital patients is known as the __________ .

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Understanding Managed Care: Medical Contracts and Ethics

Hipaa: Health Insurance Portability and Accountability Act of 1996

ICD-9-CM Medical Coding

ICD-10-CM Medical Coding

Introduction to Cpt and Place of Service Coding

Coding Procedures and Services

Hcpcs and Coding Compliance

Auditing

Physician Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Explanation of Benefits and Payment Adjudication

Refunds and Appeals

Workers Compensation

Electronic Medical Claims Processing

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