Exam 12: Hospital Medical Billing

The type of payment system initiated by Medicare that establishes the rate that will be paid for hospital services before the services are rendered is the __________ system.

What is the role of an attending physician?

On form locator 3 of the UB-04 form, the patient control number (PCN) is: A)optional. B)required. C)not applicable. D)not required.

The physician who is primarily responsible for a patient's care while in the hospital is referred to as the: A)admitting physician. B)attending physician. C)rendering physician. D)primary care physician.

A department in a hospital that provides outpatient surgery services is known as the: A)ambulatory surgical center. B)ambulatory surgical unit. C)hospital surgical center. D)outpatient surgical facility.

On the UB-04, codes that identify services and benefit days for Medicare patients are the: A)CPT codes. B)ICD-9-CM codes. C)revenue codes. D)value codes.

The UB-04 claim form is considered a summary document and is supported by an itemized or detailed bill.

What is the Diagnosis Related Group (DRG) system?

The four sections of the UB-04 claim form include information on: A)patient, billing, payer, and diagnosis. B)patient, physician, procedures, and diagnosis. C)patient, prognosis, diagnosis, and facility. D)patient, billing, payer, and physician.

The method of reimbursement that pays hospitals a fixed rate per day for all services provided is: A)capitation. B)fee for service. C)per diem. D)prospective payment system.

Diagnosis Related Group (DRG) classification takes into account all of the following criteria EXCEPT: A)age and sex of the patient. B)social status and family support. C)comorbidity and complications. D)principal and secondary diagnoses.

The process of collecting a patient's personal information and entering it into the hospital's database is referred to as: A)verification. B)registration. C)certification. D)authorization

A facility's case mix is based on all of the following EXCEPT: A)discharge status. B)severity of illness. C)treatment difficulty. D)resource intensity.

A hospital will bill for patient services: A)at the end of each day of the inpatient stay. B)on the day the patient is discharged. C)after the discharge paperwork is completed and signed by the physician. D)once per month.

A patient whose condition permits adequate time to schedule the service is reported as an urgent admission.

When using a FOUR-digit Medicare "type of bill" code in form locator 4, the type of facility is represented by the: A)first digit. B)second digit. C)third digit. D)fourth digit.

A case that cannot be assigned an appropriate Diagnosis Related Group (DRG) because of an atypical situation is referred to as a(n) __________ .

Reimbursement methods for inpatient hospital services include all of the following EXCEPT: A)capitation. B)fee for service. C)per diem. D)prospective payment system.

A patient control number (PCN) is a unique identifier assigned to each hospital patient at the time of: A)admission. B)diagnosis. C)surgery. D)discharge.

The provider who supplies the reported service or performs the reported procedure is known as the __________ physician.