Question 1

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).

Accepted Answer

A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems

Question 2

What does the abbreviation CC indicate when used with DRGs?

Accepted Answer

The answer of What does the abbreviation CC indicate when...

Question 3

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.

Accepted Answer

A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems

Question 4

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.

Accepted Answer

A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems

Question 5

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

Accepted Answer

A) True 
 B)False

Question 6

The hospital insurance claim form must always be reviewed by the

Accepted Answer

A)  admitting clerk. 
B)  ward clerk. 
C)  patient accounts representative. 
D)  nurse.

Question 7

Elective surgeries are deferrable.

Accepted Answer

A) True 
 B)False

Question 8

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.

Accepted Answer

A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems

Question 9

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.

Accepted Answer

A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems

Question 10

A review for additional Medicare reimbursement is called

Accepted Answer

A)  DRG validation. 
B)  day outlier review. 
C)  cost outlier review. 
D)  procedure review.

Question 11

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

Accepted Answer

A)  250 
B)  300 
C)  500 
D)  745

Question 12

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.

Accepted Answer

A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems

Question 13

What is QIO an abbreviation for?

Accepted Answer

The answer of What is QIO an abbreviation for?...

Question 14

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.

Accepted Answer

A) True 
 B)False

Question 15

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.

Accepted Answer

A) Ambulatory payment 
B) Bed leasing 
C) Capitation or percentage of revenue 
D) Case rate 
E) Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems

Question 16

All of the following are considered computer security safeguards EXCEPT:

Accepted Answer

A)  use of passwords and encryption. 
B)  downloading of unauthorized data from a website. 
C)  logging off workstations when leaving a workstation or desk. 
D)  policies and procedures for fax machine use.

Question 17

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

Accepted Answer

A) True 
 B)False

Question 18

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

Accepted Answer

A)  type of admission. 
B)  source of admission. 
C)  occurrence span. 
D)  treatment authorization.

Question 19

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

Accepted Answer

The answer of On the CMS 1450 (UB-04) claim form,...

Question 20

The ____________________ is the clinical résumé for final progress notes.

Accepted Answer

The answer of The ____________________ is the clinical résumé for...

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.