Deck 17: Hospital Billing and Reimbursement

Question 1

A patient's other conditions at admission that affect care during the hospitalization being coded are called __________, meaning coexisting conditions.

A) complications
B) principals
C) comorbidities
D) priors

Answer 1

comorbidities

Question 2

Each MDC is subdivided into __________ MS-DRGs.

A) surgical and hospital
B) medical and surgical
C) medical and experimental
D) surgical and experimental

Answer 2

medical and surgical

Question 3

A(n) __________ is a person admitted for services that require a stay spanning two midnights.

A) observation
B) inpatient
C) outpatient
D) skilled nurse

Answer 3

inpatient

Question 4

ASU is the abbreviation for

A) ambulance sirens update.
B) ambulatory surgical unit.
C) ambulatory systems unit.
D) ambulance systems update.

Question 5

Ambulatory care is provided in a(n)

A) inpatient facility.
B) long-term care facility.
C) assisted living facility.
D) outpatient facility or setting.

Question 6

Which of these terms refers to coexisting conditions?

A) emergency
B) hospital-acquired
C) comorbidities
D) complications

Question 7

Which of the following statements is true?

A) The terms admitting diagnosis and principal diagnosis are used interchangeably.
B) The admitting diagnosis is never the same as the principal diagnosis.
C) The admitting diagnosis may not match the principal diagnosis.
D) The admitting diagnosis is always the same as the principal diagnosis.

Question 8

The HIM department in hospitals conducts which of the following

A) orders supplies for patient stays
B) organizes and maintains patient medical records
C) documents patients stay
D) bills for patients services

Question 9

SNF is the abbreviation for

A) skilled nurses funding.
B) skilled nurses foundation.
C) skills nurses forget.
D) skilled nursing facility.

Question 10

Which term describes the main service performed for the condition listed as the principal diagnosis for a hospital inpatient?

A) principal procedure
B) primary procedure
C) principal diagnosis
D) admitting procedure

Question 11

CMS put into place the requirement for a(n) __________ indicator for every reported diagnosis code for a patient upon discharge.

A) SNF
B) POA
C) ADX
D) PDX

Question 12

The UB-04 form requires which physician information to be completed?

A) other provider
B) attending provider
C) all of these must be completed
D) operating physician

Question 13

Which of the following is true?

A) Both ASCs and ASUs are part of a hospital.
B) An ASU is a part of a hospital, whereas an ASC is a separate facility.
C) An ASC is part of a hospital, whereas an ASU is a separate facility.
D) Neither ASCs nor ASUs are part of a hospital.

Question 14

Each hospital negotiates a rate for MS-DRGs based on which of the following?

A) supply costs
B) all of these are factors in the rate
C) geographic location
D) labor

Question 15

The major steps related to hospital claims processing are

A) admission, examination, and follow-up.
B) admission, treatment, and discharge.
C) registration, procedures, and billing.
D) review, order, and prescribe.

Question 16

What involves a situation in which a delay in treatment would lead to a significant increase in the threat to a patient's life or body part?

A) hospice care
B) home health care
C) ambulatory care
D) emergency care

Question 17

The __________diagnosis is the condition or disease identified by the physician when a patient is admitted to the hospital.

A) secondary
B) discharge
C) admitting
D) principal

Question 18

Which of the following statements is true?

A) Medical practices and hospitals ask patients to sign consent forms in advance of procedures.
B) Consent forms are signed only in the office when the decision is made to complete the procedure.
C) Hospitals ask patients to sign consent forms in advance of procedures.
D) Medical practices ask patients to sign consent forms in advance of procedures.

Question 19

In hospital coding and reporting, which of the following is true?

A) The principal procedure is often a diagnostic procedure.
B) The principal procedure is reported with a CPT code.
C) The principal procedure is reported with a HCPCS code.
D) The principal procedure is often a surgical procedure.

Question 20

Which of the following services can code for suspected or unconfirmed conditions?

A) inpatient coding
B) physician coding
C) home health coding
D) outpatient coding

Question 21

Home health care is provided by

A) ASUs.
B) HHAs.
C) SNF.
D) ASCs.

Question 22

__________ involves a situation that is life-threatening.

A) Emergency care
B) Triage
C) Urgent care
D) Skilled nursing

Question 23

Hospice care is provided

A) either in a special hospice facility or a patient's home.
B) only in an acute care facility.
C) only in a patient's home.
D) only in a special hospice facility.

Question 24

APC is a __________ payment system.

A) TRICARE
B) Medicaid
C) Medicare
D) CHAMPVA

Question 25

Services in a skilled nursing facility are provided

A) under the direction of a physician's assistant by registered nurses.
B) under the direction of a physician by licensed nurses.
C) under the direction of a registered nurse and certified nursing assistants.
D) under the direction of a registered nurse by licensed practical nurses.

Question 26

Which term is generally used for the hospital admission process?

A) admitting diagnosis
B) inpatient-only list
C) inpatient
D) registration

Question 27

The DRG system is now called which of the following?

A) APR-DRGs
B) DRGs
C) CM-DRGs
D) MS-DRGs

Question 28

The__________ is the main database of a hospital's patients.

A) master patient index
B) inpatient-only list
C) case mix index
D) grouper

Question 29

Which of the following statements is correct?

A) Ambulatory care requires an overnight hospital stay.
B) Ambulatory care does not require an overnight hospital stay.
C) Ambulatory care is the same thing as home health care.
D) Ambulatory care is the same thing as inpatient care.

Question 30

A grouper is software used to help calculate and assign

A) HHAs.
B) DRGs.
C) OASIS.
D) APCs.

Question 31

An ambulatory surgical center is a clinic that provides

A) triage center.
B) emergency room visits.
C) birthing suites.
D) outpatient surgery.

Question 32

UHDDS is the classification system for

A) outpatient health data.
B) home health data.
C) ambulatory health data.
D) inpatient health data.

Question 33

As of October 1, 2015, ICD-10- _____ is used to code procedures performed during a patient's hospital stay.

A) DSM
B) CM
C) PCS
D) CPT

Question 34

Which of these are used for outpatient billing by CMS?

A) OASIS
B) DRGs
C) APCs
D) HHAs

Question 35

Charge masters contain all of the following except

A) the hospital's charge for the service.
B) the hospital's code for the service.
C) the hospital's cost to provide the service.
D) the hospital's estimated reimbursement for the service.

Question 36

What type of care covers all types of health services that do not require an overnight hospital stay?

A) hospice care
B) ambulatory care
C) home health care
D) emergency care

Question 37

A(n)__________ is a condition a patient develops after treatment or surgery.

A) hospital-acquired
B) emergency
C) comorbidity
D) complication

Question 38

The principal procedure is assigned by the

A) physician's dictation.
B) nurse on the floor.
C) pathology reports.
D) inpatient medical coder.

Question 39

HINN is the abbreviation for

A) Hospital-Issued Notice of Noncoverage.
B) Health Information Necessary Notices.
C) Hospital-Infrastructure Networking Notices.
D) Hospital-Information National Network.

Question 40

At-home recovery care refers to assistance with which of the following?

A) the activities of daily living provided for nursing home patients
B) the activities of daily living, such as bathing and eating
C) a terminal condition of those who are not expected to survive 6 months
D) at home dialysis treatments

Question 41

A charge master contains a hospital's list of all of the following except

A) charges.
B) services.
C) staff.
D) codes.

Question 42

A __________is the hospital's list of the codes and charges for its services.

A) grouper
B) charge master
C) electronic health record
D) case-mix index

Question 43

Which term describes the patient's condition that, after study, is established as the main reason for a hospital admission?

A) admitting diagnosis
B) principal procedure
C) inpatient
D) principal diagnosis

Question 44

The UB-04 form requires information about all of the following except

A) discharge hour.
B) point of origin for admission.
C) all of these are required information.
D) a patient's admission.

Question 45

Ambulatory care refers to which kind of care?

A) skilled nursing
B) home health
C) outpatient
D) inpatient

Question 46

Hospitals must submit electronic claims for Medicare Part A reimbursement to MACs using the HIPAA health care claim called

A) 837I.
B) CMS-1450.
C) CMS-1500.
D) 837P.

Question 47

The UB-04 claim form has how many data fields?

A) 101
B) 61
C) 81
D) 121

Question 48

MS-DRG is the abbreviation for

A) Microsoft-Designed Resource Grid.
B) Medicare-Severity Diagnosis Related Group.
C) Medicaid System Diagnostic Resources Group.
D) Medical Software for Diagnosis Related Groups.

Question 49

__________are complications caused by avoidable conditions that will not be reimbursed.

A) Incident reports
B) Late effects
C) Comorbidities
D) Never events

Question 50

The __________physician is primarily responsible for the care of the patient from the start of the hospital episode.

A) discharging
B) admitting
C) attending
D) consulting

Question 51

Each hospital's __________ is an average of the DRG weights handled for a specific period of time.

A) case mix index
B) grouper
C) DRG
D) master patient index

Question 52

Skilled nursing facilities specialize in offering

A) triage services.
B) outpatient services.
C) inpatient services.
D) observation services.

Question 53

HIM is the abbreviation for

A) health indexing master.
B) health identification management.
C) health information management.
D) health information master.

Question 54

The clinician primarily responsible for the care of the patient from the beginning of the hospital episode is called the

A) attending physician.
B) inpatient physician.
C) admitting physician.
D) outpatient physician.

Question 55

The attending physician is the

A) clinician primarily responsible for a patient's care during a hospital stay.
B) stand-by surgeon during procedures that may require two surgeons.
C) physician who saw the patient in the Emergency Room (or Emergency Department).
D) clinician whose advice was requested by another physician during the patient's hospital stay.

Question 56

In medical insurance terminology, an emergency is a

A) person who is terminally ill.
B) person who needs assistance with their ADLs.
C) situation in which emergency surgery is needed for the patient to survive.
D) situation in which delaying the treatment of a patient would result in a significant increase in the threat to life or to the viability of the body part.

Question 57

What is a special approach to caring for people with terminal illnesses?

A) emergency care
B) hospice care
C) home health care
D) ambulatory care

Question 58

Which term describes the patient's condition upon hospital admission?

A) admitting diagnosis
B) principal procedure
C) principal diagnosis
D) inpatient

Question 59

The HIPAA 837I or the UB-04 form may be used to report

A) Medicare Part A claims.
B) Medicare Part C claims.
C) Medicare Part B claims.
D) Medicare Part D claims.

Question 60

Patient medical records are maintained by which department?

A) HIM department
B) radiology department
C) billing department
D) emergency department

Question 61

Patients are listed in a patient register under a unique number, which makes up the

A) master patient index.
B) case mix index.
C) DRG.
D) grouper.

Question 62

The MS DRG system takes into account all of the following

A) comorbidities.
B) all of these are taken into consideration.
C) patient's age.
D) gender.

Question 63

A patient's personal and insurance information is gathered before or during hospital admission through which process?

A) registration process
B) nursing questionnaire process
C) consent process
D) discharge process

Question 64

Inpatients are admitted to hospitals in a process called

A) discharge.
B) registration.
C) acceptance.
D) admittance.

Question 65

The IPPS is the Medicare system for payments to institutions for

A) home health.
B) inpatients.
C) outpatients.
D) long-term care.

Question 66

What type of facility is equipped for patients to stay overnight?

A) inpatient
B) all of these answers are correct
C) outpatient
D) ambulatory

Question 67

What category of services includes care given at home, such as physical therapy or skilled nursing care?

A) ambulatory care
B) emergency care
C) home health care
D) hospice care