Deck 3: Hospital Billing Overview

Question 1

Revenue codes are two-digit codes that identify department services.

Answer 1

False

Question 2

The term DRG refers to a reimbursement methodology employed by Medicare for inpatient services.

Answer 2

True

Question 3

APC refers to a payment methodology utilized by Medicare for inpatient facility services.

Answer 3

False

Question 4

The Medicare Remittance Advice indicates how a claim was processed by Medicare; for example, Paid/Denied, Allowance Amount, and Amount Paid.

Question 5

When patient balances are not satisfied within a specified period of time and regulatory requirements for patient notification have been met, the account will be sent directly to the credit bureau.

Question 6

A Preferred Provider Organization (PPO) is a type of managed care plan.

Question 7

Under Health Maintenance Organization (HMO) managed care plan, the patient must utilize the HMO network, and, if so, no authorizations are necessary.

Question 8

The Medicare Part D program is free to all Medicare recipients.

Question 9

The guarantor is the individual responsible for ultimate payment for services performed.

Question 10

Patient accounts that are outstanding are referred to as accounts receivable.

Question 11

When a Medicare Advance Beneficiary Notice (ABN) has been obtained, what modifier code should be appended to the service to indicate the appropriate form has been received and was signed by the patient in accordance with Medicare guidelines?

A) Modifier ABN
B) Modifier GA
C) Modifier GZ
D) Modifier 52

Question 12

Patients eligible for Medicare usually qualify as the result of:

A) reaching age 65.
B) no income.
C) unemployment.
D) retirement.

Question 13

The name given to the insurance carriers that process Medicare claims under guidelines from CMS are referred to as:

A) Medicare Administrative Contractors (MACs)
B) agents of trust.
C) primary care contractors.
D) RACs.

Question 14

What services would be covered under Medicare Part A?

A) Hospital inpatient services
B) Ambulatory surgery
C) Outpatient laboratory
D) Physician services

Question 15

The Medicare program that functions as a Medicare HMO and may be selected by Medicare recipients in lieu of their traditional Medicare coverage is known as:

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

Question 16

The Medicaid program is intended for individuals who:

A) are homeless.
B) are unemployed.
C) are indigent or medically needy.
D) have no insurance.

Question 17

The name given to any type of insurance carrier that implements methods to control healthcare costs such as co-payments, primary care physicians, and/or the need for authorization for services to be performed is a(n):

A) HMO.
B) managed care plan.
C) indemnity plan.
D) liability coverage.

Question 18

Formerly known as CHAMPUS/CHAMPVA, the type of carrier available to active and/or retired military and their qualifying family members is:

A) COBRA.
B) HMO.
C) TRICARE.
D) Blue Cross/Blue Shield.

Question 19

The computerized summary of services provided by the facility, including such information as CPT codes, revenue codes, charges, and department numbers is known as the:

A) Charge description master (CDM).
B) the master list.
C) encounter form.
D) charge ticket.

Question 20

When the facility participates with the insurance carrier, what are their obligations? (Select all that apply.)

A) Accept the allowance as payment in full.
B) File the claim for the patient.
C) Write off the difference between the charge and the allowance.
D) Never bill the patient.

Question 21

Which of the following items are usually included on the CDM of the facility? (Select all that apply.)

A) Revenue Code
B) Description of Service
C) Department Code
D) DRG/APC Assignment

Question 22

What types of services are typically covered under the Medicaid Program?

Question 23

What are the three types of CHAMPUS/TRICARE products available to military and their families?

Question 24

Name several reimbursement methodologies utilized for facility reimbursement.

Question 25

Define a managed care plan.

Question 26

Name several types of Managed Care Plans.

Question 27

What type of information is contained on the Remittance Advice or Explanation of Benefits?

Question 28

Explain the difference between a denied claim and a rejected claim.

Question 29

Explain the primary difference in DRG and APC reimbursement methodologies.