Deck 1: The Flow of the Hospital Organization

Question 1

The admitting diagnosis is determined by the patient's chief complaint at the time of the admission.

Answer 1

False

Question 2

Outpatient services are typically provided outside the acute care hospital.

Answer 2

False

Question 3

Intermediate Care Facilities (ICF) are considered inpatient facilities.

Answer 3

True

Question 4

ASC is an acronym for ambulatory surgery coding.

Question 5

Advanced Directives are requests from the patient at the time of admission of what services they would like to have performed during their admission.

Question 6

As well as CPT codes, ICD-9-CM diagnosis and procedure codes are assigned by all hospital/facility coders.

Question 7

The form utilized for submitting charges to the insurance carrier is referred to as the CMS-1450.

Question 8

Coders in the Health Information Department of the hospital are the only individuals who need to have coding knowledge to successfully complete and understand their duties.

Question 9

The Certified Professional Coder (CPC) certification indicates that the individual who has successfully received this designation has concentrated knowledge in physician coding.

Question 10

Inpatient care usually takes place in the acute care facility such as a hospital, skilled nursing facility, or intermediate care facility.

Question 11

Physicians employed by the hospital are referred to as:

A) hospital-based physicians.
B) physician employees.
C) administrative physicians.
D) private practice physicians.

Question 12

What form would the patient be requested to sign in the event the services to be rendered may not be covered by Medicare or their insurance?

A) Release of Medical Information
B) Advanced Directive
C) Advance Beneficiary Notice
D) Assignment of benefits

Question 13

The process of gathering charge documents from all departments within the facility that have provided services to a patient is referred to as:

A) charge capturing.
B) utilization review.
C) precertification.
D) case management.

Question 14

The term third-party contractrefers to a contract:

A) with an entity other than the patient.
B) with an entity other than the hospital.
C) with a third-party liability carrier.
D) between the patient, the facility, and the insurance carrier.

Question 15

When ancillary services such as x-rays or EKGs are performed, the resources necessary to provide the services by the facility are referred to as:

A) the charge.
B) the technical charge.
C) the professional charge.
D) the chargemaster charge.

Question 16

Hospital inpatient coders utilize which coding nomenclatures for assigning codes?

A) CPT codes only
B) ICD-9-CM diagnosis codes only
C) CPT and ICD-9-CM codes
D) ICD-9-CM diagnosis and procedure codes

Question 17

Inpatient coding certification is available through which organizations?

A) AAPC (American Academy of Professional Coders)
B) MGMA (Medical Group Management Association)
C) AHIMA (American Health Information Management Association) and AAPC (American Academy of Professional Coders)
D) AHA (American Hospital Association)

Question 18

Which department within the hospital setting is typically responsible for coding assignments?

A) Health Information Management
B) Business Office
C) Utilization Review
D) Case Management

Question 19

When claims are initially denied by the insurance carrier and the facility wishes to resubmit the claim to request additional consideration for payment, the process is referred to as:

A) adjudication.
B) appeal.
C) claims processing.
D) dispute.

Question 20

What is the acronym given to the electronic medical health record?

A) EHR
B) EMHR
C) UB-04
D) CMS-1500

Question 21

Explain the difference between an inpatient and an outpatient facility.

Question 22

For services to be "medically necessary," they must meet certain criteria. Name at least three of these criteria.

Question 23

In an inpatient setting, explain which services would be billed on the UB-04?

Question 24

Explain what coding nomenclature would be utilized for coding/billing for outpatient purposes.

Question 25

List those coding certifications that are appropriate for the hospital facility.