Question 1

List at least five emerging healthcare trends that are affecting the way healthcare is delivered in terms of cost and customer satisfaction.

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Question 2

Like ICD-9-CM Volume 1 and 2,Volume 3 contains a/an ___________ and a __________,and the formats of these two sections are the same.

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Question 3

List at least six career opportunities that fall under the umbrella of hospital billing.

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Question 4

Like ICD-10-CM codes,ICD-10-PCS codes contain _____ characters,which can be numbers or letters and are based on the type of procedure performed,the approach,body part,and other characteristics.

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Question 5

Career opportunities for health insurance professionals exist in:

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Career opportunities for health insurance professionals exist in all of the above mentioned options, including hospitals, physicians' offices, nursing care facilities, and insurance firms. Health insurance professionals may work in various roles such as claims adjusters, underwriters, marketing representatives, and customer service representatives in these different settings. Therefore, the best choice is E, as it includes all possible options.

Question 6

The hospital billing process begins when the patient:

Accepted Answer

The hospital billing process begins when the patient registers for admission, as this is when the hospital collects important information such as insurance details and demographic information necessary for billing. Discharge, scheduling appointments with a physician, and providing insurance information may impact the billing process, but they do not mark the beginning of the process.

Question 7

Name the five major hospital payers discussed in the book and explain how a health insurance professional can obtain the most recent claims completion guidelines for each.

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Question 8

When registering for hospital admission,patients typically must provide certain personal information.List at least six of these informational items.

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Question 9

When the DRG rate does not apply,CHAMPVA pays _____% of the billed amount for covered services and supplies.

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Question 10

Explain what a "covered entity" is and list three examples of organizations that fall under this classification.

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Question 11

List the four methods Blue Cross and Blue Shield uses for establishing fees for facility services.

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Question 12

Define "principal diagnosis" as defined in the Uniform Hospital Discharge Data Set (UHDDS).

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Question 13

ICD-10-PCS has a ____________________,with each code character having the same meaning within the specific procedure section and across procedure sections to the extent possible.

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Question 14

Discuss the purpose of the new HIPAA edit.

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Question 15

Most medical clinics in the United States provide outpatient services only.

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Most medical clinics in the United States do not provide inpatient care, and therefore only offer outpatient services.

Question 16

List at least four elements that informed consent is typically based on:

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Question 17

Many states base Medicaid reimbursement for hospital inpatient services on a PPS that includes DRGs and:

Accepted Answer

Per diems are a common method used alongside DRGs (Diagnosis-Related Groups) in a Prospective Payment System (PPS) for Medicaid reimbursement, as they provide a fixed amount per day of a patient's hospital stay.

Question 18

The general index of surgical procedures in ICD-9 Volume 3,is structured in ____________ order.

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Question 19

Guidelines for locating the correct procedure code in ICD-9-CM Volume 3 involve first locating the procedure in the _____________ and then cross-referencing it to the ____________,where the code selection is confirmed.

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Question 20

The book discussed two relatively new rules that will affect hospital coding in the near future.What are they?

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Quiz 18: Hospital Billing and the UB-04