Deck 6: Inpatient Billing

Question 1

The prospective payment system, introduced by Medicare in 1983, is the oldest methodology for inpatient hospital reimbursement.

Answer 1

False

Question 2

Diagnosis-related group (DRG) classifications are divided into categories referred to as Major Diagnostic Categories (MDCs).

Answer 2

True

Question 3

MDC 04 pertains to the circulatory system.

Answer 3

False

Question 4

According to the MDC listing, acute and subacute endocarditis could be assigned to only one DRG group.

Question 5

The DRG assignments for rectal resection would be 374 or 375 based on whether the encounter was surgical or nonsurgical in nature.

Question 6

An admission time of 2:32 a.m. would be assigned "02" in form locator (FL) 13.

Question 7

The source of admission is assigned in FL 14.

Question 8

Revenue codes do not need to be listed on inpatient claims.

Question 9

Revenue codes in the 010X-021X categories are accommodation codes.

Question 10

A chest x-ray would be assigned Revenue Code 0324.

Question 11

The admitting diagnosis listed in FL 69 should always coincide with the patient's reason for visit in FL 70.

Question 12

External cause codes should be listed along with the "other" diagnosis codes in FL 67.

Question 13

The most commonly recognized inpatient reimbursement methodology would be:

A) FFS.
B) MDCs.
C) DRGs.
D) Prospective Payment System.

Question 14

The primary breakdown of categories of principal diagnoses is referred to as:

A) MDCs.
B) case mix index.
C) complications and comorbidities.
D) ambulatory payment classifications.

Question 15

What would be the appropriate MDC assignment for diseases of the nervous system?

A) MDC 02
B) MDC 01
C) MDC 19
D) MDC 38

Question 16

Diagnoses related to multiple significant trauma would be assigned to which MDC?

A) MDC 17
B) MDC 24
C) MDC 25
D) MDC 04

Question 17

MDCs are further partitioned into what subcategories?

A) Surgical and Nonsurgical
B) Admit and Discharge
C) Complications and Comorbidities
D) Inpatient and Outpatient

Question 18

What type of bill should be entered in which FL of the UB-04?

A) FL 04
B) FL 01
C) FL 24
D) FL 64

Question 19

In which FL is the patient's name entered on the UB-04?

A) FL 04
B) FL 02
C) FL 01
D) FL 08

Question 20

How may condition codes may be listed in FL 18-28?

A) 10
B) 7
C) 8
D) 11

Question 21

What condition code would be indicated in FL 18 for conditions related to military service?

A) 02
B) 01
C) 29
D) 45

Question 22

In what order should revenue codes be listed in FL 42?

A) Ascending
B) Descending
C) Order of occurrence
D) Any order

Question 23

Patients in the intensive care unit during their inpatient stay would have what accommodation revenue code assigned for these services?

A) Revenue Code 020X
B) Revenue Code 019X
C) Revenue Code 016X
D) Revenue Code 021X

Question 24

Hematology services will be assigned what revenue code?

A) Revenue Code 0300
B) Revenue Code 0305
C) Revenue Code 0301
D) Revenue Code 0319

Question 25

FL 44 HCPCS/Rates/HIPPS Rate Codes should contain what information on an inpatient claim?

A) CPT Codes
B) HCPCS Codes
C) Accommodation Revenue Codes
D) Room Rate (Accommodation) Daily Rate

Question 26

What are the three reimbursement methodologies utilized for inpatient reimbursement?

Question 27

Name the DRGs that are located under MDC 02 - Eye

Question 28

What would be the appropriate Type of Bill for an Admit through Discharge Inpatient Hospital claim?

Question 29

How would it be appropriate to enter the admission hour of 1:32 p.m. in FL 13/Admission Hour?

Question 30

When a patient is admitted from the emergency room (ER), in what FL is this information recorded, and what would be the appropriate entry?

Question 31

If a patient has been transferred to another type of facility, what would be the appropriate entry in FL 17/Patient Status

Question 32

What occurrence code would be indicated in FL 31 when the patient's benefits have been exhausted?

Question 33

What would be the appropriate revenue code and descriptor for room and board charges for a semiprivate room for medicine services?

Question 34

What would be the appropriate revenue code and descriptor for admission to intensive care?

Question 35

What would be the appropriate revenue code and descriptor for a chest x-ray?

Question 36

When professional services are entered on the UB-04, which revenue codes should be utilized?

Question 37

For inpatient claims, a Principal Diagnosis, Admitting Diagnosis, and Patient's Reason for Visit should be entered. Identify which FL should be utilized for these pieces of information.

Question 38

When would it be appropriate to enter a different physician's name in FL 76 versus FL 77?