Deck 12: Hospital Medical Billing

Question 1

Diagnosis Related Group (DRG) classification takes into account all of the following criteria EXCEPT:

A)age and sex of the patient.
B)social status and family support.
C)comorbidity and complications.
D)principal and secondary diagnoses.

Answer 1

social status and family support.

Question 2

The Diagnosis Related Group (DRG) system is a type of:

A)utilization review system.
B)capitation system.
C)prospective payment system.
D)retrospective payment system.

Answer 2

prospective payment system.

Question 3

Most major diagnostic categories (MDCs) are based on:

A)a particular organ system.
B)number of diagnoses.
C)age of the patient.
D)health status of the patient.

Answer 3

a particular organ system.

Question 4

A case that cannot be assigned an appropriate Diagnosis Related Group (DRG) because of an atypical situation is called a(n):

A)misdiagnosis.
B)cost differential.
C)cost outlier.
D)unsubstantiated claim.

Question 5

The method of reimbursement that pays hospitals a fixed rate per day for all services provided is:

A)capitation.
B)fee for service.
C)per diem.
D)prospective payment system.

Question 6

A patient control number (PCN) is a unique identifier assigned to each hospital patient at the time of:

A)admission.
B)diagnosis.
C)surgery.
D)discharge.

Question 7

Services covered under the Ambulatory Payment Classification (APC) system include all of the following EXCEPT:

A)outpatient surgical procedures.
B)inpatient surgical procedures.
C)emergency department visits.
D)diagnostic services.

Question 8

The list of Ambulatory Payment Classification (APC) rates is maintained by:

A)the American Medical Association (AMA).
B)the Blue Cross/Blue Shield Association.
C)the Centers for Medicare and Medicaid Services (CMS).
D)contracted health plans.

Question 9

The majority of hospital reimbursement comes from:

A)bank loans.
B)insurance companies.
C)patients.
D)private donations.

Question 10

Reimbursement methods for inpatient hospital services include all of the following EXCEPT:

A)capitation.
B)fee for service.
C)per diem.
D)prospective payment system.

Question 11

The process of collecting a patient's personal information and entering it into the hospital's database is referred to as:

A)verification.
B)registration.
C)certification.
D)authorization

Question 12

A facility's case mix is based on all of the following EXCEPT:

A)discharge status.
B)severity of illness.
C)treatment difficulty.
D)resource intensity.

Question 13

The UB-04 claim form allows for a maximum of:

A)4 diagnoses.
B)6 diagnoses.
C)8 diagnoses.
D)10 diagnoses.

Question 14

A charge description master includes all of the following information EXCEPT:

A)procedure code.
B)procedure or service description.
C)charge.
D)physician identification number.

Question 15

Software that is used to calculate the Diagnosis Related Group (DRG) payment group is called a(n):

A)claims processing system.
B)grouper.
C)accounts receivable system.
D)database.

Question 16

OPPS stands for:

A)Outpatient Payment for Preventive Services.
B)Outpatient Prospective Payment System.
C)Optimal Payment for Procedures and Services.
D)Other Payments for Procedures and Services.

Question 17

The method of reimbursement that establishes the rate of payment to a hospital before services are rendered is:

A)capitation.
B)fee for service.
C)per diem.
D)prospective payment system.

Question 18

The physician who is primarily responsible for a patient's care while in the hospital is referred to as the:

A)admitting physician.
B)attending physician.
C)rendering physician.
D)primary care physician.

Question 19

The Ambulatory Payment Classification (APC) system bases payments on:

A)usual fees.
B)procedures.
C)diagnoses.
D)number of days.

Question 20

A hospital will bill for patient services:

A)at the end of each day of the inpatient stay.
B)on the day the patient is discharged.
C)after the discharge paperwork is completed and signed by the physician.
D)once per month.

Question 21

On form locator 3 of the UB-04 form, the patient control number (PCN) is:

A)optional.
B)required.
C)not applicable.
D)not required.

Question 22

When using a FOUR-digit Medicare "type of bill" code in form locator 4, the frequency is represented by the:

A)first digit.
B)second digit.
C)third digit.
D)fourth digit.

Question 23

To signify that a patient was discharged from the hospital at midnight, which code would be entered in form locator 16 on the UB-04?

A)00
B)12
C)24
D)99

Question 24

When using a FOUR-digit Medicare "type of bill" code in form locator 4, the bill classification (type of care) is represented by the:

A)first digit.
B)second digit.
C)third digit.
D)fourth digit.

Question 25

If the time that a patient was admitted to the hospital is unknown, which code would be entered in form locator 13?

A)It would be left blank.
B)It would be noted as "unknown."
C)Code 00
D)Code 99

Question 26

The volume of ICD-9 codes that is used to code hospital services and procedures is:

A)Volume 3.
B)Volume 2.
C)Volume 1.
D)Version 5010.

Question 27

A preexisting condition that, because of its effect on the principal diagnosis, results in more intensive therapy or a longer stay is a(n):

A)chronic condition.
B)complication.
C)comorbidity.
D)exacerbation.

Question 28

In form locator 17 on the UB-04 claim form, the codes for "Left against medical advice or discontinued care," "Expired (or did not recover)," and "Admitted as an inpatient to this hospital" represent:

A)admission source codes.
B)discharge status codes.
C)admission type codes.
D)condition codes.

Question 29

For a patient whose condition requires immediate attention for the treatment of a physical or mental disorder, the admission type code would be reported as:

A)emergency.
B)urgent.
C)elective.
D)trauma.

Question 30

On form locator 67 of the UB-04 form, the principal diagnosis code is:

A)optional.
B)required.
C)not applicable.
D)not required.

Question 31

For a patient whose condition permits adequate time to schedule the service, the admission type code would be reported as:

A)emergency.
B)urgent.
C)elective.
D)trauma.

Question 32

When referring to Diagnosis Related Groups (DRGs), the abbreviation CC is used to indicate:

A)chief complaint.
B)closed case.
C)chronic condition.
D)complications or comorbidities.

Question 33

On the UB-04, codes that identify services and benefit days for Medicare patients are the:

A)CPT codes.
B)ICD-9-CM codes.
C)revenue codes.
D)value codes.

Question 34

Which of the following codes would be entered to report that the patient is female in form locator 11 on the UB-04?

A)1
B)2
C)M
D)F

Question 35

On form locator 10 of the UB-04 form, the patient birth date is:

A)optional.
B)required.
C)not applicable.
D)not required.

Question 36

On the UB-04, codes that identify the department that supplied the services are the:

A)CPT codes.
B)ICD-9-CM codes.
C)revenue codes.
D)value codes.

Question 37

When using a FOUR-digit Medicare "type of bill" code in form locator 4, the type of facility is represented by the:

A)first digit.
B)second digit.
C)third digit.
D)fourth digit.

Question 38

On form locator 1 of the UB-04 form, the provider name, address, and telephone number is:

A)optional.
B)required.
C)not applicable.
D)not required.

Question 39

In form locator 15 on the UB-04 claim form, the codes for Physician Referral, HMO Referral, and Transfer from a skilled nursing facility (SNF) represent:

A)admission source codes.
B)discharge status codes.
C)admission type codes.
D)condition codes.

Question 40

Codes that identify special circumstances, events, or room accommodations that may affect the payer's processing of the bill are called:

A)condition codes.
B)occurrence codes.
C)value codes.
D)revenue codes.

Question 41

A department in a hospital that provides outpatient surgery services is known as the:

A)ambulatory surgical center.
B)ambulatory surgical unit.
C)hospital surgical center.
D)outpatient surgical facility.

Question 42

An emergency room physician who admits a patient to the hospital and has no further involvement in the patient's care is referred to as the attending physician.

Question 43

The Diagnosis Related Group (DRG) system categorizes patients (cases) who are medically related with respect to diagnosis, treatment, and length of stay.

Question 44

Per diem is a type of reimbursement that pays a fixed rate per day for all services provided by a hospital.

Question 45

Ambulatory payment classifications are applied to outpatient services that include chemotherapy, implants, and preventive screenings.

Question 46

A case that involves a unique combination of diagnoses and procedures that result in higher-than-usual costs is designated as a cost outlier.

Question 47

A patient control number (PCN) is a unique number given to each patient for each day of inpatient care.

Question 48

The four sections of the UB-04 claim form include information on:

A)patient, billing, payer, and diagnosis.
B)patient, physician, procedures, and diagnosis.
C)patient, prognosis, diagnosis, and facility.
D)patient, billing, payer, and physician.

Question 49

The UB-04 claim form is considered a summary document and is supported by an itemized or detailed bill.

Question 50

A code that describes an accident or mishap responsible for the patient's admission to the hospital is known as a(n):

A)condition code.
B)occurrence code.
C)value code.
D)revenue code.

Question 51

The number of form locators on the UB-04 claim form is:

A)33.
B)62.
C)81.
D)94.

Question 52

The prospective payment system (PPS) is NOT widely used as a reimbursement method for inpatient care.

Question 53

Situations that require immediate attention to avoid the loss of life or limb are:

A)critical.
B)emergencies.
C)urgent.
D)terminal.

Question 54

Comorbidity may affect payment if the condition causes an increase in hospital length of stay by at least 2 days in approximately 50% of cases.

Question 55

The type of facility that would use the UB-04 claim form includes all of the following EXCEPT:

A)rehabilitation centers.
B)physicians' offices.
C)outpatient surgical centers.
D)skilled nursing facilities.

Question 56

The type of care that provides palliative services for terminally ill patients is known as:

A)hospice care.
B)home health care.
C)critical care.
D)terminal care.

Question 57

Hospice care, billed using a UB-04 claim form, can be delivered as:

A)inpatient only.
B)outpatient only.
C)either inpatient or outpatient.
D)ambulatory care.

Question 58

The universal claim form used for hospital billing of private and government payers is the:

A)UB-82.
B)UB-92.
C)UB-04.
D)CMS-1500.

Question 59

The majority of hospital reimbursement comes from insurance companies.

Question 60

The four main sections of the UB-04 claim form include all of the following EXCEPT:

A)patient information.
B)billing information.
C)physician information.
D)diagnosis information.

Question 61

A case that cannot be assigned an appropriate Diagnosis Related Group (DRG) because of an atypical situation is referred to as a(n) __________ .

Question 62

It is the responsibility of the __________ physician to determine the principal diagnosis for his or her patient.

Question 63

Revenue codes on the UB-04 claim form identify services and benefit days for Medicare patients.

Question 64

If a patient were admitted to the hospital because of an auto accident, an occurrence code would be used to describe the accident.

Question 65

Inpatient care refers to a hospital confinement of more than 24 hours.

Question 66

The admission and discharge hour codes on the UB-04 form are based on military time.

Question 67

The type of care provided in a hospital that does NOT require the patient to stay overnight is known as outpatient or __________ care.

Question 68

The number assigned to a patient upon admission to the hospital is the __________ number.

Question 69

The hospital database that contains information on all admitted patients is the __________ index.

Question 70

The type of payment system initiated by Medicare that establishes the rate that will be paid for hospital services before the services are rendered is the __________ system.

Question 71

What does the process of admitting a patient to the hospital involve?

Question 72

A patient whose condition permits adequate time to schedule the service is reported as an urgent admission.

Question 73

An ambulatory surgical center must be affiliated with a hospital in order to operate.

Question 74

The UB-04 claim form is required by all private payers and is accepted by the Centers for Medicare and Medicaid Services (CMS).

Question 75

The provider who supplies the reported service or performs the reported procedure is known as the __________ physician.

Question 76

In urgent care situations, there is no risk of the patient losing life or limb.

Question 77

In determining payment for hospital services, diagnoses and treatments are categorized into groups called __________ Groups.

Question 78

The computerized comprehensive list of codes for all services and items provided to hospital patients is known as the __________ .

Question 79

For Medicare services, the type of bill code in form locator 4 must include four digits.

Question 80

A condition code would be used to describe a situation in which neither the patient nor the spouse is employed.