Billing

Question 1

How many MS DRG’s can a patient have?

Answer 1

One

Question 2

What does payment status indicator N mean?

Answer 2

The payment is packaged into the payment for other services

Question 3

True or false, anesthesia is packed under OPPS

Answer 3

False

Question 4

True or false, medical visits are exempt from packaging under OPPS payments

Answer 4

True

Question 5

True or false, HIPPA administrative simplification provisions require the use of DSM codes

Answer 5

False

Question 6

Which PPS reimburses physicians for outpatient surgery?

Answer 6

ASC m

Question 7

What Occurs when the MS-DRG payment is lower than the actual dots of providing inpatient services?

Answer 7

The hospital absorbs the loss

Question 8

How is a case mix index calculated? (CMI)

Answer 8

Sum of CMS relative value weight for all MS-DRG/total # of patients

Question 9

How long does HIPPA require retention of insurance claims and accounting records?

Answer 9

Six years, unless stated as longer by state

Question 10

Which law prohibits physicians from referring patients to lab or Doctor who is a family member or where they have a financial interest?

Answer 10

The stark I

Question 11

When a patient is discharged from inpt rehab then returns within three days (prior to midnight the third day) what is it called?

Answer 11

Interrupted stay

Question 12

Which type of hospital is excluded from the IP PS payment system when it applies for a waiver?

Answer 12

Cancer hospitals

Question 13

What type of code is used to identify procedures, services, or supplies?

Answer 13

HCPCS

Question 14

What information is used to assign each item to particular section of the general ledger in a facilities accounting system?

Answer 14

The general ledger key

Question 15

Currently what is Medicare’s limiting charge?

Answer 15

15%

Question 16

If a nonparticipating physician does not except assignment and the non-par allowed amount is $190, how much can the patient from Medicare

Answer 16

$218.50 , $190 plus the 15% limiting charge

Question 17

What is most common way of communicating with the position and complete documentation?

Answer 17

physician query forms

Question 18

What does payment status indicator X mean

Answer 18

Ancillary services

Question 19

What does payment status indicator V mean

Answer 19

Clinic or emergency department visits ( medical visits )and

Question 20

What does payment status indicator C mean?

Answer 20

Inpatient procedures/services

Question 21

True or false: hospitals will not receive additional payment for hospital acquired conditions when they’re not present on admission

Answer 21

True

Question 22

Which Medicare benefit, a BC or D allows for lifetime reserve days?

Answer 22

Part A

Question 23

How many lifetime reserved days does each patient get

Answer 23

60

Question 24

What are lifetime reserve days usually reserved for?

Answer 24

The patients final or terminal hospital stay

Question 25

The patient assessment instrument which classifies patients into the CMG or case mix groups is utilized in which type of facility?

Answer 25

Inpatient rehabilitation

Question 26

HAVEN is used by what type of service?

Answer 26

Home health agencies

Question 27

What is Haven?

Answer 27

Free software developed by CMS for data entry by home health agencies

Question 28

If the fee schedule amount is (par) is $60, how much is collected from Medicare?

Answer 28

$48, 80%

Question 29

If the fee schedule amount is (par) is $60, how much is collected from the patient?

Answer 29

$12 or 20%

Question 30

OK providers found guilty under any civil claims statute are placed under what by the Inspector General?

Answer 30

Corporate integrity agreement

Question 31

In calculating the fee for physicians reimbursement the three RVU units are each multiplied by what?

Answer 31

Geographic practice cost indices

Question 32

Describe episode of care reimbursement methods

Answer 32

When a lump sum payment is issued to a provider to compensate them for a healthcare services delivered to be patient for specific illness and/or over specific period of time

Question 33

What is incident to billing?

Answer 33

When a nonphysician practitioner provide subsequent services to a patient under the direct supervision of a physician

Question 34

Name two services that use the HIPPS codes

Answer 34

Home health agencies and inpatient rehabilitation

Question 35

Patient admitted with a symptom which is later given a final diagnosis would this be considered present on admission?

Answer 35

Yes

Question 36

Patient develops a atrial fibrillation in the emergency room and he subsequently admitted, is this present on admission?

Answer 36

Yes

Question 37

True or false pulmonary embolism developed postoperatively during the inpatient admission is considered present on admission

Answer 37

False,The patient had already been admitted when the pulmonary embolus him occurred

Question 38

True or false Pressure ulcers discovered four days into the patient inpatient stay,currently unstageable. No documentation was indicated prior to the fourth day, POA indicator IS u

Answer 38

True documentation is insufficient to determine if condition was present at the time of admission

Question 39

True or false | Pelee indicators are required for all principal and secondary diagnoses

Answer 39

True

Question 40

True or false POA indicators are required for all payer claims

Answer 40

False only Medicare inpatient admission

Question 41

What is the newest prospective payment system

Answer 41

Inpatient psychiatric

Question 42

Who can opt to receive hospice services?

Answer 42

Terminally ill patients with six months or less

Question 43

Which of the following conditions would be considered a hospital acquired condition Air embolism, stage one pressure ulcer, to Trumatic wound infection, breach birth

Answer 43

Air embolism

Question 44

Why would or in transplantation not be covered by OPP S?

Answer 44

Because Organ transplantation occurs in an inpatient setting

Question 45

If clear based group health insurers are part of which insurance category

Answer 45

Commercial payers

Question 46

What system classifies inpatient hospital cases into groups that are expected to consume similar hospital resources?

Answer 46

DRG

Question 47

What system classifies the non-Medicare population such as HIV patients, neonates, and pediatric patients for payment purposes?

Answer 47

APR – DRG

Question 48

What is stated in the oasis rule?

Answer 48

hospitals are to be paid he graduated per diem rate for each day of the patients day, not to exceed the PPS DRG rate

Question 49

The APC payment system is based on what coding system?

Answer 49

CPT and HCPCS

Question 50

Name the three code subdivisions of myocardial infarction

Answer 50

Timing, ECG findings of ST elevation, wall of the heart infarcted

Question 51

When coding an acute myocardial infarction,What are the two types of ECG findings regarding ST elevation?

Answer 51

STEMI, ST elevation or NSTEMI, no ST elevation MI or unable to determine

Question 52

Name the three walls of the heart which can be infarcted

Answer 52

Anterior, inferior, other