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20 Cards in this Set
- Front
- Back
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Dr. Mendez is receiving reimbursement based on actual charges after the patient has been treated. She's reimbursed on a/an _____ system. A. usual, customary, and reasonable charges B. retrospective fee for service payment C. prospective payment D. Indemnity |
B. retrospective fee for service payment |
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Which of the following statements is true of major complicating conditions (MCCs)? A. They decrease the reimbursements for DRGs B. They maximize the reimbursement for DRGs. C. They never change the reimbursement for DRGs. D. They often change the reimbursement for DRGs. |
D. They often change the reimbursement for DRGs.
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DRGs are grouped into: A. 1 of 25 Major Diagnostic Categories (MDC) B. 3 of 18 Current Procedural Groups (CPG) C. 2 of 25 Major Reimbursement Categories (MRC) D. 5 of 35 Relative Value Reimbursement Categories (RVRC) |
A. 1 of 25 Major Diagnostic Categories (MDC)
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What is the purpose of the explanation of benefits? A. To summarize the physician payment indicators. B. To provide the results of the claim that was processed. C. To outline the benefits provided by physician groups. D. To list the payee elements of third party providers. |
B. To provide the results of the claim that was processed.
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Which of the following is a reason that an insurance claim may be denied? A. Claim resubmitted with additional info. B. Lack of available funds. C. Excessive length of hospital stay. D. Middle initial missing from form. |
C. Excessive length of hospital stay. |
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The process of assigning codes to certain pieces of information in the medical record is called: A. medical coding B. medical fee abstraction C. code correction D. OASIS |
A. medical coding
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When calculating expenses, what differs for each health care facility? A. ICD-9-CM diagnosis codes B. Base rate C. MS-DRG relative weight D. The codes that are MCCs |
B. Base rate
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The CMS published the relative value units (RVU) as a part of the: A. Annual Coding Clinic B. Medicare fee schedule C. Ambulatory fee schedule D. Federal Coding and Reimbursement Registry |
B. Medicare fee schedule
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Inpatient rehabilitation facilities (IRF) provide: A. inpatient holistic treatments B. services for drug rehabilitation C. measurements for patient rehabilitation studies D health care services with a concentration of patient rehabilitation |
D. Health care services with a concentration on patient rehabilitation
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What is needed to determine a facilitys CMI (case mix index)? A. the hospital base rate and DRG relative weight B. The relative weight, sum of all discharges, and hospital base rate C. The sum total of all DRG weights and sum of all discharges D. The relative weight of a specific DRG and total discharges for that DRG |
C. The sum total of all DRG weights and sum of all discharges
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Comorbidities and complications are referred to as _____ diagnoses. A. secondary B. principal C. primary D. ancillary |
A. Secondary
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OASIS is important in home health care because it: A. allows coders to estimate reimbursement for physician services. B. helps foster and monitor improved home health care outcomes. C. helps administrators calculate costs for inpatient treatment. D. allows coders to determine the correct case mix for physician reimbursement |
B. helps foster and monitor improved home health outcomes
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Code 428.0 for congestive heart failure is an example of a/an _____ code. A. ICD-9-CM diagnosis B. HCPCS C. RBRVS D. CPT |
A. ICD-9-CM diagnosis
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Which statement is true of a skilled nursing facility (SNF)? A. OPPS guidelines are generally used to pay for SNF care. B. SNFs are generally needed for just a short period of time after hospitalization. C. SNFs are never reimbursed under a third party payer. D, SNFs are essentially the same as a hospital emergency room. |
B. SNFs are generally needed for just a short period of time after hospitalization
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What does the acronym MS-DRG stand for? A. Medicaid Severe Diagonal Relevance Group B. Medicare Severity Diagnosis Related Group C. Medicare Severe Diagnostic Relevant Group D. Medicaid Severity Diagnostic Related Group |
B. Medicare Severity Diagnosis Related Group
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Dr. Smiths medical office group and the hospital in which the doctor is affiliated are both examples of: A. providers B. suppliers C. payers D. resources |
A. providers
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Patty just had her appendix removed. The appendix removal appears on the claim form as a _____ code. A. diagnosis B. provider C. procedure D. payer |
C. procedure
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ICD-9-CM procedure codes are: A. used mainly for outpatient facilities B. listen in alphabetical order C. assigned in numerical sequence D. used mainly for inpatient settings |
D. used mainly for inpatient settings
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Your grandmother has a question about her Medicare reimbursement but its 10:30 PM. What organization will answer her questions at this time of night? A. CMS - Center for Medicare and Medicaid Services B. OIG - Office of Inspector General C. SCHIP - State Childrens Health Insurance Program D. HCPCS - HCFA Common Procedure Coding System |
A. CMS - Center for Medicare and Medicaid Services
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Which statement about the RBRVS (resource-based relative value scale) system is true? A. RBRVS is based on the case mix of the hospital B. the RBRVS system is used only with Medicare patients C. RBRVS is calculated by hand D. RBRVS is based on the resources used when treating patients |
D. RBRVS is based on the resources used when treating patients |
