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A Fordney 16
| Question | Answer |
|---|---|
| Confidential information about patients should never be discussed with | Coworkers, family, or friends |
| When criteria are used by the review agency for admission screening, this is referred to as | AEPs |
| One criterion that needs to be met to certify severity of illness (SI) in an admission is | active, uncontrolled bleeding |
| One criterion that needs to be met for intensity of service (IS) in an admission is | administration and monitoring of intravenous medications |
| A patient is considered an inpatient to the hospital on admission | for an overnight stay |
| When a patient is admitted who has a managed care contract for an emergency to a hospital, the managed care program needs to be notified within | 48 hours |
| The rule stating that when a patient recives outpatient services within 72 house of admission, then all outpatient services are combined with inpatient services and become part of the diagnostic-related group rate for admission, is called the | 72-hour rule |
| What organization is responsible for admission review, readmission review, procedure review, day and cost outlier review, DRG validation, and transfer review | PRO |
| Readmission review occurs if the patient is readmitted within | 7 days of discharge |
| A review for additional Medicare reimbursement is called | day outlier review |
| The significant reason for which a patient is admitted to the hospital is coded using the | princial diagnosis |
| Classifications of surgical and nonsurgical procedures and miscellaneous therapeutic and diagnostic procedures are found in | ICD-9-CM volume 3 |
| ICD-9-CM procedure codes contain | at least two digits, and two to four digits |
| The code book used to list procedures on outpatient hospital claims is | CPT |
| The person who interviews the patient and obtains personal and insurance information and the admitting diagnosis is a/an | admitting clerk |
| Daily progress notes are entered on the patient's medical record by a | nurse |
| The claim form sent to the insurance carrier for reimbursement for inpatient hospital services is called the | UB-92 |
| The form that accompanies the billing claim form for inpatient hospital services is called a | detailed statement |
| The hospital insurance claim form must always be reviewed by the | insurance billing editor |
| Professional services billed by the physician include | hospital consultations, hospital visits and emergency department visits |
| If a patient is being admitted to a hospital and refuses all preadmission testing but a bill is sent to the insurance carrier for these services anyway, this is called | double billing |
| A tentative DRG is based on | admission diagnosis, scheduled procedures, age, and secondary diagnosis |
| How many major diagnostic categories (MDCs) are there in the DRG-based system | 25 |
| On the UB-92 claim form, code 6 (transfer from another health care facility) in block 20 is used to indicate | source of admission |
| The claim form used for outpatient hospital services is the | UB-92 claim form |
| PAT is an abbreviation for | preadmission testing |
| The hospital department that conducts an admission and concurrent review on all cases and prepares a discharge plan to determine whether admissions are justified is called the __ department | utilization review |
| The ___ coding system is used to list procedural codes for Medicare patients on hospital insurance claims that are not in the CPT book | Healthcare Common Procedure |
| The ___ is the clinical resume for final progress note | discharge summary |
| The Uniform Bill claim form is considered a ___ statement | summary |
| Medicare provides stop loss called ___ in its regulations | outliers |
| The abbreviation of the phrase that indicates when claims are submitted electronically is | EDI electronic data interchange |
| On the UB-92 claim form, the first digit of the three-digit bill code in block 4 indicates the type of ____ | facility |
| On the UB-92 claim forn, the number of inpatient days is indicated in block 7; these are referred to as ___ days | covered |
| On the UB-92 claim form, 15:53 listed as the hour of admission indicates that the patient was admitted at | 3:53 pm |
| A three- or four-digit code corresponding to each narrative description or standard abbreviation that identifies a specific accommodation, ancillary service, or billing calculation related to services billed is called a ___ code | revenue |
| The DRG-based system changed hospital reimbursement from a fee-for-service system to a lump-sum, fixed-fee payment based on the ___ rather than on time or services rendered | diagnosis |
| Cases that cannot be assigned an appropriate DRG because of atypical situations are called ___ | cost outliers |
| An unethical pratice of upcoding a patient's DRG category for a more severe diagnosis to increase reimbursement is called ___ | DRG creep |
| ___ is a preexisting condition that will, because of its effect on the specific principal diagnosis, require more intensive therapy or cause an increase in length of stay by at least 1 day in approximately 75% of cases | comorbidity |
Created by:
leemiller
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