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.

Accepted Answer

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.

Accepted Answer

The DRG system is a prospective payment system, meaning that healthcare providers are paid a fixed amount for treating a patient with a specific diagnosis, regardless of the actual cost of the care provided. This system was implemented to control healthcare costs and incentivize more efficient and effective care.

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.

Accepted Answer

Most major diagnostic categories are based on a particular organ system, such as the nervous system or respiratory system. This helps to categorize and group together similar types of diagnoses, which can inform treatment plans and healthcare decision-making.

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.

Accepted Answer

The answer of A case that cannot be assigned an...

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.

Accepted Answer

Per diem is the method of reimbursement that pays hospitals a fixed rate per day for all services provided.

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.

Accepted Answer

A patient control number (PCN) is assigned to a patient at the time of admission to the hospital. This number is used to identify the patient throughout their stay and is also used for billing and record-keeping purposes.

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.

Accepted Answer

The answer of Services covered under the Ambulatory Payment Classification...

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.

Accepted Answer

The answer of The list of Ambulatory Payment Classification (APC)...

Question 9

The majority of hospital reimbursement comes from:
A)bank loans.
B)insurance companies.
C)patients.
D)private donations.

Accepted Answer

The majority of hospital reimbursement comes from insurance companies. This is through payments made by patients' insurance plans for medical services received at the hospital. While patients themselves may also contribute to hospital reimbursement through co-pays and deductibles, insurance companies are the primary source of revenue for hospitals. Bank loans and private donations may also provide additional funding, but they are not the main sources of reimbursement for hospitals.

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.

Accepted Answer

The answer of Reimbursement methods for inpatient hospital services include...

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

Accepted Answer

The term used for collecting a patient's personal information and entering it into the hospital's database is registration.

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.

Accepted Answer

A facility's case mix is not based on discharge status but rather on severity of illness, treatment difficulty, and 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.

Accepted Answer

The answer of The UB-04 claim form allows for a...

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.

Accepted Answer

A charge description master (CDM) is a comprehensive listing of items that could possibly be charged to a patient or a patient's insurance carrier. The CDM includes procedure codes, procedure or service descriptions, and charges for each item. However, it does not include physician identification numbers.

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.

Accepted Answer

The answer of Software that is used to calculate the...

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.

Accepted Answer

OPPS stands for Outpatient Prospective Payment System. This is a payment system used by Medicare to reimburse hospital outpatient services. The payment is based on a predetermined rate that takes into account the type of service provided, the location of the hospital, and other factors.

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.

Accepted Answer

Prospective payment system (PPS) establishes the rate of payment to a hospital based on a predetermined amount for a specific diagnosis or procedure, regardless of the actual cost of providing the service. This method of reimbursement is used by Medicare and other payers to control healthcare costs and encourage efficiency in healthcare delivery. Capitation (A) involves paying a fixed amount per patient per month to a healthcare provider, regardless of the services provided. Fee for service (B) involves paying for each service or procedure performed, which can create incentives for healthcare providers to over-treat or provide unnecessary services. Per diem (C) involves paying a fixed rate per day for hospital services, which can also create incentives for providers to over-treat or keep patients in the hospital longer than necessary.

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.

Accepted Answer

The attending physician is the physician who is primarily responsible for a patient's care while in the hospital. The admitting physician is the physician who admits the patient to the hospital but may not necessarily be involved in the patient's care while in the hospital. The rendering physician is the physician who performs a service or procedure for the patient, but may not necessarily be the primary physician responsible for the patient's care. The primary care physician is the physician who provides primary care services for a patient in an outpatient setting.

Question 19

The Ambulatory Payment Classification (APC) system bases payments on:
A)usual fees.
B)procedures.
C)diagnoses.
D)number of days.

Accepted Answer

The APC system bases payments on procedures, not on usual fees, diagnoses, or 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.

Accepted Answer

The answer of A hospital will bill for patient services:
A)at...

Quiz 12: Hospital Medical Billing

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.

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.

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.

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.

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.

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.

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.

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.

The majority of hospital reimbursement comes from: A)bank loans. B)insurance companies. C)patients. D)private donations.

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.

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

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.

The UB-04 claim form allows for a maximum of: A)4 diagnoses. B)6 diagnoses. C)8 diagnoses. D)10 diagnoses.

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.

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.

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.

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.

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.

The Ambulatory Payment Classification (APC) system bases payments on: A)usual fees. B)procedures. C)diagnoses. D)number of days.

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.