Bell Ringer Review Ch 1-5

Question 1

Which qualifier under HIPAA limits the amount of PHI shared to only that needed to accomplish the intended purpose of the use of disclosure?

Answer 1

Minimum Necessary

Question 2

How can HIM professionals use predictive analytics to better manage the revenue cycle?

Answer 2

to correct issues that impact revenue before they occur

Question 3

What is the first step of the life cycle of a payment claim?

Answer 3

the patient checks in at front desk

Question 4

Which of the following will happen when a claim goes under the adjudication process?

Answer 4

the claim is compared to the health plan benefits

Question 5

Which of the following is part of the physical safeguards identified under the HIPAA Security Rule that helps to protect health information?

Answer 5

workstation and security devices

Question 6

What is the purpose of a DNFB report?

Answer 6

to monitor the billing process for discharged patients

Question 7

When the Centers for Medicare and Medicaid Services (CMS) makes a payment using the Prospective Payment System, what is the Medicare payment based on?

Answer 7

a predetermined, fixed amount

Question 8

Which of the following is used by Medicare to make payments to providers based on a predetermined, fixed amount?

Answer 8

a Prospective Payment System

Question 9

Why are human logic and intelligent decision-making in medical coding important?

Answer 9

procedures can be referenced in different terms

Question 10

What is the goal of the case management programs and other collaborative processes used by caregivers?

Answer 10

appropriate use of acute care resources

Question 11

How are most health care insurance plans in the United States managed?

Answer 11

through managed care organizations (MCOs)

Question 12

As a non-income-producing department, what role does the health information management department have in the revenue cycle?

Answer 12

ensures claims are accurate and complete

Question 13

In accounts receivable, when is revenue recorded?

Answer 13

when it is earned

Question 14

Which of the following best describes accounts receivable?

Answer 14

claims where payment has not yet been made

Question 15

Which of the following represents the time frame during which a bill is awaiting late charges, diagnosis codes, or other required information?

Answer 15

bill-hold period

Question 16

Which of the following represents a charge?
revenues
expenses
reimbursements
operational fees

Answer 16

revenues

Question 17

In managerial accounting, how do department managers determine the resources their departments are using?

Answer 17

direct costs

Question 18

How are department budgets used in an organization?

Answer 18

to forecast revenue and expenses

Question 19

Why do some patients receive an Advanced Beneficiary Notice (ABN) as one of the first financial communication documents shared with them?

Answer 19

to explain what may not be covered by insurance

Question 20

Where would a health care provider find information on adjustments made by Medicare, secondary health plans, and expected copays and coinsurance of a patient?

Answer 20

in the Remittance Advice

Question 21

What is the name of the inpatient prospective payment rule, and in what setting does it apply?

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The rule identifies qualifying factors in cases where a patient was admitted as an inpatient, and it was later found, after review, that the case should have been outpatient; services can then be billed as outpatient.

Answer 21

condition code 44. acute care hospital

Question 22

Which prospective payment system rule or provision was applied in the following case?

A patient was discharged from an inpatient psychiatric facility on Sunday, then readmitted to another inpatient psychiatric facility on the Tuesday following his discharge from the original facility. This was considered one continuous stay for the purposes of payment.

Answer 22

interrupted stay

Question 23

In the assignment of diagnoses to DRGs, if one age group in a DRG tends to use more resources than another, then the DRG is split according to what variable?

Answer 23

age

Question 24

What is the appropriate term for groups of Medicare Severity Diagnosis-Related Groups (MS-DRGs) with the same set of principal diagnoses, classified as with or without operating room procedures, then divided by severity of illness levels?

Answer 24

MS-DRG families

Question 25

How are patient diagnoses identified in the Major Diagnostic Categories (MDCs) within the DRG system?

Answer 25

by ICD-10-CM diagnosis codes

Question 26

A patient’s secondary diagnosis within an MS-DRG within a Major Diagnostic Category (MDC) requires which of the following during the inpatient hospital stay?

Answer 26

clinical evaulation and therapeutic treatment

Question 27

Consider this Inpatient Prospective Payment System (IPPS) transfer rule payment policy: Two facilities share the MS-DRG total payment for care of a transferred patient. To which of the patient transfer scenarios does this payment policy apply?

Answer 27

a patient is transferred from one acute inpatient hospital to a different acute inpatient hospital to complete care

Question 28

In the process of assigning a case to an MS-DRG, what is placed into one of 25 Major Diagnostic Categories (MDCs) by matching the ICD-10-CM code?

Answer 28

principal diagnosis

Question 29

In the All-Patient Refined Diagnosis-Related Groups (APR-DRG) system, a patient case is grouped based on which of the following?

Answer 29

severity of illness subclass and/or risk of mortality subclass

Question 30

Which of these variables impacting MS-DRG assignment describes a secondary condition that, along with a principal diagnosis, causes a statistical increase in the length of stay of at least one day in at least 75 percent of patients with the same principal diagnosis?

Answer 30

complication or comorbidity (CC)

Question 31

Which of the following states that the median cost of the most expensive item or service cannot be more than double the median cost of the least expensive item within the same group?

Answer 31

the two times rule

Question 32

What does it mean when a relative payment weight is higher than 1.000?

Answer 32

more resources needed to treat patient

Question 33

When would an ambulatory surgical center be used by a patient or care provider?

Answer 33

when hospitalization is not required

Question 34

When is bundling most likely to occur when calculating payments under APCs?

Answer 34

when predetermined services are performed together

Question 35

Why is it important to assign the correct APCs when a patient receives multiple services on the same day?

Answer 35

APCs have varying reimbursement amounts

Question 36

Which of the following is the standardized coding system used to identify procedures and submit claims to Medicare?

Answer 36

HCPCS

Question 37

When services with a status indicator are performed, what typically happens to the associated ancillary items used during that service?

Answer 37

they are packaged into the payment

Question 38

Which of the following would be reimbursed under the HCPCS Level I code set?

Answer 38

lab work

Question 39

What was the goal of the Outpatient Prospective Payment System (OPPS) when it was implemented?

Answer 39

to shift financial risk to hospitals

Question 40

Under the Home Health Prospective Payment System (HHPPS), what is the basis for measuring patient outcomes in a quality improvement report?

Answer 40

OASIS