Bell Ringer Review Ch 1-5 Flashcards
Which qualifier under HIPAA limits the amount of PHI shared to only that needed to accomplish the intended purpose of the use of disclosure?
Minimum Necessary
How can HIM professionals use predictive analytics to better manage the revenue cycle?
to correct issues that impact revenue before they occur
What is the first step of the life cycle of a payment claim?
the patient checks in at front desk
Which of the following will happen when a claim goes under the adjudication process?
the claim is compared to the health plan benefits
Which of the following is part of the physical safeguards identified under the HIPAA Security Rule that helps to protect health information?
workstation and security devices
What is the purpose of a DNFB report?
to monitor the billing process for discharged patients
When the Centers for Medicare and Medicaid Services (CMS) makes a payment using the Prospective Payment System, what is the Medicare payment based on?
a predetermined, fixed amount
Which of the following is used by Medicare to make payments to providers based on a predetermined, fixed amount?
a Prospective Payment System
Why are human logic and intelligent decision-making in medical coding important?
procedures can be referenced in different terms
What is the goal of the case management programs and other collaborative processes used by caregivers?
appropriate use of acute care resources
How are most health care insurance plans in the United States managed?
through managed care organizations (MCOs)
As a non-income-producing department, what role does the health information management department have in the revenue cycle?
ensures claims are accurate and complete
In accounts receivable, when is revenue recorded?
when it is earned
Which of the following best describes accounts receivable?
claims where payment has not yet been made
Which of the following represents the time frame during which a bill is awaiting late charges, diagnosis codes, or other required information?
bill-hold period
Which of the following represents a charge?
revenues
expenses
reimbursements
operational fees
revenues
In managerial accounting, how do department managers determine the resources their departments are using?
direct costs
How are department budgets used in an organization?
to forecast revenue and expenses
Why do some patients receive an Advanced Beneficiary Notice (ABN) as one of the first financial communication documents shared with them?
to explain what may not be covered by insurance
Where would a health care provider find information on adjustments made by Medicare, secondary health plans, and expected copays and coinsurance of a patient?
in the Remittance Advice
What is the name of the inpatient prospective payment rule, and in what setting does it apply?
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.
condition code 44. acute care hospital
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.
interrupted stay
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?
age
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?
MS-DRG families
How are patient diagnoses identified in the Major Diagnostic Categories (MDCs) within the DRG system?
by ICD-10-CM diagnosis codes
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?
clinical evaulation and therapeutic treatment
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?
a patient is transferred from one acute inpatient hospital to a different acute inpatient hospital to complete care
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?
principal diagnosis
In the All-Patient Refined Diagnosis-Related Groups (APR-DRG) system, a patient case is grouped based on which of the following?
severity of illness subclass and/or risk of mortality subclass
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?
complication or comorbidity (CC)
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?
the two times rule
What does it mean when a relative payment weight is higher than 1.000?
more resources needed to treat patient
When would an ambulatory surgical center be used by a patient or care provider?
when hospitalization is not required
When is bundling most likely to occur when calculating payments under APCs?
when predetermined services are performed together
Why is it important to assign the correct APCs when a patient receives multiple services on the same day?
APCs have varying reimbursement amounts
Which of the following is the standardized coding system used to identify procedures and submit claims to Medicare?
HCPCS
When services with a status indicator are performed, what typically happens to the associated ancillary items used during that service?
they are packaged into the payment
Which of the following would be reimbursed under the HCPCS Level I code set?
lab work
What was the goal of the Outpatient Prospective Payment System (OPPS) when it was implemented?
to shift financial risk to hospitals
Under the Home Health Prospective Payment System (HHPPS), what is the basis for measuring patient outcomes in a quality improvement report?
OASIS
