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CCS-P > Billing > Flashcards

Billing Flashcards

1
Q

How many MS DRG’s can a patient have?

A

One

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2
Q

What does payment status indicator N mean?

A

The payment is packaged into the payment for other services

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3
Q

True or false, anesthesia is packed under OPPS

A

False

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4
Q

True or false, medical visits are exempt from packaging under OPPS payments

A

True

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5
Q

True or false, HIPPA administrative simplification provisions require the use of DSM codes

A

False

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6
Q

Which PPS reimburses physicians for outpatient surgery?

A

ASC m

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7
Q

What Occurs when the MS-DRG payment is lower than the actual dots of providing inpatient services?

A

The hospital absorbs the loss

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8
Q

How is a case mix index calculated? (CMI)

A

Sum of CMS relative value weight for all MS-DRG/total # of patients

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9
Q

How long does HIPPA require retention of insurance claims and accounting records?

A

Six years, unless stated as longer by state

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10
Q

Which law prohibits physicians from referring patients to lab or Doctor who is a family member or where they have a financial interest?

A

The stark I

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11
Q

When a patient is discharged from inpt rehab then returns within three days (prior to midnight the third day) what is it called?

A

Interrupted stay

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12
Q

Which type of hospital is excluded from the IP PS payment system when it applies for a waiver?

A

Cancer hospitals

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13
Q

What type of code is used to identify procedures, services, or supplies?

A

HCPCS

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14
Q

What information is used to assign each item to particular section of the general ledger in a facilities accounting system?

A

The general ledger key

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15
Q

Currently what is Medicare’s limiting charge?

A

15%

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16
Q

If a nonparticipating physician does not except assignment and the non-par allowed amount is $190, how much can the patient from Medicare

A

$218.50 , $190 plus the 15% limiting charge

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17
Q

What is most common way of communicating with the position and complete documentation?

A

physician query forms

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18
Q

What does payment status indicator X mean

A

Ancillary services

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19
Q

What does payment status indicator V mean

A

Clinic or emergency department visits ( medical visits )and

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20
Q

What does payment status indicator C mean?

A

Inpatient procedures/services

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21
Q

True or false: hospitals will not receive additional payment for hospital acquired conditions when they’re not present on admission

A

True

22
Q

Which Medicare benefit, a BC or D allows for lifetime reserve days?

A

Part A

23
Q

How many lifetime reserved days does each patient get

A

60

24
Q

What are lifetime reserve days usually reserved for?

A

The patients final or terminal hospital stay

25
Q

The patient assessment instrument which classifies patients into the CMG or case mix groups is utilized in which type of facility?

A

Inpatient rehabilitation

26
Q

HAVEN is used by what type of service?

A

Home health agencies

27
Q

What is Haven?

A

Free software developed by CMS for data entry by home health agencies

28
Q

If the fee schedule amount is (par) is $60, how much is collected from Medicare?

A

$48, 80%

29
Q

If the fee schedule amount is (par) is $60, how much is collected from the patient?

A

$12 or 20%

30
Q

OK providers found guilty under any civil claims statute are placed under what by the Inspector General?

A

Corporate integrity agreement

31
Q

In calculating the fee for physicians reimbursement the three RVU units are each multiplied by what?

A

Geographic practice cost indices

32
Q

Describe episode of care reimbursement methods

A

When a lump sum payment is issued to a provider to compensate them for a healthcare services delivered to be patient for specific illness and/or over specific period of time

33
Q

What is incident to billing?

A

When a nonphysician practitioner provide subsequent services to a patient under the direct supervision of a physician

34
Q

Name two services that use the HIPPS codes

A

Home health agencies and inpatient rehabilitation

35
Q

Patient admitted with a symptom which is later given a final diagnosis would this be considered present on admission?

A

Yes

36
Q

Patient develops a atrial fibrillation in the emergency room and he subsequently admitted, is this present on admission?

A

Yes

37
Q

True or false pulmonary embolism developed postoperatively during the inpatient admission is considered present on admission

A

False,The patient had already been admitted when the pulmonary embolus him occurred

38
Q

True or false
Pressure ulcers discovered four days into the patient inpatient stay,currently unstageable. No documentation was indicated prior to the fourth day, POA indicator IS u

A

True documentation is insufficient to determine if condition was present at the time of admission

39
Q

True or false

Pelee indicators are required for all principal and secondary diagnoses

A

True

40
Q

True or false POA indicators are required for all payer claims

A

False only Medicare inpatient admission

41
Q

What is the newest prospective payment system

A

Inpatient psychiatric

42
Q

Who can opt to receive hospice services?

A

Terminally ill patients with six months or less

43
Q

Which of the following conditions would be considered a hospital acquired condition

Air embolism, stage one pressure ulcer, to Trumatic wound infection, breach birth

A

Air embolism

44
Q

Why would or in transplantation not be covered by OPP S?

A

Because Organ transplantation occurs in an inpatient setting

45
Q

If clear based group health insurers are part of which insurance category

A

Commercial payers

46
Q

What system classifies inpatient hospital cases into groups that are expected to consume similar hospital resources?

A

DRG

47
Q

What system classifies the non-Medicare population such as HIV patients, neonates, and pediatric patients for payment purposes?

A

APR – DRG

48
Q

What is stated in the oasis rule?

A

hospitals are to be paid he graduated per diem rate for each day of the patients day, not to exceed the PPS DRG rate

49
Q

The APC payment system is based on what coding system?

A

CPT and HCPCS

50
Q

Name the three code subdivisions of myocardial infarction

A

Timing, ECG findings of ST elevation, wall of the heart infarcted

51
Q

When coding an acute myocardial infarction,What are the two types of ECG findings regarding ST elevation?

A

STEMI, ST elevation or NSTEMI, no ST elevation MI or unable to determine

52
Q

Name the three walls of the heart which can be infarcted

A

Anterior, inferior, other

CCS-P (7 decks)

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