Billing Flashcards
How many MS DRG’s can a patient have?
One
What does payment status indicator N mean?
The payment is packaged into the payment for other services
True or false, anesthesia is packed under OPPS
False
True or false, medical visits are exempt from packaging under OPPS payments
True
True or false, HIPPA administrative simplification provisions require the use of DSM codes
False
Which PPS reimburses physicians for outpatient surgery?
ASC m
What Occurs when the MS-DRG payment is lower than the actual dots of providing inpatient services?
The hospital absorbs the loss
How is a case mix index calculated? (CMI)
Sum of CMS relative value weight for all MS-DRG/total # of patients
How long does HIPPA require retention of insurance claims and accounting records?
Six years, unless stated as longer by state
Which law prohibits physicians from referring patients to lab or Doctor who is a family member or where they have a financial interest?
The stark I
When a patient is discharged from inpt rehab then returns within three days (prior to midnight the third day) what is it called?
Interrupted stay
Which type of hospital is excluded from the IP PS payment system when it applies for a waiver?
Cancer hospitals
What type of code is used to identify procedures, services, or supplies?
HCPCS
What information is used to assign each item to particular section of the general ledger in a facilities accounting system?
The general ledger key
Currently what is Medicare’s limiting charge?
15%
If a nonparticipating physician does not except assignment and the non-par allowed amount is $190, how much can the patient from Medicare
$218.50 , $190 plus the 15% limiting charge
What is most common way of communicating with the position and complete documentation?
physician query forms
What does payment status indicator X mean
Ancillary services
What does payment status indicator V mean
Clinic or emergency department visits ( medical visits )and
What does payment status indicator C mean?
Inpatient procedures/services
True or false: hospitals will not receive additional payment for hospital acquired conditions when they’re not present on admission
True
Which Medicare benefit, a BC or D allows for lifetime reserve days?
Part A
How many lifetime reserved days does each patient get
60
What are lifetime reserve days usually reserved for?
The patients final or terminal hospital stay
The patient assessment instrument which classifies patients into the CMG or case mix groups is utilized in which type of facility?
Inpatient rehabilitation
HAVEN is used by what type of service?
Home health agencies
What is Haven?
Free software developed by CMS for data entry by home health agencies
If the fee schedule amount is (par) is $60, how much is collected from Medicare?
$48, 80%
If the fee schedule amount is (par) is $60, how much is collected from the patient?
$12 or 20%
OK providers found guilty under any civil claims statute are placed under what by the Inspector General?
Corporate integrity agreement
In calculating the fee for physicians reimbursement the three RVU units are each multiplied by what?
Geographic practice cost indices
Describe episode of care reimbursement methods
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
What is incident to billing?
When a nonphysician practitioner provide subsequent services to a patient under the direct supervision of a physician
Name two services that use the HIPPS codes
Home health agencies and inpatient rehabilitation
Patient admitted with a symptom which is later given a final diagnosis would this be considered present on admission?
Yes
Patient develops a atrial fibrillation in the emergency room and he subsequently admitted, is this present on admission?
Yes
True or false pulmonary embolism developed postoperatively during the inpatient admission is considered present on admission
False,The patient had already been admitted when the pulmonary embolus him occurred
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
True documentation is insufficient to determine if condition was present at the time of admission
True or false
Pelee indicators are required for all principal and secondary diagnoses
True
True or false POA indicators are required for all payer claims
False only Medicare inpatient admission
What is the newest prospective payment system
Inpatient psychiatric
Who can opt to receive hospice services?
Terminally ill patients with six months or less
Which of the following conditions would be considered a hospital acquired condition
Air embolism, stage one pressure ulcer, to Trumatic wound infection, breach birth
Air embolism
Why would or in transplantation not be covered by OPP S?
Because Organ transplantation occurs in an inpatient setting
If clear based group health insurers are part of which insurance category
Commercial payers
What system classifies inpatient hospital cases into groups that are expected to consume similar hospital resources?
DRG
What system classifies the non-Medicare population such as HIV patients, neonates, and pediatric patients for payment purposes?
APR – DRG
What is stated in the oasis rule?
hospitals are to be paid he graduated per diem rate for each day of the patients day, not to exceed the PPS DRG rate
The APC payment system is based on what coding system?
CPT and HCPCS
Name the three code subdivisions of myocardial infarction
Timing, ECG findings of ST elevation, wall of the heart infarcted
When coding an acute myocardial infarction,What are the two types of ECG findings regarding ST elevation?
STEMI, ST elevation or NSTEMI, no ST elevation MI or unable to determine
Name the three walls of the heart which can be infarcted
Anterior, inferior, other
