Ch 18: Review Test Flashcards
Hospital Billing and the UB-04
The construction of today’s modern hospital is regulated by ____?
- Federal and state laws
- State health department policies
- City ordinances
Today’s hospitals mainly offer what?
Private and semiprivate rooms
Hospitals that provide all levels of care are referred to as what?
Vertically integrated hospitals
A popular designation given to today’s healthcare patients is what?
Customers
A single building or campus, typically having a large number or beds, specialized facilities for various medical care types, and an emergency department, is called a ____
General hospital
A medical facility smaller than a hospital is typically referred to as what?
Clinic
A healthcare facility that is equipped and staffed to respond immediately to critical situations and provide continuous care to patients with “worst-case” scenarios is a(n) ____?
Acute care facility
A facility designed for patients who have had acute events as a result of an illness, injury, or exacerbation of a disease process is a(n) ____?
Subacute care facility
The type of facility in which patients have the advantage of constant access to nursing care as they more toward recovery and return to their home is a(n) ____?
Subacute care facility
A facility that is licensed or approved under state or local law that is primarily engaged in providing experienced nursing care and related services is a(n) ____?
Skilled nursing facility
Temporary relief for an individual providing healthcare to a family member is commonly called what?
Respite care
The type of care facility provided for adults who are chronically ill or disabled and are no longer able to manage in independent living situations is referred to as what?
Long-term care
What is the acronym for the federal act the ensures public assess to emergency services regardless of ability to pay?
EMTLA (emergency medical treatment & labor act)
The voluntary process through which an organization is able to measure the quality of its services and performance against nationally recognized standards is called ____?
Accreditation
The independent, nonprofit organization that performs quality-oriented accreditation reviews on HMOs and similar types of managed care plans is ____?
NCQA (national committee for quality assurance)
What is the acronym for the organization formed in 1979 to assist ambulatory healthcare organizations in improving the quality of care provided to patients?
AAHC (association of academic health centers)
What is the independent, nonprofit organization that promotes continuous improvement in the quality and efficiency of healthcare delivery through the establishment of standards, education, and communication?
URAC (Utilization review accreditation commission)
How any organization is run, in its simplest definition, is referred to as ____?
Governance
Moral principles that govern the practice of medicine by physicians and other healthcare practitioners are commonly referred to as medical ____?
Ethics
Medicare hospital claims are processed by contracted nongovernment organizations or agencies that are commonly referred to as ____?
- Medicare administrative contractors (MACs)
- Fiscal intermediaries
- Medicare carriers
Medicare Part A pays toward what?
Hospital charges
Medicare’s acute care payment system is called the ____?
Prospective payment system (PPS)
What is the abbreviation for an inpatient hospital coding system that groups related diagnoses and their associated medical/surgical treatment?
DRGs
Many Medicaid programs adjust payments to reflect such things as patient demographics, diagnostic and treatment information, and total charges, which is referred to as ____?
A case mix
If a military treatment facility is unavailable, TRICARE patients, in many cases, must obtain a ____?
Nonavailability statement (NAS)
Most third-party payers’ reimbursement rates are subject to change how often?
Annually
Most hospitals in the United States contract with Blue Cross and Blue Shield and are referred to as ____?
Member hospitals
The designated spaces on the UB-04 are called what?
Form locators
The universal claim form for current use in inpatient hospital claims is what?
UB-04
The process by which a patient can participate in choices about his or her healthcare’s commonly referred to as what?
Informed consent
An individual who has the legal authority to speak on a patient’s behalf is called what?
Surrogate
What manual is currently used for inpatient diagnostic coding?
ICD-10-CM
What manual is now used for inpatient procedural coding?
ICD-10-PCS
Coders must distinguish key elements or words in the patient’s hospital health record that identify the ____?
Principal diagnosis
What is the electronic equivalent to the UB-04 paper claim form?
837I
The overall data stream of the electronic UB-04 file is known as a(n) ____?
Transaction set
The total number of codes in the ICD-10-PCS system is approximately ____?
12,500
“That condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care” defines the ____?
Principal diagnosis
The payment system implemented in 2000 and used by the Centers for Medicare and Medicaid Services (CMS) to reimburse for hospital outpatient services is called the ____?
Hospital outpatient prospective payment system
OPPS (or HOPPS) allows for temporary payment of new technologies, drugs, devices, and biologies for which no ambulatory payment classification (APC) payment rate is available, which is called ____?
Pass-throughs
A computer application interface commonly used in hospitals to send and retrieve data for grouping, editing, and reimbursement outcomes is called the ____?
Grouper software system
Identify the program implemented by CMS in 1996 to control improper coding that leads to inappropriate increased payment for healthcare services
National Correct Coding Initative
Impatient acute care hospitals that are paid under the DRG payment system are required to report a specific indicator for every diagnosis on inpatient acute care hospital claims called ____?
Present on admission (POA)
Identify the congressional act that stipulates that hospitals cannot charge uninsured patients more for the same treatment than what those with health insurance are billed
The Affordable Care Act
The process of verifying that the diagnosis and procedure codes used on claims comply with all current coding guidelines and rules is called ____?
Coding compliance
According to the textbook, the implementation date for the ICD-10 coding system is ____?
October 1, 2015
ICD-10-PCS codes are composed of ____ characters
7
Regardless of the coding system used, diagnosis codes must be supported by ____?
Medical documentation
Identify the number of significant procedures other than the principal procedure that may be reported on the UB-04 claim form
5
