Ch 18: True and False Flashcards
Hospital Billing and the UB-04
T/F: Clinics generally provide outpatient services only
True
T/F: Ambulatory surgery centers (ASCs) are facilities at which surgeries are performed that do not require hospital admission
True
An ASC (ambulatory surgery center) treats patients who already have seen a healthcare provider and patients who have not
False
T/F: Because ASC (ambulatory surgery center) patients are not formally admitted to the hospital, ASCs are among the more loosely regulated healthcare facilities
False
T/F: A subacute care facility provides a level of maintenance care at which there is no urgent or life-threatening condition that requires medical treatment
True
T/F: A nursing home can qualify as an SNF
True
T/F: Licensed hospitals must provide care within the minimum health and safety standards established by state rules and regulations
True
T/F: All hospitals must seek accreditation by nationally recognized accrediting agencies
False
T/F: Critical Access Hospitals are certified under a different set of Medicare Conditions of Participation (CoP) that are more flexible than those of acute care hospitals
True
T/F: Privacy and confidentiality issues are not as important in hospitals compared with physicians’ offices
False
T/F: The HIPAA Privacy Rule is not intended to prohibit providers from talking to other providers and to their patients
True
T/F: Each state’s Medicaid program determines the method it uses to pay for hospital inpatient services
True
T/F: An NAS is necessary for all outpatient procedures
False
T/F: Inpatient TRICARE payments are calculated using the same PPS as Medicare
True
T/F: Most third-party payers require preauthorization for inpatient hospitalization and some outpatient procedures and diagnostic testing
True
T/F: Most private insurers negotiate contracts with facilities regarding hospital inpatient payment methods on a month-to-month basis
False
T/F: The hospital billing process begins when the patient is discharged from the facility
False
T/F: The “principal diagnosis” is defined as the condition determined after study to be chiefly responsible for the patient’s admission to the hospital
True
T/F: In ICD-10 coding, some body system categories include codes for nonspecific conditions, which should be ignored
False
T/F: Transaction Standard Version 5010 accommodates the proposed new ICD-10 codes sets
True
T/F: CPT-4/HCPCS codes are used only in physicians’ offices and outpatient clinics
True
T/F: The 72-hour rule states that all diagnostic services provided for Medicare patients within 72 hours of the hospital admission must be billed separately from inpatient charges
False
T/F: APC is the grouping system that the CMS developed for facility reimbursement of hospital outpatient services
True
T/F: The primary goal of the Affordable Care Act is to provide free healthcare to all American citizens
False
T/F: Hospitals submitting claims electronically can use any format available
False
T/F: The accrediting body for many allied health education programs is CAAHEP
True
T/F: The law requires electronic processing of all documents between the healthcare provider and the insurance carrier, without exception
False
T/F: Secondary conditions are either comorbidities or complications, frequently referred to as “CCs”
True
T/F: Like ICD-10-CM codes, ICD-10-PCS codes contain seven characters, which can be numbers or letters and are based on the type of procedure performed, the approach, the body part, and other characteristics
True
T/F: Each character in the structure of an ICD-10-PCS code must be alphabetic
False
