Deck 14: Hospital Insurance

Question 1

Which committee maintains the UB-04?

A) HIPAA
B) workers' compensation
C) National Uniform Billing
D) Centers for Medicare and Medicaid Services

Answer 1

National Uniform Billing

Question 2

Which claim form is also known as the hospital paper claim form?

A) UB-04
B) UB-04 or CMS-1450
C) 837I
D) UB-04 or 837I

Answer 2

UB-04 or CMS-1450

Question 3

A machine operator had an accident and cut off two of his fingers. What is this an example of?

A) Regular Care
B) Long Term Care
C) Urgent care
D) Emergency care

Answer 3

Emergency care

Question 4

What is QIO the abbreviation for?

A) Quality Improvement Organization
B) Quantity Information Organization
C) Quantity Interchange Order
D) Quality Information Order

Question 5

What is PRO the abbreviation for?

A) Provider Reimbursement Order
B) Peer Review Organizations
C) Physician Reinforcement Order
D) Patient Review Organization

Question 6

Which of the following is urgently needed care (not emergency care)?

A) spinal cord injury
B) heart attack
C) broken bone
D) stroke

Question 7

Why are electronic claims beneficial for billing purposes?

A) it is the same as a paper form
B) they take precedence over paper claims
C) paid ten to fifteen days earlier
D) it automatically corrects errors

Question 8

Which form is sent to hospitals to advise that payment will be transmitted by payers to their accounts?

A) 837IP
B) EOB
C) RA
D) UB-04

Question 9

Which of the following does Medicare Part A not cover?

A) hospice
B) home health care
C) SNF
D) outpatient diagnostics

Question 10

What term is used to describe conditions that develop after surgery and/or treatments that affect care during the hospitalization?

A) complications
B) comorbidities
C) pre-existing conditions
D) complications and comorbidities

Question 11

What term is also used to describe coexisting conditions that affect care during the hospitalization?

A) complications
B) comorbidities
C) pre-existing conditions
D) complications and comorbidities

Question 12

A patient is rushed to the emergency for having symptoms of a heart attack, and upon further testing, it is discovered that he did have a heart attack in addition to terminal cancer and end stage renal disease. Which is considered the primary diagnosis?

A) heart attack
B) cancer
C) they are both primary
D) end stage renal disease

Question 13

Which new system has Medicare adopted to better reflect the different severity of illness among patients who have the same basic diagnosis?

A) RV
B) MS-DRG
C) RB
D) OPPS

Question 14

What method is used by many private payers for setting prospective payment for hospital services?

A) DRG
B) RVU
C) RBRVS
D) CPT

Question 15

What is the UB-04 also referred to as?

A) 837I
B) UB-92
C) CMS-1450
D) CMS-1500

Question 16

What does the "P" in 837P stand for?

A) protective
B) professional
C) physician
D) provider

Question 17

What does the "I" in 837I stand for?

A) interchange
B) information
C) informative
D) institutional

Question 18

Which part of Medicare covers hospital charges?

A) Part A
B) Part B
C) Part C
D) Part D
Hospitals must submit claims for reimbursement to Medicare Part

Question 19

What type of care is provided in an outpatient facility or setting?

A) ambulatory
B) urgent
C) emergency
D) provider

Question 20

Which of the following is not a major step related to the hospital claim process?

A) admission
B) treatment
C) discharge and billing
D) lab charges

Question 21

Which is an example of emergency care?

A) nosebleed
B) upper respiratory infection
C) ankle sprain
D) stroke

Question 22

Which type of facility is more likely to give tube feedings and change sterile dressings?

A) Medical Departments
B) Hospital Emergency Rooms
C) Skilled Nursing Facility
D) Long Term Care Facility

Question 23

What types of facilities are equipped for patients to stay overnight?

A) outpatient facilities
B) inpatient facilities
C) ambulatory care facilities
D) all facilities are equipped for patients to stay overnight

Question 24

What types of facilities are designed to provide skilled nursing or rehabilitation services to help with recovery after a hospital stay?

A) Skilled Nursing Facilities (SNF)
B) Long-Term Care Facilities
C) Hospital Emergency Rooms
D) Medical Departments

Question 25

What types of facilities are designed to provide ongoing care for patients with chronic disabilities and prolonged illnesses?

A) Skilled Nursing Facilities (SNF)
B) Long-Term Care Facilities
C) Hospital Emergency Rooms
D) Medical Departments

Question 26

What department in a hospital is responsible for the organizing and maintaining of patient's medical records?

A) patient registration department
B) emergency care department
C) health information management department
D) medical department

Question 27

From the insurance perspective, a list of the three major steps in a patient's hospital stay does not include

A) family visits
B) treatment
C) admission
D) discharge

Question 28

The numbers and names of registered patients in a hospital make up the

A) patient register
B) master patient index
C) main patient database
D) patient list

Question 29

The patient's hospital medical record does not contain

A) correspondence
B) notes of the attending physician
C) ancillary documents
D) nurse competencies

Question 30

Hospitals usually charge inpatients for which of these services?

A) paging the on-call physician
B) maintenance
C) research medications
D) room and board

Question 31

As opposed to physician coding, hospital coding permits assigning diagnosis codes to

A) surgical procedures
B) suspected or unconfirmed diagnoses
C) reasons for accidents
D) visits for chemotherapy

Question 32

The items to be billed are recorded on the hospital's charge description master file, usually called the

A) charge ticket
B) charge master
C) master ticket
D) charge ticket or a charge master

Question 33

What part of the ICD-10 code set is used to code inpatient procedures?

A) CM
B) PCS
C) Volume 3
D) Volume 4

Question 34

Medicare's actions to control the cost of hospital services began with

A) DRGs
B) QIOs
C) SNFs
D) HIMs

Question 35

When Medicare changed the way hospitals were paid, the payment changed from a fee-for-service approach to the Medicare

A) Payment Plan
B) Prospective Payment System
C) Revised Payment System
D) None of these

Question 36

Which of the following is used for Medicare Part A reimbursement?

A) CMS-1500
B) UB-40
C) 837I
D) UB-92

Question 37

Which is not a typical department of the hospital?

A) housekeeping
B) food service
C) radiology
D) welfare

Question 38

Which agency provides skilled nursing, physical therapy, occupational therapy, and speech therapy?

A) long term care
B) home health care
C) hospice
D) inpatient

Question 39

Where is the diagnostic and procedural coding on a hospital patient obtained from?

A) progress notes
B) final report
C) discharge summary
D) principal procedure

Question 40

Which payment system would be used to pay for a same-day surgery or procedure?

A) OPPS
B) IPPS
C) ADL
D) DRG

Question 41

Which activity does at-home recovery care include?

A) skilled nursing
B) massage
C) eating
D) wound care

Question 42

What is an additional fee for services provided that may be charged in addition to hospital fees?

A) professional fee
B) housekeeping fee
C) surgeon fee
D) health information fee

Question 43

When is the date that ICD-10 codes go into effect?

A) January 1, 2016
B) January 1, 2014
C) October 1, 2014
D) October 1, 2016

Question 44

Mr. Smalls was admitted into the hospital for an emergency appendectomy. He developed a urinary tract infection due to a cross contaminated catheter which increased the duration of his stay. Some of the services were not reimbursed, what could be the reason?

A) there was a "never event"
B) he had a pre-existing condition
C) it exceeded the duration for that diagnosis
D) there may have been a mistake