Reimbursement Quiz #4

All of the following elements are found in a charge description, except: a. ICD-9-CM code b. procedure/service charge c. HCPCS/CPT code d. narrataive description of procedure/service

Which of the following is the definition of revenue cycle management? a. The regularly repeating set of events that produces revenue or income b. The method by which patients are grouped together based on a set of characteristics c. The systematic comparison of the products, services, and outcomes of one organization with those of a similar organization d. Coordination of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue

The term "hard coding" refers to: a. CPT codes that are coded by the coders b. CPT codes that appear in the hospital's chargemaster c. ICD-9-CM

In healthcare settings, the record of the cash the facility will receive for the services it has provided is known as which of the following terms? a. dollars billed b. aging of accounts c. accounts receivable d. cash balance

Healthcare facilities should think of the collection process as part of the complete billing process and should educate staff to the fact that not all money billed is: a. pending b. charged c. reimbursable d. collected

Aging of accounts is the practice of counting the days, generally in ______ increments, from the time a bill has been sent to the payer to the current day a. 7 days b. 14 day c. 30 day d. 90 day

Most facilities begin counting days in accounts receivable at which of the following times? a. the date the patient registers b. the date the patient is discharged c. the date the bill drops d. the date the bill is received by the payer

The amount of money owed a healthcare facility when claims are pending is called: a. dollars in accounts receivable b. bad debt c. the write off account d. delayed revenue

The dollar amount the facility actually bills for the services is known as: a. cost b. charge c. reimbursement d. contractual allowance

The difference between what is charged and what is paid is known as: a. cost b. charges c. reimbursement d. contractual allowance

What is the name of the notice sent after the provider files a claim that details amounts billed by the provider, amounts approved by Medicare, how much Medicare paid, and what the patient must pay? a. EOB b. EOMB c. MSN d. ABN

Which is not a characteristic of the "old RCM approach? a. proactive b. linear and unidirectional c. silo mentality d. front end and back end

which of the following is not a function area of the revenue cycle? a. volunteer services b. patient financial services c. admitting d. medical record coding

which entity is responsible for processing part A claims and hospital based part b claims for institutional services on behalf of Medicare? a. Medicare administrative contractor b. Medicare carrier c. third party payer d. claim editor

which of the following is not used to reconcile accounts in the patient accounting department? a. explanation of benefits b. Medicare code editor c. remittance advice d. Medicare summary notice

In a typical acute care setting, admitting is located in which revenue cycle area? a. pre claims submission b. claims processing c. accounts receivable d. claims reconciliation /collections

In a typice acute care setting, aging of accounts reports are monitored in which revenue cycle area? a. pre claims submission b. claims processing c. accounts receivable d. claims reconciliation /collections

In a typical acute care setting charge entry is located in which revenue cycle area? a. pre claims submission b. claims processing c. accounts receivable d. claims reconciliation /collections

In a typical acute care setting patient education of payment policies is located in which revenue cycle area? a. pre claims submission b. claims processing c. accounts receivable d. claims reconciliation /collections

In a typical acute care setting the EOB, Medicare summary notice, and remittance advice documents (provided by the payer) is monitored in which revenue cycle area? a. pre claims submission b. claims processing c. accounts receivable d. claims reconciliation /collections

In a typical acute care setting which revenue cycle area uses an internal auditing system (scrubber) to ensure that error free claims (clean claims) are submitted to third party payers? a. pre claims submission b. claims processing c. accounts receivable d. claims reconciliation /collections

The most comprehensive medical literature database is ______. a. SDILINE B. AIDSLINE C. MEDLINE d. none of the above

_________ is a programmable mannequin of a child on which sstudents can practice procedures. a. childsim b. pediasim c. the small virtual patient d. none of the aboe

___________is an expert system that helps in diagnosis. a. MYCIN b. INTERNIST c. none of the above d. a and b are both expert systems

_____________ is a computerized library of human anatomy. a. the visible human b. the virtual hospital c. the databank of cardiovascular disease d. none of the above

The best place to look for authoritative general health care information online for consumers would be _______. a. medlineplus b. Centerwatch c. any search will find authoritative information d. there is no reliable information on the internet.

Which of the following is likely to be a source of reliable health care information on the internet? a. a site maintained by a drug company b. a site maintained by a patient c. a site maintained by a university d. none of the above is likely to provide reliable information

_________ is a database of the most recent additions to MEDLINE. a. MEDLARS b. AIDSLINE c. NEWLINE d. SDILINE

Which of the following is currently being taught with the aid of simulation using virtual reality? a. minimally invasive surgical techniques b. the administration of epidual anesthesia c. some aspects of dentistry d. all of the above

_________ is a program which teaches anatomy by allowing the student to use a mouse to click away layers of the body. a. ILIAD b. ADAM c. KISMET d. none of the above

It is not difficult to find support groups on the web Starbright world __________. a. attempts to link seriously ill children in hospitals in the US. b. is a network of AIDS patients c. is a network of people with cancer. d. is a network of families of people with cancer.

Expert systems will eventually replace doctors. t/f

all the information on the internet is reliable and accurate. t/f

MEDLARS is a collection of medical literature databases. t/f

The visible human provides anatomically detailed, three dimensional representations of the male and female human body. t/f

The virtual hospital was a service of the university of Iowa that provided up to date accurate health related information on the web. t/f

In order to post health related information on the internet, a person needs to pass a rigorous exam. t/f

Information on current clinical drug trials is available on the internet. t/f

Some studies have contended that there are programs which are helpful in treating mild clinical depression. t/f

ADAM is a program that teaches anatomy. t/f

Simulation programs were used in health care education as far back as 1949. t/f

Under the SNF PPS, which one of the following healthcare services is excluded from the consolidated payment? a. laboratory tests b. routine cares c. medications d. radiation therapy

Which classification system is used to case mix adjust the SNF payment rate? a. IRVEN b. geographic cost index c. resource utilization groups. d. wage index

In the SNF PPS, which data set determines a resident's classificiation into a resource utilization group? a. Medicare provider analysis review b. Uniform Hospital discharge data set c. activities of daily living d. minimum data set

The therapist in the skilled nursing facility is treating multiple patients who are each performing different therapies. how does CMS clarify this mode of delivery? a. concurrent b. group c. individual d. modalitic

In the PAC payment systems, which tool does CMS use to adjust its payment rates to account for geographic variatiobns to cost? a. national episode amount b. neutrality adjustor c. cost reports d. market basket

In which of the PAC payment systems is the unit of payment the 60 day episode of care: a. skilled nursing facility b. long term care hospital c. inpatient rehabilitation facility d. home health agency

CMS analysts divide SNF admissions into upper and lower categories. Which of the following categories requires the resident's admission to be justified on an individual basis? a. reduced physical function b. rehabilitation + extensive c. clinically complex d. special care

Generally, what is the average length of stay of long term care hospitals? a. more than 15 days b. more than 25 days c. more than 30 days d. more than 60 days

patients with all the following conditions are appropriate candidates for LTCHs except: a. acute myocardial infarction b. chronic tuberculosis c. sequelae of head trauma d. ventilator dependent emphysema

In terms of their composition how do the groups of the MS-LTC-DRGs compare to the groups of the acute care MS drgs? a. fewer groups with wider range of conditions in each b. exactly the same c. refined with greater specificity d. none of the above

In terms of grouping and reimbursement, how are the MS-LTC-DRGs and acute care MS drgs similar a. relative weights b. based on principjal diagnosis c. categorization of low volume groups into quintiles d. classification of short stay outliers

In the LTCH PPS what is the standard federal rate? a. constant that converts the MS-LTC-drg weight into a payment b. relative weight based on the market basket of goods c. geographic wage index d. adjustment mandated by the Benefits Improvement and Protection Act (BIPA) of 2000

13In the IRF PPS what 85 item tool collects the data that drives reimbursement? a. PAI b. MDS c. OASIS d. IGC-UHDDS

To meet the definition of an IRF facilities must have an inpatient population with at least a specified percentage of patients with certain conditions. Which of the following conditions is counted in the a. brain injury b. chronic myelogenous leukemia. c. acute myocardial infarction d. cancer

All of the following elements are part of the IRF PPS except: a. major diagnostic category b. impairment group code c. rehabilitation impairment category d. patient assessment instrument

All of the following types of diagnoses are used in the IRF PPS except: a. principal b. admitting c. etiologic d. complication or comorbidity

In the IRF PPS, what is the tool for data collection that drives payment. a. Medicare provider analysis review b. inpatient rehabilitation validation and entry c. activities of daily living d. patient assessment instrument

What data set provides the underpinning of the HHPPS? a. UHDDS b. MHDS c OASIS d HAVEN

All of the following services are consolidated into a single payment under the HHPPS except: a. home health aide visits b. routine and nonroutine medical supplies c. durable medical equipment d. nursing and therapy services

all of the following domains are part of the HHPPS case mix except: a. clinical severity b. functional status c. service utilization d. medical malpractice

How many HHRGs are there? a. 80 b. 153 c. 510 d. 945

For what variations in resource consumption does the HHPPS account? a. type of health personnel, such as nurse versus therapist b. labor vs. non labor c. number of therapy visits by a therapist d. all of above

Which of the following elements is directly adjusted by the local wage index? a. labor portion b. OASIS c. national standard episode amount d. product

In which of the PAC payment systems is the adjusted rate multiplied by the patients number of Medicare days to determine the reimbursement amount? a. skilled nursing facility b. long term care hospital c. inpatient rehabilitation facility d. home health agency

What is the term used in a rehabilitation facility to mean "a patient's ability to perform activities of daily living? a. compliance threshold b. etiologic diagnosis c. functional status d. normalization

The creation of medications using computers to create a model of the target molecule and design a medication to inhibit or stimulate its work is called _______. a. biotechnology b. rational drug design c. visualization d. none of the above

The _________ is a project attempting to understand the genetic makeup of the human being. a. international genome project b. national institute of health project c. genetic script d. human genome project

A centralized computerized hospital pharmacy system involves the use of______ a. barcodes to identify drugs b. robots c. a and b d. none of the above

which of the following is true of decentralized point of use dispensing a. it decreases the waiting time for the first dose of a drug b. it increase the likelihood that drugs are administered on schedule c. it decrease dispensing errors d. all of the above

The linking of a drug cabinet in a doctor's office with a pharmacist via telecommunications lines is called _____ a. telemedicine b. Telepharmacy c. remote pharmacy d. robotic pharmacy

Information technology has made the human genome project possible by _________ a. enabling scientists to keep track of genes as they are identified and allowing findings to be immediately communicated via the internet b. making pharmacy robots available internationally c. keeping tract of new drugs as they enter clinical trials d. keeping records of the results of clinical drug trials

Telepharmacy raises certain legal problems associated with _______. a. the prescribing of drugs that are not FDA approved b. interstate licensing of pharmacists c. a doctor prescribing medications d. none of the above

The human genome project may lead to a. a more complete understanding of genetics b. more accurate predictions of who is likely to develop a disease with a genetic basis c. both a and b d. none of the above

The use of computers to simulate drug trials a. means that we do not need actual clinical trials b. means that we do not need actual clinical trials c. helps save both time and money d. b and c

DNA provides a blueprint of genetic information ______ helps create the proteins: a. Biotechnology b. RNA c. TNA d. none of the above

Errors in software can leand to errors in filling prescriptions true/false

Understanding the genetic basis of a disease can lead to the development of an effective drug. true/false

3Hospital pharmacy robots can dispense any drug with a barcode true/false

4 Decentralized hospital dispensing units reduce dispensing errors to zero. true/false

5 Telepharmacy allows one pharmacist to serve a large geographical area true/false

6 Automation of pharmacy may lead to unemployment among pharmacists true/false

7 Antisense technology attempts to treat cancer by turning off a gene that keeps cells alive true/false

8 biotechnology sees the human body as a collection of molecules true/false

computers have helped in the development of drugs used to treat AIDS true/false

10 Computer assisted trial design means that real clinical trials are not needed. true/false

The ______ is analogous to the endoscope used in surgery. a. digital x ray b. laser c. fiber optic camera d. none of the above

______ is the dental specialty that diagnoses and treats disease of the pulp a. periodontics b. endodontics c. cosmetic dentistry d. digital dentistry

_____ is the dental specialty that is the dental specialty that diagnoses and treats a. periodontics b. endodontics c. cosmetic dentistry d. digital dentistry

4 is the dental specialty concerned with smile makeovers a. periodontics b. endodontics c. cosmetic dentistry d. digital dentistry

5 ________ emphasizes prevention and the least possible intervention a. periodontics b. endodontics c. cosmetic dentistry d. minimally invasive dentistry

6 _____ can find cavities developing behind metal fillings. a. traditional examination b. DIFOTI c. traditional x rays d. digital x rays

7 _____ is a software that allows the creation of medical and dental expert systems. a. POEMS b. MYCIN c. INTERNIST d. EXPERTMD

8 ______ can remove small amounts of a tooth; it involves high speed particles aimed at the tooth. a. DIFOTI b. light illumination c. air abrasion d. none of the above

9 _______ deliver light energy. Depending on the target, the light travels at different wavelengths. a. lasers b. x rays c. air abrasion d. all of the above

10 one study traced the high number of cavities in poor children to ________. a. increased lead levels in the children's blood b. shortages in calcium c. shortages in vitamin C d. all of the above

some orthodontics is performed via teledentristry. The technician is with the patient and the clinician directs the technician from afar. true/false

Dental health is general has improved over the last century. true/false

teeth are constantly affected by acids which demineralize the surfaces true/false

The percentage of dentists who are specialists is not expected to rise true/false

The change in the conditions for which people seek dental care is related to demographic changes true/false

The laser vaporizes decay by direction a stream of light at the affected area. true/false

The earliest application of information technology in the dentists office was administrative - related to bookkeeping and accounting true/false

Lasers can always be used in to help clean out the root canal and to remove bacteria true/false

Lasers are used inn cosmetic dentistry true/false

traditional clinical exams and x rays can detect cavities only after they are somewhat advanced. true/false

ratio representing the relationship between average salaries in a geographic area compared to national average

amount adjusted for location, inflation, case mix, and other factors; unique to each facility

number of days a patient remains in a healthcare facility

process where a physician verifies and documents the health services that a patient receives are medically necessary

database used to house the price list for services provided to patients, can be used to automate charge capturing

computer software that attempts to recreate real life situations

comprehensive online database of current medical research

process of collecting all services, procedures, and supplies providing during patient care

regularly repeating set of events that produces case flow

computer software for the collection and submission of OASIS data elements

use of virtual worlds in therapy

use of the charge description master to code repetitive services

the application of information technology to biology

virtual body

provides patients with health care services for their recuperation and rehabilitation after an illness or injury

represents the complexity of illness and conditions of the organizations patient population

cost sharing measure in which a set amount is paid per service

quantifiable data about a function or process aka indicator

network of healthcare professionals who coordinate the care of patients in an effort to generate quality and improved savings

system that enables physicians to enter orders and prescriptions while comparing to external and internal databases for safety