TRUE / FALSE COMPLETION MATCHING I MATCHING II MATCHING III
1
What is True.
The hospital billing process consists of all the functions performed to prepare charges for submission to patients and third party payers. The purpose of the process is to obtain reimbursement for services and items rendered by the hospital.
1
What is claim
The _________________ process refers to the portion of billing that involves preparing claims for submission to payers.
1
What is CMS-1450 / UB-04
The claim form that is generally used to submit facility charges for services provided in the hospital.
1
What is revenue code
A four-digit code assigned in the charge master to each service or item provided by the hospital to designate the category of service.
1
What is Professional Charges
Charges that represent the component of patient care services performed by physicians and other non-physician clinical providers.
2
What is True.
Functions of the billing process include registration, posting of charges, chart review and coding, preparation of claim forms and patient invoices or statements for charge submission and monitoring of and follow-up on outstanding accounts.
2
What is billing process.
The purpose of a ______________ ____________ is to submit charges to third party payers for reimbursement.
2
What is Participating provider agreement (PAR)
A written agreement between the hospital and a payer that outlines the terms and conditions of participation for the hospital and the payer.
2
What is Health Information Management (HIM)
The department in the hospital generally responsible for chargemaster maintenance.
2
What is chargemaster maintenance
The function that involves changes, revisions, and deletions of codes and incorporation of changes in payer guidelines in the chargemaster.
3
What is True.
Participating provider agreements outline the terms and conditions of participation for hospitals and payers. Four common provisions covered in thes agreements include patient care services, billing requirements, reimbursement, and standards of medical c
3
What is traditional
Fee-for-service; fee schedule; percentage of accrued charges; and usual, customary, and reasonable (UCR) are examples of ________________ reimbursement methods.
3
What is Medical necessity
Services that are considered reasonable and necessary to address the patient’s condition based on standards of medical practice.
3
What is Facility charges
Charges that represent cost and overhead for providing patient care services, including space, equipment, supplies, drugs and biologicals, and technical staff.
3
What is CPT and Medicare National Codes
Two levels of codes in the HCPCS coding system.
4
What is What is True.
The patient’s financial responsibility, as defined by the patient’s plan, may represent a deductible, coinsurance, and/or copayment amounts.
4
What is Percentage of Accrued Charges
The ________________ ________________ _________________ _____________ reimbursement method calculates payment for charges accrued during a hospital stay based on a percentage of the approved charges.
4
What is timely filing
The term that describes payer requirements regarding claim submission and the specified period that claims must be filed within after services are provided.
4
What is Coding Systems
The systems that were developed to standardize descriptions of conditions, services, and items for the purpose of consistent reporting and tracking of procedures and conditions.
4
What is Health information system
The computerized system that allows the recording of, storage of, processing of, and access to data by various departments simultaneously.
5
What is False.
A claim that needs additional information and does not pass paper edits is a clean claim.
5
What is traditional and fixed payment
_________________ reimbursement methods base payments for health care services on charges submitted while _______________ ____________ methods are determined based on predetermined amounts.
5
What is Charge description master (CDM)
The computerized system used by hospitals to inventory and record services and items provided in various locations in the hospital during a patient stay.
5
What is National Uniform Billing Committee (NUBC)
The organization that defines revenue code categories.
5
What is admitting
The physician who prepares orders for an inpatient admission.






HOSPITAL BILLING

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