If a patient has Medicare and the fee schedule amount is $450 after the surgeon’s charge of $1050, what is the patient’s co-pay?
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You are the CFO at a community hospital where there has been a reduction in revenue reported over the last three months. With whom might you consult to determine the cause? (choose all that apply)
The former CFO.
The payroll manager
The human resources officer
When you meet with the controller, he tells you the volume report did not show any issues. Where else might he check?
A collections and accounts receivable analysis.
The payroll totals for the year.
The insurance payoffs.
An employee absence report analysis.
While ICD-10 is the most recent coding source, ICD-9 was still used prior to October 2015 for __________.
Patients born before 1960
Coding older diseases
________________ can best be described as weighing the probability of one disease versus another disease as the cause of the pateint’s symptoms.
Which factors could contribute to the difficulties of being a CFO?
Lower state and federal revenues.
Reduced labor costs.
Lower costs for regulatory compliance.
Lower liability costs.
A self-pay patient with no insurance is billed:
22% of actual cost due to new state healthcare guidelines
Only after it is determined by a doctor that the patient is actually sick and in need of care
With a 56% deduction due to new healthcare guidelines
The full price
When you ask the controller to look into federal reimbursements to see if he can find the cause of the reduction, how might he respond? (Select all that apply)
Federal reimbursements are not part of the revenue cycle, the problem lies in revenue.
Since federal reimbursements are part of the revenue cycle, we might find the problem there.
The problem lies in revenue so it’s possible that charges are not being generated.
The problem lies in revenue so there could be a problem in claims.
In 1922 interest grew in using classification to categorize not only causes of mortality, but also _____________.
Causes of immortality
Causes of morbidity
Causes of disease pathology
Causes of disease spread
The determination of medical _______ involves comparing the procedure being billed to the diagnosis submitted.
A main cause for the spread and severity of the Black Death includes:
Large extended families living together
Lack of medical knowledge
Historical trend of resistance to medical treatment
Once a diagnosis has been made by the doctor, _________ can then be determined.
Florence Nightingale’s work to improve sanitation reduced the mortality rate in her hospital from __________ in one year.
43% to 5%
62% to 5%
33% to 2%
60% to 2%
The first step toward a diagnosis is:
Family morbidity rate
Known genetic defects
Cause of disease
CPT is part of HCPCS, known as _____________
Procedure coding encompasses a wide variety of services to patients, including:
Gas expenses related to travel for care
Pathology and diagnostic testing
Reimbursement for time lost at work
This form has space for 12 diagnosis codes and 6 procedure codes:
Diagnosis can best be classified as the identification of a disease from its ____________.
Point of origin
When you provide the results of your analysis about the reduction in revenue problem to the CEO, what might you report? (Select all that apply)
You were right about the bundling – the problem resides with the APC outpatient billing.
We found that the claims included an APC code, but not the specific procedure code.
All of the Medicare payments were exactly correct.
We looked just at drugs as a snapshot and they are billing for the drug itself, but not for its administration.
Dr. William Farr is best known for is contribution to:
Finding the cure for the Black Death
Streamlining scientific method
Refining the Cullen disease clarification
Refining the classification of disease pathology
In the 1960s and 1970s the expansion of the CPT led to:
Adoption of 5-digit codes in CPT-2
Adopton of 5-digit codes in CPT-3
Adoption of 3-digit codes in CPT-4
Adoption of 4-digit codes in CPT-2
Select the two types of claim forms used by different types of providers.
CMS-1500 and UB-04
CSM-110 and UR-42
C3P-0000 and R2-D2
CMS-1200 and RD-92
An amendment to the ____________ in 1974 made the National Committee on Vital and Health Statistics a statutory body and required that there be an annual report to Congress on the health of the American people.
Public Information Act
National Healthcare Act
Procedure Coding Act
Public Health Act
The purpose of the ICD-10 is:
To promote international comparability in the collection, classification, processing, and presentation of morbidity and mortality statistics
To promote the advancement of medical science
To promote international standards for the collection and dissemination of medical statistics
To provide a clear and concise method for documenting disease and illness
The doctors review system is intended to:
Make the patient aware of what is going on
Convert symptoms into code
Certify that the correct evaluations were made
Identify symptoms you may have forgotten to mention