week 9 study guide

48 terms by tseeley 

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True

There is more chance for advancement working in a hospital facility than in a private physician's office

True

Because of the diversity in reimbursement methods, it is very important that the insurance billing specialist have basic knowledge of insurance programs.

False

Emergency department charges are billed along with the impatient stay on the CMS-1500 claim form.

True

When admitted as a workers's compensation case, the patient will not have an insurance card.

True

A patient has a right to request an itemized bill from a hospital stay with no cost to the patient.

True

The purpose of the DRG-based system is to hold down rising health care costs:

Co-worker; family; friends

Confidential information about patients should never be discussed with

For an overnight stay

A patient is considered an inpatient to the hospital on admission.

48 hours

When a patient who has a managed care contract is admitted to a hospital for an emergency the managed care program needs to be notified within.

The 72 hour rule

The rule stating that when a patient receives outpatient services within 72 hours of admission then all outpatient services and become part of the diagnostic-related group rate for admission is called

Principal diagnosis

The significant reason for which a patient is admitted to the hospital is coded using the.

At least two digits; Two to four digits

ICD-9-CM procedure codes contain.

CPT

The codebook used to list procedures on outpatient hospital claims is

Admitting clerk

The person who interviews the patient and obtains personal and insurance information and the admitting diagnosis is a/an

Nurse

Daily progress notes are entered on the patient's medical record by a/an

UB-04

The claim form transmitted to the insurance carrier for reimbursement for inpatient hospital services is called the

Hospital consultations; Hospital visits; Emergency department visits

Professional services billed by the physician include.

25

How many major diagnostic categories (MDCs) are there in the DRG-bases system.

Source of admission

On the UB-04 claim form code 6 (transfer from another health care facility) in the Field 15 is used to indicate.

Pre admission testing

PAT is the abbreviation for .

UR

The hospital department that conducts an admission and concurrent review on all cases and prepares a discharge plan to determine whether admissions are justified is called the.

The discharge summary

What is the clinical resume for final progress note

Quality improvement organization

What is QIO the abbreviation for

EDI

The abbreviation of the phrase that indicates when claims are submitted electronically is

Discharge summary

What is the document that needs to be completed and signed by the physician after a patient leaves the hospital before the hospital can receive reimbursement.

Complication & Comorbidity

What does the abbreviation CC indicate when used with DRGs

True

An insurance billing specialist may be employed by a physician hospital or other medical facility or may choose to be self-employed

True

A blind mailing means sending information to potential employers who have not advertised a job opening.

True

In completing an application for employment abbreviations are not used unless space is extremely limited

False

It is never acceptable to fax a resume to a prospective employer

Flase

It is discriminatory for an employer to ask if an applicant smokes.

True

An alien employee must have on file with his or her employer an Employment Eligibility Verification form.

True

An insurance billing specialist should join a professional organization of billers because this helps in keeping up to date with coding information.

Secure an interview

The main goal of a cover letter is to

Customized; State a summary of your qualities ; Secure an interview

Cover letters should be.

Place of last employment

In an interview inquiries about the following are illegal except.

Thank the employer for granting the interview; keep the applicant's name at the attention of the potential employer;

After an interview a follow up letter should be written to

1 year or more

When an individual wishes to start his or her own medical billing service he or she should have sufficient funds to run the business for a period of .

Business associate

Under HIPAA when a health care provider outsources billing this is known as a.

Instructions

An employer may evaluate the application itself to determine whether the applicant can follow

Chronological resume

A resume that provides recent experiences first with dates and descriptive data for each job is.

Functional resume

A resume that states the skills an individual is able to perform is.

Combination resume

A resume that summarizes the applicant's job skills as well as educational and employment history is the.

Proofread

The resume carefully for spelling punctuation grammatical and typographic errors.

Physical appearance

It has been found that when applicants have similar skills and education the decision to hire has been based on___ at the interview.

Portfolio

Letters of recommendation school diplomas or degrees certificates names and addresses of references and some neatly typed insurance claim forms are items and applicant may enclose in a/an.

Requesting an interview

What should a cover letter end with

Five ways to search for a job

Blind mailing.. Cold Calls...Internet...Employment agencies...Attend meetings and workshops ..Join professional groups

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