An organization consisting of a network of providers that are organized within a health system to offer patients a full range of managed health services is a(n):
Integrated delivery system
The stages of the billing process include:
) Services and items are provided and recorded in the patient's medical record and coded.
B) Invoices and claim forms are prepared for submission of the charges to patients and payers.
C) The payer reviews the claim and determines payment, denial, or pending the claim.
The purpose of the billing process in a hospital includes the following:
) Medical care provided to a patient must be processed for billing to patients and third-party payers.
B) The hospital must perform the necessary functions required to submit charges for services rendered to patients and third-party payers.
C) Hospitals maintain financial stability through the billing process.
An area in the hospital where services are provided to patients who come in with a condition or illness that requires immediate attention
Hospitals maintain an inventory of available rooms in the hospital to which patients are assigned to as they are admitted. The inventory is called:
The hospital Credit and Collections Department is responsible for collecting on outstanding accounts, which include monies owed by:
B) Government programs
C) Other third-party payers
When billing for ambulatory surgery services, the hospital bills for which portion of services?
Care provided to a patient who is admitted on an inpatient basis is ordered by the:
The Health Information Management (HIM) Department is responsible for the following:
A) Ensuring confidentiality and security of medical records
B) Monitoring documentation to ensure documentation standards are met throughout the hospital
C) Coding medical records and chargemaster maintenance
Billing and coding professionals do not play a role in ensuring the hospital is in compliance with billing, coding, and documentation guidelines.
This government agency oversees the federal responsibilities for the Medicare and Medicaid programs.
Centers for Medicare and Medicaid Services
What legislation was implemented to improve continuation of insurance coverage, prevent and detect fraud and abuse, simplify the administration of health insurance, and protect the privacy of health information?
Health Insurance Portability and Accountability Act (HIPAA)
The agency under the Department of Defense that is responsible for the oversight of the TRICARE Program:
TRICARE Management Activity (TMA)
The Hospital Survey and Construction Act (Hill-Burton Act), Amendment to the Social Security Act (SSA), Consolidated Omnibus Budget Reconciliation Act (COBRA), and Emergency Medical Treatment and Labor Act (EMTALA) are legislative actions designed to address:
Access to and quality of health care
The federal legislation's role in the implementation and enforcement of healthcare legislation includes:
Enacting laws commonly referred to as "statutes"
B) Responsibility of the executive branch to enforce the laws
C) Delegation by the president of the responsibility and authority to administer and enforce laws to various departments
State governmental responsibilities that contribute to the government's involvement in regulating health care include:
A) Each state has hospitals that are owned and operated by the state.
B) States are involved in the funding for teaching hospitals and medical education.
C) States are responsible for the public health departments and for certification and licensing of healthcare facilities.
The mission of this state regulatory agency includes promoting public health and health and safety of all state residents through disease prevention and ensuring that quality medical care is provided.
Department of Health
What codes are used on claim forms to describe services and procedures billed to third-party payers?
Payers do not pay for services that are not covered or services that are not deemed reasonable and necessary in response to the patient's condition. Payers will pay only for services that are covered and considered to be:
Codes developed in the 1980s to provide a standard system for reporting supplies, equipment, medication, and other items to Medicare carriers.
HCPCS Level II Medicare National codes
Thinking they are candy, Bobby Joe eats a whole bottle of Grandma's blood pressure pills. This is an example of a(n)
Which of the following organizations is responsible for updating the diagnosis classification of ICD-9-CM?
National Center for Health Statistics
Which of the following provides a set of codes used for collecting data about substance abuse and mental health disorders?
The Health Insurance Protability and Accountability Act of 1996 includes all EXCEPT
Medicare reserve days