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48 terms

week 9 study guide

STUDY
PLAY
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