CCS Billing, Reimbursement, & Insurance Policies 3

Question 1

What does the term 'chargemaster' refer to in hospital billing?

Accepted Answer

A comprehensive list of services, supplies, and procedures with their assigned charges and billing codes

Answer

A list of all credentialed medical staff

Answer

A software system for scheduling inpatient admissions

Answer

The master file of approved ICD-10-CM codes

Question 2

Under the Medicare Inpatient Prospective Payment System (IPPS), which factor does NOT directly influence DRG assignment?

Accepted Answer

Patient's insurance carrier

Answer

Principal diagnosis

Answer

Complication and Comorbidity (CC) or Major CC (MCC)

Answer

Patient's age

Question 3

A coder submits a claim with a diagnosis code that is not supported by the clinical documentation. This is an example of which compliance risk?

Accepted Answer

Upcoding

Answer

Undercoding

Answer

Unbundling

Answer

Duplicate billing

Question 4

Which revenue code category is used on a UB-04 to report medical/surgical supplies?

Accepted Answer

27X

Answer

30X

Answer

36X

Answer

45X

Question 5

What is 'timely filing' in the context of insurance claims submission?

Accepted Answer

Submitting claims within the payer's required deadline from the date of service

Answer

Filing a claim appeal within 30 days of denial

Answer

Sending the patient statement within 10 business days

Answer

Completing the discharge summary within 24 hours

Question 6

The MS-DRG system includes Complication or Comorbidity (CC) and Major Complication or Comorbidity (MCC) designations. What is their primary purpose?

Accepted Answer

To increase DRG payment weight when documented conditions affect resource use

Answer

To identify hospital-acquired conditions for quality reporting

Answer

To flag claims for Medicare audit review

Answer

To determine the patient's readmission risk score