Revenue Cycle and Reimbursement Flashcards
6 cards from real RHIA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Revenue Cycle and Reimbursement flashcards as text
Which form is used by hospitals to submit inpatient Medicare claims?
Answer: UB-04 (CMS-1450)
The UB-04 (also called CMS-1450) is the standardized claim form used by hospitals and other institutional providers to bill Medicare and most other payers.
What is the purpose of the present on admission (POA) indicator in hospital billing?
Answer: Indicate whether a condition existed at the time of admission to differentiate from hospital-acquired conditions
The POA indicator identifies whether a diagnosis was present at admission, which affects Medicare payment and quality reporting by distinguishing hospital-acquired conditions.
What is upcoding in medical billing?
Answer: Submitting codes for a higher level of service than was actually provided
Upcoding is a fraudulent practice of billing for a higher-paying service or diagnosis than what was actually provided or documented.
Which coding system is used exclusively for inpatient hospital procedure coding under HIPAA?
Answer: ICD-10-PCS
ICD-10-PCS (Procedure Coding System) is mandated by HIPAA for reporting inpatient hospital procedures on institutional claims.
What does case mix index (CMI) measure in hospital management?
Answer: The average relative weight of all inpatient cases, reflecting clinical complexity and resource use
CMI is the average DRG relative weight across all inpatient cases, serving as an indicator of a hospital's overall patient complexity and expected resource consumption.
Which revenue cycle function is responsible for verifying patient eligibility before services are rendered?
Answer: Patient access / pre-registration
Patient access (pre-registration) verifies insurance eligibility and benefits before or at the time of service to prevent claim denials due to coverage issues.