RHIA Revenue Cycle and Reimbursement 2

Question 1

Which form is used by hospitals to submit inpatient Medicare claims?

Accepted Answer

UB-04 (CMS-1450)

Answer

CMS-1500

Answer

ADA dental claim form

Answer

HCFA-1450

Question 2

What is the purpose of the present on admission (POA) indicator in hospital billing?

Accepted Answer

Indicate whether a condition existed at the time of admission to differentiate from hospital-acquired conditions

Answer

Identify patients admitted through the emergency department

Answer

Confirm patient insurance coverage at admission

Answer

Flag high-cost DRGs for utilization review

Question 3

What is upcoding in medical billing?

Accepted Answer

Submitting codes for a higher level of service than was actually provided

Answer

Correcting previously submitted codes

Answer

Converting diagnosis codes to procedure codes

Answer

Updating the chargemaster annually

Question 4

Which coding system is used exclusively for inpatient hospital procedure coding under HIPAA?

Accepted Answer

ICD-10-PCS

Answer

CPT

Answer

HCPCS Level II

Answer

CDT

Question 5

What does case mix index (CMI) measure in hospital management?

Accepted Answer

The average relative weight of all inpatient cases, reflecting clinical complexity and resource use

Answer

The ratio of inpatient to outpatient visits

Answer

The number of complication/comorbidity codes per case

Answer

The percentage of Medicare versus commercial payer cases

Question 6

Which revenue cycle function is responsible for verifying patient eligibility before services are rendered?

Accepted Answer

Patient access / pre-registration

Answer

Medical coding

Answer

Charge capture

Answer

Accounts receivable follow-up