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

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.

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

The POA indicator identifies whether a diagnosis was present at admission, which affects Medicare payment and quality reporting by distinguishing hospital-acquired conditions.

Question 3

What is upcoding in medical billing?

Accepted Answer

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

Answer

Upcoding is a fraudulent practice of billing for a higher-paying service or diagnosis than what was actually provided or documented.

Question 4

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

Accepted Answer

ICD-10-PCS

Answer

ICD-10-PCS (Procedure Coding System) is mandated by HIPAA for reporting inpatient hospital procedures on institutional claims.

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

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.

RHIA Exam Practice Test

RHIA Exam Practice Test

RHIA Revenue Cycle and Reimbursement 2