Podcast
Questions and Answers
Home healthcare is provided by ________
Home healthcare is provided by ________
HHA's
Hospice care is provided ________
Hospice care is provided ________
in a number of environments
Ambulatory care refers to which kind of care?
Ambulatory care refers to which kind of care?
outpatient
Skilled nursing facilities specialize in offering _______
Skilled nursing facilities specialize in offering _______
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The attending physician is the ________
The attending physician is the ________
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A _________ is the hospital's list of the codes and charges for its services
A _________ is the hospital's list of the codes and charges for its services
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Medical practices and hospitals ask patients to sign consent forms in advance of procedures.
Medical practices and hospitals ask patients to sign consent forms in advance of procedures.
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Charge masters contain all of the following except _______
Charge masters contain all of the following except _______
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HIM is the abbreviation for ______
HIM is the abbreviation for ______
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The HIM department in hospitals conducts which of the following?
The HIM department in hospitals conducts which of the following?
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The _____ attending physician is primarily responsible for the care of the patient from the start of the hospital episode.
The _____ attending physician is primarily responsible for the care of the patient from the start of the hospital episode.
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UHDDS is the abbreviation for _______
UHDDS is the abbreviation for _______
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UHDDS is the classification system for ________
UHDDS is the classification system for ________
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CC is the abbreviation for _______
CC is the abbreviation for _______
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As of Oct. 1, 2015, ICD-10 ______ is used to code procedures during a patient's hospital stay.
As of Oct. 1, 2015, ICD-10 ______ is used to code procedures during a patient's hospital stay.
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Which of these are used for outpatient billing by CMS?
Which of these are used for outpatient billing by CMS?
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The MS DRG system takes into account all of the following except:
The MS DRG system takes into account all of the following except:
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DRG is the abbreviation for ______
DRG is the abbreviation for ______
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The DRG system is now called which of the following?
The DRG system is now called which of the following?
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The UB-04 form requires which physician information to be completed?
The UB-04 form requires which physician information to be completed?
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What involves a situation in which a delay in treatment would lead to a significant increase in the threat to a patient's life or body part?
What involves a situation in which a delay in treatment would lead to a significant increase in the threat to a patient's life or body part?
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What is a special approach to caring for people with terminal illnesses?
What is a special approach to caring for people with terminal illnesses?
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What category of services include care given at home, such as physical therapy or skilled nursing care?
What category of services include care given at home, such as physical therapy or skilled nursing care?
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What type of care covers all types of health services that do not require an overnight hospital stay?
What type of care covers all types of health services that do not require an overnight hospital stay?
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A patient's other conditions at admission that affect care during the hospitalization being coded are called ______, meaning coexisting conditions.
A patient's other conditions at admission that affect care during the hospitalization being coded are called ______, meaning coexisting conditions.
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Which term describes the patient's condition upon hospital admission?
Which term describes the patient's condition upon hospital admission?
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Which term describes the patient's condition that, after study, is established as the main reason for a hospital admission?
Which term describes the patient's condition that, after study, is established as the main reason for a hospital admission?
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Each hospital's _______ is an average of the DRG weights handled for a specific period of time.
Each hospital's _______ is an average of the DRG weights handled for a specific period of time.
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CMS put into place the requirement for a(n)_______ indicator for every reported diagnosis code for a patient upon discharge.
CMS put into place the requirement for a(n)_______ indicator for every reported diagnosis code for a patient upon discharge.
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Each MDC is subdivided into _______ MS-DRG's.
Each MDC is subdivided into _______ MS-DRG's.
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Study Notes
Home Healthcare and Hospice Care
- Home healthcare is provided by Home Health Agencies (HHAs).
- Hospice care can be provided in various environments tailored to patient needs.
Types of Care
- Ambulatory care refers to outpatient services without the need for overnight stays.
- Skilled nursing facilities specialize in inpatient services, offering advanced medical care.
Hospital Staff and Responsibilities
- The attending physician is responsible for the patient's care during their hospital stay, ensuring continuous treatment.
- The Health Information Management (HIM) department organizes and maintains patient medical records.
Billing and Reimbursement Processes
- A charge master is a comprehensive list of service codes and charges utilized by hospitals.
- Charge masters do not include estimated reimbursement amounts for services rendered.
Classification Systems
- UHDDS stands for Uniform Hospital Discharge Data Set, which classifies inpatient health data.
- The DRG (Diagnosis Related Group) system, now referred to as MS-DRGs, categorizes patients for billing based on their diagnoses and treatment.
Coding and Data Management
- ICD-10-PCS is used to code procedures performed during a hospital stay since October 1, 2015.
- Complications and comorbidities (CC) refer to additional conditions affecting patient care, coded alongside the primary diagnosis.
Emergency and Specialized Care
- Emergency care involves urgent situations where delays in treatment could significantly threaten a patient's life or limb.
- Hospice care provides a specialized approach for individuals with terminal illnesses.
Patient Conditions and Diagnoses
- The admitting diagnosis refers to the patient's condition upon hospital admission.
- The principal diagnosis is established as the main reason for the hospital admission after further evaluation.
Additional Hospital Financial Metrics
- Each hospital's case mix index represents the average DRG weights handled over a specified period, reflecting the complexity of cases treated.
- CMS requires a Patient On Admission (POA) indicator for every reported diagnosis code upon patient discharge.
Forms and Administrative Details
- The UB-04 form requires details about the attending provider, operating physician, and other providers involved in patient care, highlighting the collaborative nature of healthcare delivery.
- Medical services are categorized by Major Diagnostic Categories (MDCs), which are further divided into medical and surgical MS-DRGs.
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Description
Test your knowledge of hospital billing and reimbursements with this flashcard quiz. From home healthcare providers to skilled nursing facilities, each card covers essential terms and definitions in the context of healthcare operations. Perfect for students studying health care administration.
