HIT 220 - Lesson 1-14 Questions & Answers 100% Accurate

Which type of reimbursement methodology puts the health insurance company at the greatest degree of risk? (1) - ANSWERretrospective Which type of health insurance guarantees employees the right to keep their group health care coverage for up to 18 months when they would otherwise lose it after losing their job? (1) - ANSWERCOBRA To which of the following factors is health insurance status most closely linked? (1) - ANSWERemployment In the healthcare industry, what is the term for receiving compensation for healthcare services? (1) - ANSWERreimbursement In which type of reimbursement methodology do healthcare insurance companies reimburse providers after the costs have been incurred? (1) - ANSWERretrospective payment A patient saw a neurosurgeon for treatment of a nerve that was severed in an industrial accident. The patient worked for Basic Manufacturing Company, where the industrial accident occurred. Basic Manufacturing carried workers' compensation insurance. The workers' compensation insurance paid the fees of the neurosurgeon. Which entity is the "third-party"? (1) - ANSWERworker's compensation insurance In the United States, what is healthcare insurance? (1) - ANSWERReduction of a person's or a group's exposure to risk for unknown healthcare costs by the assumption of that risk by an entity. The health plan reimburses Dr. Tan $15 per patient per month. In January, Dr. Tan received $4,500 from the health plan. What method is the health plan using to reimburse Dr. Tan? (1) - ANSWERcapitation Which of the following is a form of cost control performed while the patient is in the hospital by either a nursing or health information professional to assess the appropriateness and medical necessity of hospital-based healthcare services by evaluating documentation? (1) - ANSWERutilization review In which type of healthcare payment method does the healthcare plan pay non-negotiated rates for each service that a provider renders? (1) - ANSWERfee for service "Daily Documentation" in the inpatient health record usually includes: (2) - ANSWERphysician progress notes, physician orders The Uniform Bill-04 (UB-04) allows for the reporting of _____diagnosis codes and _____procedure codes. (2) - ANSWER18, 6 The "Cooperating Party" responsible for providing coding training and certification is the: (2) - ANSWERAmerican Health Information Management Association (AHIMA) The original purpose of the UHDDS (Uniform Hospital Discharge Data Set) was to improve the _____and _____ of Medicare and Medicaid hospital discharge data. (2) - ANSWERuniformity, comparability As a general coding rule, "Other Diagnoses" are conditions that will be reported because: (2) - ANSWERthey are the conditions documented in the health record that have been evaluated Procedures that are either surgical in nature, carry a procedural or anesthetic risk, or require specialized training, should be reported because they are considered to be a(n): (2) - ANSWERsignificant procedure A patient is admitted for a coronary artery bypass graft (CABG) because of arteriosclerotic heart disease (ASHD). Following admission, but prior to surgery , the patient slips and falls, suffering an intertrochanteric femoral neck fracture. The CABG was rescheduled for a later date and the patient was taken to the OR for a total hip replacement. The patient was discharged three (3) days later, to return to the hospital in one month for the CABG. What will be reported a