Chapter 9. Medical Billing
Which prospective payment system (PPS) determines a preestablished payment that
depends on the patient's principal diagnosis, comorbidities, complications, and principal
and secondary procedures? – answer IPPS
The skilled nursing facility prospective payment system (SNF PPS) uses a _____
model. - answer patient driven payment
Which replaced the reasonable cost-based payment system to now classify patients
according to long-term (acute) care diagnosis-related groups (DRGs) based on patients'
clinical characteristics and expected resource needs? – answer LTCH PPS
The Resource-Based Relative Value Scale (RBRVS) system, originally implemented in
1992, is now referred to as the - answer Medicare physician fee schedule
Reviewing types and/or categories of patients treated by a facility is part of __________
management. - answer case mix
Diagnosis-related groups are organized into mutually exclusive categories called _____,
which are loosely based on body systems. - answer major diagnostic categories
Physician work, practice expense, and malpractice expense are components of -
answerrelative value units
Which are medical conditions or complications that patients develop during inpatient
hospital stays and that were not present on admission? - answerhospital acquired
conditions
A condition that exists at the time an order for inpatient hospital admission occurs is
categorized as - answerpresent on admission
A patient is admitted as a hospital inpatient with a diagnosis of possible myocardial
infarction. During admission, the physician documented that the patient fell out of their
hospital bed and fractured the left hip. Which present on admission (POA) indicator
applies to the left hip fracture diagnosis? - answerN (not present at the time of inpatient
admission)
A patient is admitted as a hospital inpatient with a diagnosis of pneumococcal
pneumonia. The physician documented in the history and physical examination that the
patient also has chronic asthma and diabetes mellitus, both of which were medically
managed during the inpatient admission. Which present on admission (POA) indicator
Which prospective payment system (PPS) determines a preestablished payment that
depends on the patient's principal diagnosis, comorbidities, complications, and principal
and secondary procedures? – answer IPPS
The skilled nursing facility prospective payment system (SNF PPS) uses a _____
model. - answer patient driven payment
Which replaced the reasonable cost-based payment system to now classify patients
according to long-term (acute) care diagnosis-related groups (DRGs) based on patients'
clinical characteristics and expected resource needs? – answer LTCH PPS
The Resource-Based Relative Value Scale (RBRVS) system, originally implemented in
1992, is now referred to as the - answer Medicare physician fee schedule
Reviewing types and/or categories of patients treated by a facility is part of __________
management. - answer case mix
Diagnosis-related groups are organized into mutually exclusive categories called _____,
which are loosely based on body systems. - answer major diagnostic categories
Physician work, practice expense, and malpractice expense are components of -
answerrelative value units
Which are medical conditions or complications that patients develop during inpatient
hospital stays and that were not present on admission? - answerhospital acquired
conditions
A condition that exists at the time an order for inpatient hospital admission occurs is
categorized as - answerpresent on admission
A patient is admitted as a hospital inpatient with a diagnosis of possible myocardial
infarction. During admission, the physician documented that the patient fell out of their
hospital bed and fractured the left hip. Which present on admission (POA) indicator
applies to the left hip fracture diagnosis? - answerN (not present at the time of inpatient
admission)
A patient is admitted as a hospital inpatient with a diagnosis of pneumococcal
pneumonia. The physician documented in the history and physical examination that the
patient also has chronic asthma and diabetes mellitus, both of which were medically
managed during the inpatient admission. Which present on admission (POA) indicator
