# CPAT Prep Hospital And Clinic Billing Pfs

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Brandy Cummins
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Preparation for Hospital/ Clinic portion of CPAT.

• 1.

### The uniform billing form is also known as the UB-04.

• A.

True

• B.

False

A. True
Explanation
The statement is true because the uniform billing form is indeed known as the UB-04. The UB-04 is a standard claim form used by institutional healthcare providers to bill Medicare and Medicaid, as well as other insurance companies. It replaced the UB-92 form in 2007 and is widely used in the United States.

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• 2.

### The UB-04 contains how many data elements?

• A.

78

• B.

81

• C.

92

B. 81
Explanation
The UB-04 contains 81 data elements.

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• 3.

### Conditons codes are found in which field locators?

• A.

39-41

• B.

66-74

• C.

18-28

• D.

31-34

A. 39-41
Explanation
Condition codes are found in the field locators 39-41.

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• 4.

### Revenue codes are found in which fields:

• A.

42-49

• B.

31-34

• C.

66-74

• D.

18-28

A. 42-49
Explanation
Revenue codes are found in the fields numbered 42-49.

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• 5.

• A.

18-28

• B.

31-34

• C.

39-41

• D.

42-49

B. 31-34
• 6.

### A UB04 code that identifies a specific accommodation, ancillary service or billing calculation:

• A.

Condition code

• B.

Occurrence code

• C.

Value code

• D.

Revenue code

D. Revenue code
Explanation
A revenue code is a UB04 code that identifies a specific accommodation, ancillary service, or billing calculation. It is used to indicate the type of service or item provided to a patient, which helps in determining the appropriate billing and reimbursement. Revenue codes are essential for accurate and efficient medical billing and coding processes.

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• 7.

### A UB-04 code which identifies the condition(s) relating to the bill that may affect payer processing:

• A.

Condition code

• B.

Occurrence code

• C.

Value code

• D.

Revenue code

A. Condition code
Explanation
A condition code is a UB-04 code that is used to identify specific conditions or circumstances related to a medical bill that may impact how the payer processes the claim. These codes provide additional information to the payer about the patient's condition or the services provided, helping them determine the appropriate payment or reimbursement for the claim.

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• 8.

### A UB04 code used to identify values of monetary nature:

• A.

Condition code

• B.

Occurrence code

• C.

Value code

• D.

Revenue code

C. Value code
Explanation
Value code is a UB04 code used to identify values of monetary nature. This code is used to indicate specific monetary amounts related to services provided, such as charges, payments, or adjustments. It helps in accurately documenting and billing for the financial aspects of healthcare services.

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• 9.

### A UB04 code used which identifies the specific date defining a significant event relating to the bill that my affect payment processing:

• A.

Condition code

• B.

Occurrence code

• C.

Value code

B. Occurrence code
Explanation
An occurrence code is a UB04 code used to identify a specific date that defines a significant event related to the bill. This code helps in determining the payment processing for the bill.

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• 10.

### The type of bill code is how many digits:

• A.

2

• B.

3

• C.

4

• D.

5

B. 3
Explanation
The type of bill code consists of three digits.

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• 11.

### The type of bill code is found in what form locator:

• A.

5

• B.

6

• C.

2

• D.

4

D. 4
Explanation
The type of bill code is found in form locator 4. The form locator is a specific field on a claim form that indicates where certain information should be entered. In this case, the type of bill code, which is a code that identifies the type of service being billed, is entered in form locator 4.

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• 12.

### The first digit in the type of bill indicates:

• A.

Frequency

• B.

Type of facility

• C.

Bill classification

• D.

None of the above

B. Type of facility
Explanation
The first digit in the type of bill indicates the type of facility. This means that the first digit in the bill number corresponds to the specific type of healthcare facility where the services were provided. This classification helps in identifying the type of facility and streamlining the billing process accordingly.

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• 13.

### The third digit in the type of bill indicates:

• A.

Frequency

• B.

Type of facility

• C.

Bill classification

• D.

None of the above

A. Frequency
Explanation
The third digit in the type of bill indicates the frequency. This means that it represents how often a bill is being generated or how often a certain service is being provided. It is used to classify bills and determine the billing cycle for a particular facility or service. The third digit helps in organizing and tracking the frequency of bill generation or service provision, making it easier for administrative purposes.

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• 14.

### Type of bill code 131 indicates:

• A.

Skilled Nursing, Outpatient, Interim –first claim

• B.

Hospital, outpatient, nonpayment zero claims

• C.

Hospital, inpatient, admit through discharge claim

• D.

Hospital, outpatient, admit through discharge claim

D. Hospital, outpatient, admit through discharge claim
Explanation
Type of bill code 131 indicates a Hospital, outpatient, admit through discharge claim. This means that the claim is being submitted for services provided at a hospital on an outpatient basis, starting from the admission of the patient to their discharge. This type of bill code is used to report the entire episode of care for a patient who is admitted to the hospital as an outpatient and undergoes various treatments or procedures before being discharged.

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• 15.

### Type of bill code 227, the third digit 7 indicates:

• A.

Final claim for a home health PPS episode

• B.

Interim-last claim

• C.

Replacement of prior claim

• D.

Late charge only

C. Replacement of prior claim
Explanation
The correct answer is "Replacement of prior claim." The third digit of the type of bill code 227 indicates that it is a replacement of a prior claim. This means that the current claim is being submitted to replace a previously submitted claim for the same episode of care.

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• 16.

### Type of bill code 333, the second digit 3 indicates:

• A.

Outpatient

• B.

Inpatient Part B

• C.

Swing bed

• D.

Inpatient Part A

A. Outpatient
Explanation
The correct answer is Outpatient. In the type of bill code 333, the second digit 3 indicates that the bill is for an outpatient service. Type of bill codes are used in medical billing to categorize the type of services provided to the patient. In this case, the code 333 specifically identifies outpatient services.

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• 17.

• A.

251

• B.

182

• C.

145

• D.

262

B. 182
• 18.

### CWF is the acronym for:

• A.

Common Working Field

• B.

Constant Working File

• C.

Conditional Working File

• D.

Common Working File

D. Common Working File
Explanation
CWF stands for Common Working File. This term refers to a shared workspace or storage area where multiple users can access and collaborate on documents, data, or projects. It is a central location that allows for easy communication and coordination among team members, ensuring that everyone is working with the most up-to-date information. The use of a Common Working File promotes efficiency, productivity, and effective teamwork.

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• 19.

### The CWF contains all of the following except:

• A.

Part A and B deductible information

• B.

Date of birth

• C.

Date of service

• D.

Benefit periods and days remaining in the current benefit period

C. Date of service
Explanation
The Correct answer is "Date of service". The reason for this is that the CWF (Common Working File) is a database used by Medicare to store and track beneficiary information. It contains various details such as Part A and B deductible information, date of birth, and benefit periods and days remaining in the current benefit period. However, it does not include the specific date of service, which refers to the date on which a particular medical service or treatment was provided to the beneficiary.

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• 20.

### MSP is the acronym for:

• A.

Medicaid secondary payer

• B.

Medicare seasonal payer

• C.

Miscellaneous secondary payer

• D.

Medicare secondary payer

D. Medicare secondary payer
Explanation
The correct answer is Medicare secondary payer. MSP refers to Medicare secondary payer, which is a provision that requires certain types of insurance to pay claims as secondary to Medicare. This means that if someone has Medicare coverage along with another type of insurance, such as employer-sponsored insurance or Medicaid, Medicare will act as the primary payer and the other insurance will act as the secondary payer. This ensures that Medicare is not responsible for covering costs that should be covered by another insurance source.

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• 21.

### A claim that contains complete and necessary information but the information is illogical or incorrect is:

• A.

Clean claim

• B.

Incomplete claim

• C.

Invalid claim

• D.

None of the above

C. Invalid claim
Explanation
An invalid claim refers to a statement that contains all the necessary information but is illogical or incorrect. This means that the claim might have all the required details, but the information provided is not accurate or does not make sense. It is important to distinguish between incomplete claims, which lack necessary information, and invalid claims, which have incorrect or illogical information.

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• 22.

### A clean claim is one which:

• A.

If investigated does not require contact with the provider

• B.

Will pass all front end edits

• C.

Is processed electronically

• D.

All of the above

D. All of the above
Explanation
A clean claim is one that meets all the criteria mentioned in the options. It does not require contact with the provider when investigated, passes all front-end edits, and is processed electronically. Therefore, the correct answer is "All of the above."

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• 23.

### The Medicare Part A deductible for days 1 through 60 is:

• A.

\$1000

• B.

\$1132

• C.

\$1200

• D.

\$1500

B. \$1132
Explanation
The Medicare Part A deductible for days 1 through 60 is \$1132. This means that if a person is admitted to the hospital and stays for less than 60 days, they will be responsible for paying this deductible amount before Medicare coverage kicks in.

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• 24.

### The Medicare Part A Lifetime Reserve 91 through 150 days:

• A.

\$275 per day

• B.

\$350 per day

• C.

\$550 per day

• D.

\$1100 per spell of illness

C. \$550 per day
Explanation
The correct answer is \$550 per day. Medicare Part A provides coverage for hospital stays, and the Lifetime Reserve days are additional days of coverage that can be used after the initial 90 days. During these reserve days, Medicare covers a portion of the cost, and the beneficiary is responsible for the daily coinsurance. In this case, the coinsurance amount is \$550 per day.

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• 25.

### Blood deductible for Medicare Part A and Part B is:

• A.

1 pint per year

• B.

2 pints per year

• C.

3 pints per year

• D.

4 pints per year

C. 3 pints per year
Explanation
Medicare Part A and Part B have a blood deductible of 3 pints per year. This means that Medicare beneficiaries are responsible for the cost of the first 3 pints of blood they receive in a calendar year. After the deductible is met, Medicare will cover the cost of any additional blood transfusions. This deductible helps to ensure that Medicare resources are used efficiently and encourages beneficiaries to use blood transfusions judiciously.

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• 26.

### SNF days 21 through 100:

• A.

\$125 per day

• B.

\$127.50 per day

• C.

\$137.50 per day

• D.

\$150.00 per day

C. \$137.50 per day
Explanation
The correct answer is \$137.50 per day. This is because the given information states that the SNF (Skilled Nursing Facility) charges different rates for different days. From days 21 through 100, the rate increases progressively from \$125 per day to \$127.50 per day, then to \$137.50 per day, and finally to \$150 per day. Therefore, the rate for day 100 would be \$137.50 per day.

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• 27.

### What form provides a complete listing or detailed account of every service posted to a  patient account:

• A.

Data mailer

• B.

Superbill

• C.

Itemized Statement

• D.

Both B and C

D. Both B and C
Explanation
Both a superbill and an itemized statement provide a complete listing or detailed account of every service posted to a patient account. A superbill is a document that healthcare providers use to record the services provided to a patient during a visit, including the procedure codes, diagnosis codes, and charges. An itemized statement is a detailed breakdown of all the services rendered to a patient, including the date of service, description of the service, and the associated charges. Therefore, both options B (superbill) and C (itemized statement) are correct answers to this question.

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• 28.

### An invoice used to document the services ordered or render during a patient visit:

• A.

Superbill

• B.

Data Mailer

• C.

Itemized Statement

• D.

Both A and C

B. Data Mailer
• 29.

### A system generated free-form statement that is used to communicate the status of a patient’s account:

• A.

Data Mailer

• B.

Superbill

• C.

Itemized Statement

• D.

Both B and C

A. Data Mailer
Explanation
A system generated free-form statement that is used to communicate the status of a patient's account is called a Data Mailer. This statement provides information about the patient's account, including any outstanding balances, payments made, and any adjustments or charges. It is generated by the system and can be sent to the patient via mail or electronically. This statement helps in keeping the patient informed about their account status and facilitates communication between the healthcare provider and the patient.

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• 30.

### Medicare is secondary payer to which of the following:

• A.

Federal Black Lung

• B.

Workers’ Compensation

• C.

Automobile medical, no-fault or liability insurance

• D.

All of the above

D. All of the above
Explanation
Medicare is considered a secondary payer to Federal Black Lung, Workers' Compensation, and Automobile medical, no-fault or liability insurance. This means that if an individual has any of these types of insurance coverage, Medicare will only pay for healthcare services after the primary insurance has paid its share. In other words, Medicare will step in to cover any remaining costs that the primary insurance does not cover. Therefore, the correct answer is "All of the above."

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• 31.

### If ESRD is the only reason a patient was entitled to Medicare, the coverage will end in the following time frames except:

• A.

24 months after they no longer require maintenance dialysis

• B.

36 months after the month of a successful kidney transplant

• C.

Employer group health plans with greater than 20 employees

• D.

12 months after they no longer require maintenance dialysis

A. 24 months after they no longer require maintenance dialysis
Explanation
If ESRD (End-Stage Renal Disease) is the only reason a patient was entitled to Medicare, their coverage will end in the following time frames except 24 months after they no longer require maintenance dialysis. This means that if a patient with ESRD stops needing regular dialysis, their Medicare coverage will continue for 24 months after that point. After those 24 months, their Medicare coverage will end. The other options listed have different time frames for when Medicare coverage will end, such as 36 months after a successful kidney transplant or 12 months after no longer needing maintenance dialysis. However, the exception is the 24-month time frame.

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• 32.

### When a person with VA benefits and Medicare receives healthcare, they can use both benefits:

• A.

True

• B.

False

B. False
Explanation
A person with VA benefits and Medicare cannot use both benefits simultaneously. When receiving healthcare, they must choose to use either their VA benefits or Medicare. This is because VA benefits are specifically designed to provide healthcare services to veterans, while Medicare is a federal health insurance program available to all individuals aged 65 and older, as well as certain younger individuals with disabilities. Therefore, the correct answer is False.

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• 33.

### Working aged means a person is:

• A.

At least 65 years of age

• B.

Currently works and is covered by an EGHP

• C.

65 years of age and currently works and is covered by an EGHP

• D.

All of the above

C. 65 years of age and currently works and is covered by an EGHP
Explanation
A working aged person is defined as someone who is 65 years of age and currently works and is covered by an EGHP (Employer Group Health Plan). This means that they are of a certain age, still employed, and have health coverage through their employer. This definition encompasses all the given options, making "All of the above" the correct answer.

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• 34.

### What is a payment made by Medicare where another payer is responsible for payment and the claim is not expected to be paid promptly:

• A.

Assignment of Benefits

• B.

Medicare Secondary Payer

• C.

Conditional Payments

• D.

C. Conditional Payments
Explanation
Conditional Payments refer to payments made by Medicare when another payer is responsible for payment, but the claim is not expected to be paid promptly. These payments are made on a temporary basis and are subject to reimbursement by the primary payer once they have made their payment. Conditional Payments are typically made when there is a delay or dispute in determining the primary payer, and Medicare steps in to cover the costs in the meantime.

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• 35.

### What is a written authorization, signed by the policyholder to an insurance company, to pay benefits directly to the hospital?

• A.

Assignment of Benefits

• B.

Medicare Secondary Payer

• C.

Conditional Payments

• D.

A. Assignment of Benefits
Explanation
Assignment of Benefits is a written authorization, signed by the policyholder, that allows an insurance company to pay benefits directly to the hospital. This means that the policyholder assigns their right to receive the insurance benefits to the hospital, so the hospital can directly receive the payment for the services provided. This is commonly used in healthcare settings where the hospital wants to ensure they receive payment for services rendered without relying on the patient to pay and then seek reimbursement from the insurance company.

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• 36.

### The assignment of benefits is usually acquired at what time?

• A.

Discharge

• B.

• C.

After Surgery

• D.

None of the above

Explanation
The assignment of benefits is usually acquired at the time of admission. This means that when a patient is admitted to a healthcare facility, they typically sign an agreement that allows the healthcare provider to directly bill their insurance company for the services rendered. This ensures that the healthcare provider will receive payment from the insurance company, rather than the patient having to pay out of pocket and then seek reimbursement.

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• 37.

### Who is primary according to the birthday rule?

• A.

Mother

• B.

Father

• C.

The plan that has covered the parent longer

• D.

The parent born first in the calendar year

D. The parent born first in the calendar year
Explanation
According to the birthday rule, the primary coverage is determined by the parent who was born first in the calendar year. This means that if both parents have coverage through different plans, the plan of the parent who has their birthday earlier in the year will be considered primary. This rule is used to determine which insurance plan will be responsible for paying claims first when a dependent child is covered by both parents' plans.

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• 38.

### Who is primary if both parents have the same birthday?

• A.

Mother

• B.

Father

• C.

The plan that has covered the parent longer

• D.

The parent born first in the calendar year

C. The plan that has covered the parent longer
Explanation
If both parents have the same birthday, the primary parent would be determined by the plan that has covered the parent longer. This means that the parent who has been covered by the insurance plan for a longer period of time would be considered the primary parent.

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• 39.

### In a divorce or separation which plan is primary?

• A.

Father

• B.

The parent who has custody

• C.

Mother

• D.

The parent that presented the child for treatment

B. The parent who has custody
Explanation
The parent who has custody is considered the primary plan in a divorce or separation. This means that they have the responsibility and authority to make decisions regarding the child's well-being, including medical treatment. They are the one who has the legal right to make decisions for the child and are responsible for their day-to-day care. The parent who presented the child for treatment may have a role in the child's healthcare, but ultimately, the parent with custody has the primary authority.

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• 40.

### Benefits of electronic billing include all of the following except:

• A.

Provides proof of receipt

• B.

Less paper

• C.

Provides better follow-up capabilities

• D.

Attachments can be sent electronically

D. Attachments can be sent electronically
Explanation
Electronic billing offers several benefits, such as providing proof of receipt, reducing the need for paper, and enabling better follow-up capabilities. However, the statement "Attachments can be sent electronically" is not a benefit of electronic billing, but rather a feature that is commonly associated with it. This feature allows users to easily attach supporting documents, such as invoices or receipts, to the electronic bill.

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• 41.

### Problems with electronic billing include all of the following except:

• A.

Creates challenges

• B.

Less paper

• C.

Vendor reporting is inflexible and/or not available

• D.

B. Less paper
Explanation
The correct answer is "Less paper". This is because electronic billing actually reduces the need for paper, as it allows for digital invoices and transactions to be sent and received electronically. The other options listed all highlight potential issues or challenges that can arise with electronic billing, such as creating challenges, vendor reporting being inflexible or unavailable, and upload/download issues.

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• 42.

### Elements of a Chargemaster are found in what locator fields on the UB04:

• A.

18-28

• B.

31-34

• C.

39-41

• D.

42-49

D. 42-49
Explanation
The elements of a Chargemaster are found in locator fields 42-49 on the UB04 form. These fields correspond to the Revenue Codes, HCPCS codes, and charges associated with each service or item provided by the healthcare facility. The Chargemaster is a comprehensive list of all the services and items that can be billed to the patient or their insurance, along with their corresponding charges. By referencing fields 42-49 on the UB04, healthcare providers can accurately document and bill for the services they have provided.

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• 43.

### Elements of a chargemaster include all of the following except:

• A.

Modifiers

• B.

Revenue codes

• C.

ICD-9 codes

• D.

CPT/HCPCS codes

C. ICD-9 codes
Explanation
A chargemaster is a comprehensive list of all the services and procedures provided by a healthcare facility along with their corresponding prices. It is used for billing purposes and includes various elements such as revenue codes, CPT/HCPCS codes, and modifiers. However, ICD-9 codes are not typically included in a chargemaster. ICD-9 codes are used for diagnostic coding and are not directly related to the pricing and billing of services.

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• 44.

### Department numbers are usually how many digits?

• A.

1

• B.

2

• C.

3

• D.

4

C. 3
Explanation
Department numbers are usually three digits because they provide a unique identifier for each department within an organization. Using three digits allows for a larger range of department numbers to be assigned, accommodating a larger number of departments. Additionally, three digits are easier to read and manage compared to longer numbers, making them more practical for administrative purposes.

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• 45.

### How many major diagnostic categories are there?

• A.

25

• B.

50

• C.

745

• D.

500

A. 25
Explanation
There are 25 major diagnostic categories.

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• 46.

### MS-DRG’s were created on which tiers of payments?

• A.

A major complication or comorbidity

• B.

A complication or comorbidity

• C.

No complication or comorbidity

• D.

Only A and B

• E.

All of the above

E. All of the above
Explanation
The correct answer is "All of the above". MS-DRGs (Medicare Severity Diagnosis Related Groups) were created on all tiers of payments, including major complications or comorbidities, complications or comorbidities, and no complications or comorbidities. This means that the payment system takes into account the severity of the patient's condition and any additional complications or comorbidities they may have, in order to determine the appropriate reimbursement level.

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• 47.

### MS-DRG’s result in savings to Medciare.

• A.

True

• B.

False

B. False
Explanation
MS-DRG's (Medicare Severity-Diagnosis Related Groups) do not result in savings to Medicare. In fact, MS-DRG's are a payment system used by Medicare to classify and reimburse hospitals for inpatient services based on the patient's diagnosis, severity of illness, and other factors. The purpose of MS-DRG's is to standardize payment and ensure appropriate reimbursement, but they do not inherently lead to savings for Medicare. Therefore, the statement is false.

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• 48.

### Assignment of a MS-DRG uses the following elements in order for correct selection except:

• A.

Principle diagnosis

• B.

Condition codes

• C.

Discharge Status

• D.

Surgical Procedure

B. Condition codes
Explanation
The assignment of a MS-DRG uses the principle diagnosis, discharge status, and surgical procedure to determine the appropriate code. However, condition codes are not used in the selection process. Condition codes are additional codes that provide information about the patient's health status, such as whether the patient has a specific condition or is receiving certain treatments. While condition codes are important for providing additional information, they do not directly impact the selection of the MS-DRG.

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• 49.

### How many days does CMS allow a hospital to file a subsequent inpatient DRG adjustment?

• A.

30 Days

• B.

45 Days

• C.

60 Days

• D.

90 Days

C. 60 Days
Explanation
CMS allows a hospital to file a subsequent inpatient DRG adjustment within 60 days. This means that the hospital has a window of 60 days after the initial filing to submit any necessary adjustments or corrections to the inpatient DRG. This timeframe allows the hospital to review and assess the accuracy of the initial filing and make any necessary changes within a reasonable period.

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• 50.

### Resource Utilization Groups are used to assess payment for which facilities:

• A.

Skilled Nursing Facility

• B.

Inpatient Hospital

• C.

Outpatient Hospital

• D.

Ambulatory Surgical Facility

A. Skilled Nursing Facility
Explanation
Resource Utilization Groups (RUGs) are a classification system used to assess payment for Skilled Nursing Facilities (SNFs). RUGs categorize patients based on their level of care needs, such as therapy services, nursing care, and activities of daily living. This classification helps determine the appropriate reimbursement rate for each patient in an SNF. RUGs are not used to assess payment for Inpatient Hospitals, Outpatient Hospitals, or Ambulatory Surgical Facilities.

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• Current Version
• Feb 19, 2024
Quiz Edited by
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• Nov 16, 2010
Quiz Created by
Brandy Cummins

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