A case that cannot be assigned an appropriate Diagnosis Related Group (DRG) because of an atypical situation is called a(n):
misdiagnosis.
cost differential.
cost outlier.
unsubstantiated claim.
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Q. 2) Most major diagnostic categories (MDCs) are based on:
a particular organ system.
number of diagnoses.
age of the patient.
health status of the patient.
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Q. 3) The method of reimbursement that pays hospitals a fixed rate per day for all services provided is:
capitation.
fee for service.
per diem.
prospective payment system.
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Q. 4) The key elements in determining the level of evaluation and management (E/M) services include the extent of the history, physical exam, and medical decision making.
Indicate whether this statement is true or false.
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Q. 5) A prospective audit would typically be done on claims that require an attachment or more information.
Indicate whether this statement is true or false.
(
Q. 6) Which services covered under Medicaid are exempt from copayments?
What will be an ideal response?
(
Q. 7) The person who is ultimately responsible for paying for medical services is known as the __________ .
Fill in the blank with correct word.
(
Q. 8) What is meant by the birthday rule?
What will be an ideal response?
(
Q. 9) If documentation in the patient chart supports a higher level of service than that coded, the error would be called:
upcoding.
downcoding.
bundling.
unbundling.
(
Q. 10) An internal audit would determine:
the coders' skill and knowledge.
whether procedures were coded correctly.
if additional training is needed for office staff.
all of the above.
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