Reimbursement Methodologies: Final Examination
Final Examination Booklet
Reimbursement Methodologies
Examination Examination
1
Reimbursement Methodologies Final Examination
EXAMINATION NUMBER:
40976200
Whichever method you use in submitting your exam answers to the school, you must use the number above. For the quickest test results, go to http://www.takeexamsonline.com
You must type all of the answers to the examination questions. Include your name, address, and student number on the top of the first page of your exam answers. Use the exam number 40976200. Be certain to indicate the proper question number before each of your answers. To submit your answers online, go to http://www.takeexamsonline.com and attach your answers as a Word document. If you don’t have access …show more content…
Each answer is worth four points. 1. You work in the hospital’s health information management department. Part of your job is to assist the medical residents with completing records documentation. One of the residents complains that he doesn’t understand why insurance companies need so much documentation and the reimbursement system is so complex. How do you respond? 2. Mary was receiving Medicaid in Texas. When she moves to California, can Mary assume that she’ll receive the same coverage there? 3. Compare point-of-service (POS) plans with health maintenance organization (HMO) plans. 4. You’re an inpatient coder in a hospital. You’ve just coded a Medicare Part A record with a diagnosis-related group (DRG) reimbursement of $12,000. You notice in the hospital’s computer billing system that the patient’s charges are $19,500. That’s $7,500 more than the hospital will be reimbursed. How does the difference between the charges and the DRG reimbursement become resolved? 5. You work in a physician’s office performing billing. You notice that guidelines haven’t been followed accurately in completing the claim form. What will happen if you don’t correct the claim form? 6. Why did the Centers for Medicare and Medicaid Services (CMS) implement the National Correct Coding Initiative in 1996? 7. List some of the risk areas that can be identified through the auditing …show more content…
You’re an HMO director. You would like to ensure that your managed care plan is meeting industry standards. What’s one way that you can do this? 9. You work for a third-party payer performing medical records review. Your job is to match codes that were submitted on the claim to documentation in the medical record. You notice that a code has been input for a colonoscopy procedure, but you don’t see the procedure report anywhere in the record. As the third-party payer representative, what will your action be regarding the code that was submitted on the claim form? 10. You’re reviewing reimbursement for a Medicare surgical craniotomy case. The case falls into DRG 1, which has a relative weight of 3.0970 and a geometric mean length of stay of 6.3. The hospital’s current standard reimbursement rate is $1500. Calculate the DRG reimbursement for this
Reimbursement Methodologies
Examination Examination
1
Reimbursement Methodologies Final Examination
EXAMINATION NUMBER:
40976200
Whichever method you use in submitting your exam answers to the school, you must use the number above. For the quickest test results, go to http://www.takeexamsonline.com
You must type all of the answers to the examination questions. Include your name, address, and student number on the top of the first page of your exam answers. Use the exam number 40976200. Be certain to indicate the proper question number before each of your answers. To submit your answers online, go to http://www.takeexamsonline.com and attach your answers as a Word document. If you don’t have access …show more content…
Each answer is worth four points. 1. You work in the hospital’s health information management department. Part of your job is to assist the medical residents with completing records documentation. One of the residents complains that he doesn’t understand why insurance companies need so much documentation and the reimbursement system is so complex. How do you respond? 2. Mary was receiving Medicaid in Texas. When she moves to California, can Mary assume that she’ll receive the same coverage there? 3. Compare point-of-service (POS) plans with health maintenance organization (HMO) plans. 4. You’re an inpatient coder in a hospital. You’ve just coded a Medicare Part A record with a diagnosis-related group (DRG) reimbursement of $12,000. You notice in the hospital’s computer billing system that the patient’s charges are $19,500. That’s $7,500 more than the hospital will be reimbursed. How does the difference between the charges and the DRG reimbursement become resolved? 5. You work in a physician’s office performing billing. You notice that guidelines haven’t been followed accurately in completing the claim form. What will happen if you don’t correct the claim form? 6. Why did the Centers for Medicare and Medicaid Services (CMS) implement the National Correct Coding Initiative in 1996? 7. List some of the risk areas that can be identified through the auditing …show more content…
You’re an HMO director. You would like to ensure that your managed care plan is meeting industry standards. What’s one way that you can do this? 9. You work for a third-party payer performing medical records review. Your job is to match codes that were submitted on the claim to documentation in the medical record. You notice that a code has been input for a colonoscopy procedure, but you don’t see the procedure report anywhere in the record. As the third-party payer representative, what will your action be regarding the code that was submitted on the claim form? 10. You’re reviewing reimbursement for a Medicare surgical craniotomy case. The case falls into DRG 1, which has a relative weight of 3.0970 and a geometric mean length of stay of 6.3. The hospital’s current standard reimbursement rate is $1500. Calculate the DRG reimbursement for this