Medical Reimbursement

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Dr. M is receiving reimbursement based on actual charges after the patient has been treated. She's being reimbursed on a

A. retrospective, fee-for-service payment system.
B. prospective payment system.
C. indemnity system.
D. usual, customary, and reasonable charges system.

What did the government use to control skyrocketing health care costs?

A. Prospective payment system
B. Medigap
C. SCHIP
D. Retrospective payment system

What is used when billing outpatient claims?

A. CMS-1500
B. UB-92
C. CMS-1450
D. UB-4

When calculating expenses, what differs for each health care facility?

A. Base rate
B. MS-DRG relative weight
C. ICD-9-CM diagnosis codes
D. The codes that are MCCs

Which system is used to bill for services used in a skilled nursing facility?

A. RUGs
B. RBRVS
C. IPPS
D. OPPS

You're a coder who's reviewing the record of a 62-year-old woman who was admitted to the hospital with shortness of breath and minor chest pain. The doctor diagnosed the patient with Staphylococcus aureus pneumonia and you assigned a code of 482.41. Additionally, you coded decompensated chronic systolic congestive heart failure (as documented by the physician) as 428.22 and 428.0. The coding system grouped the information into MS-DRG 178 (RW: 1.4860). The hospital has a base rate of $4,500.
Which code is the principal diagnosis?


A. 482.
B. 428.22
C. 428.0
D. 178
You're a coder who's reviewing the record of a 62-year-old woman who was admitted to the hospital with shortness of breath and minor chest pain. The doctor diagnosed the patient with Staphylococcus aureus pneumonia and you assigned a code of 482.41. Additionally, you coded decompensated chronic systolic congestive heart failure (as documented by the physician) as 428.22 and 428.0. The coding system grouped the information into MS-DRG 178 (RW: 1.4860). The hospital has a base rate of $4,500.
What is the admitting diagnosis?


A. Shortness of breath
B. Staphylococcus aureus
C. Pneumonia
D. CHF

Please help me. I have done all thirty one courses by myself with no help. This is my last course and I can't figure these out.

  • Medical Reimbursement -

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    Please use your textbook, study materials, and a good search engine or two to find your answers.

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    3. Read different search results until you find what you need.

    4. Re-search with different search terms if you don't find all you need.

  • Medical Reimbursement -

    A,c,b,b,c,a,a,a,a,b,c,c

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