Use the following contract matrix to answer the following question. Payer Inpatient Services Outpatient Services A...
Use the following contract matrix to answer the following question.
|
Payer |
Inpatient Services |
Outpatient Services |
|
A |
62% billed charges |
56% of billed charges |
|
B |
$6,500 obstetric delivery case rate |
Fee Schedule |
|
$70 per clinic visit |
||
|
$85 per initial OT evaluation |
||
|
$50 per OT visit (non-eval) |
||
|
C |
$2,100 obstetric delivery per diem |
$75 per clinic visit |
|
$45 per OT visit |
||
|
D |
$6,350 obstetric delivery case rate |
$65 per clinic visit |
|
$55 per initial OT evaluation |
||
|
$35 per OT visit (non-eval) |
Patient 89423 is seen in the outpatient clinic at Happy Hospital for a pneumonia follow-up visit. The charges for the encounter total $135.00. Which payer will reimburse the hospital the lowest amount?
Homework Answers
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Use the following contract matrix to answer the
following question.
Payer
Inpatient Services
Outpatient Services
A...
Patient 72341 is admitted as an inpatient for delivery. Length of stay is 3 days. The...
Patient 72341 is admitted as an inpatient for delivery. Length
of stay is 3 days. The charges for the encounter are $10,425. The
cost of the encounter is $5,848.45. Which payer will reimburse the
hospital the highest amount?
Payer Inpatient Services 62% billed charges $6,500 obstetric delivery case rate Outpatient Services 56% of billed charges Fee Schedule $70 per clinic visit $85 per initial OT evaluation $50 per OT visit (non-eval) $75 per clinic visit $45 per OT visit $65...
Overview in the outpatient setting the first sted diagnosis is reported (instead of the inpatient setting's...
Overview in the outpatient setting the first sted diagnosis is reported (instead of the inpatient setting's principal diagnosis), and it is the condition chiefly responsible for the outpatient services provided during the encounter visit. It is determined in accordance with ICD-10-CM coding conventions (or rules) as well as general and disease specific coding guidelines. Because diagnoses are often not established at the time of the patient's initial encounter or visit, two or more visits may be required before the diagnosis...
Direction Use your CPT manual to code the following services from Evaluation & managment section! 11....
Direction Use your CPT manual to code the following services
from Evaluation & managment section!
11. Dr. Schrute telephoned Angela Martin to report on the test results of her laboratory work and tests that included SMA-12, lipid panel, TSH, Complete Blood Count, Chest X-ray, and EKG. The call lasted 12 minutes and was 8 days after lab specimens were collected. Code(s): 12. Toby Flenderson, a 60-year-old established patient, was seen by Dr, Schrute for an annual routine preventive medicine examination....
QUESTION 1 Physicians and mid-level practitioners (NPs and PAs) use which coding system to capture their...
QUESTION 1 Physicians and mid-level practitioners (NPs and PAs) use which coding system to capture their professional fees? A. DSM-5 B. CPT/HCPCS C. ICD-10-PCS D. ICD-10-CM 10 points QUESTION 2 Choose the best answer. Because each CPT/HCPCS code has its own separate fee, are coders allowed to code all services separately? A. Yes. In order to properly capture all charges, every CPT and HCPCS code should be coded separately to optimize reimbursement. B. No. A coder can only choose...
Instructions Assign ICD-10-CM codes to the following diagnostic statements. When multiple codes are assigned, make sure...
Instructions Assign ICD-10-CM codes to the following diagnostic statements. When multiple codes are assigned, make sure you sequence them property according to coding conventions and guidelines, including the definition of first-listed diagnosis. Refer to the diagnostic coding and reporting guidelines for outpatient services in your textbook when assigning codes. Fever, difficulty swallowing, acute tonsilitis Chest pain, rule out arteriosclerotic heart disease 2 3 Hypertension, acute bronchitis, family history of lung cancer Lipoma, subcutaneous tissue of left thigh 4. Audible wheezing,...
QUESTION 4 On the day of Max's discharge from the hospital, the attending physician asked him...
QUESTION 4 On the day of Max's discharge from the hospital, the attending physician asked him questions and provided information such as Max's final diagnosis, prognosis, the results of various diagnostic tests, and necessary follow-up in the outpatient setting. The provider created two medical records for this same date of service. A progress note for the day of discharge records the physicians review of diagnostic tests, assessment of the patient's condition, and decision to discharge home. The discharge summary provides...
QUESTION 1 Which modifier would a radiologist append to the CPT code to reflect that charges...
QUESTION 1 Which modifier would a radiologist append to the CPT code to reflect that charges were only for "interpretation and report?" A. 53 B. TC C. 22 D. 76 E. 26 F. 25 10 points QUESTION 2 Any CPT code designated as a "separate procedure" is only coded and billed when? A. When bills are not submitted to Medicare B. When it is not considered a component of another procedure C. When the physician demands separate payment for...
Use the answer sheet provided for the project to identify which (if any) of the events...
Use the answer sheet provided for the project to identify which (if any) of the events or sitautions described happened in each cases. Use our report template to create a report for the medical staff review committee. Under conclusion discuss one process change that can be implemented to reduce risk exposure and provide at least two ways in which change can be managed smoothly when implementing the new process. Presume you are a data analyst in the hospital health information...
1. Focusing on only the inpatient care cost (i.e., ignoring operating room costs), what is the...
1. Focusing on only the inpatient care cost (i.e., ignoring
operating room costs), what is the cost of a TAH (non-oncology)
under each of the cost accounting systems? A tuboplasty? A TAH
(oncology)? What accounts for the differences?
Croswell University Hospital This report doesn't describe where our costs are generated. We're applying one standard to all patients, regardless of their level of care. What incentive is there to identify and account for the costs of each type of procedure? Unless...
Overview CPT modiners clanly services and procedures performed by providers. Although the CPT code and description...
Overview CPT modiners clanly services and procedures performed by providers. Although the CPT code and description remain unchanged, modifiers indicate that the description of the service or procedure performed has been altered. CPT modifiers are reported as two-digit numeric codes added to the five digit CPT code. (HCPCS level Il national modifiers are reported as two character alphabetical and alphanumeric codes added to the five-digit CPT or HCPCS level Il code.) Instructions Circle the most appropriate response 1. Dr. Marshall...
Patient 72341 is admitted as an inpatient for delivery. Length
of stay is 3 days. The charges for the encounter are $10,425. The
cost of the encounter is $5,848.45. Which payer will reimburse the
hospital the highest amount?
Payer Inpatient Services 62% billed charges $6,500 obstetric delivery case rate Outpatient Services 56% of billed charges Fee Schedule $70 per clinic visit $85 per initial OT evaluation $50 per OT visit (non-eval) $75 per clinic visit $45 per OT visit $65...
Overview in the outpatient setting the first sted diagnosis is reported (instead of the inpatient setting's principal diagnosis), and it is the condition chiefly responsible for the outpatient services provided during the encounter visit. It is determined in accordance with ICD-10-CM coding conventions (or rules) as well as general and disease specific coding guidelines. Because diagnoses are often not established at the time of the patient's initial encounter or visit, two or more visits may be required before the diagnosis...
Direction Use your CPT manual to code the following services
from Evaluation & managment section!
11. Dr. Schrute telephoned Angela Martin to report on the test results of her laboratory work and tests that included SMA-12, lipid panel, TSH, Complete Blood Count, Chest X-ray, and EKG. The call lasted 12 minutes and was 8 days after lab specimens were collected. Code(s): 12. Toby Flenderson, a 60-year-old established patient, was seen by Dr, Schrute for an annual routine preventive medicine examination....
Instructions Assign ICD-10-CM codes to the following diagnostic statements. When multiple codes are assigned, make sure you sequence them property according to coding conventions and guidelines, including the definition of first-listed diagnosis. Refer to the diagnostic coding and reporting guidelines for outpatient services in your textbook when assigning codes. Fever, difficulty swallowing, acute tonsilitis Chest pain, rule out arteriosclerotic heart disease 2 3 Hypertension, acute bronchitis, family history of lung cancer Lipoma, subcutaneous tissue of left thigh 4. Audible wheezing,...
1. Focusing on only the inpatient care cost (i.e., ignoring
operating room costs), what is the cost of a TAH (non-oncology)
under each of the cost accounting systems? A tuboplasty? A TAH
(oncology)? What accounts for the differences?
Croswell University Hospital This report doesn't describe where our costs are generated. We're applying one standard to all patients, regardless of their level of care. What incentive is there to identify and account for the costs of each type of procedure? Unless...
Overview CPT modiners clanly services and procedures performed by providers. Although the CPT code and description remain unchanged, modifiers indicate that the description of the service or procedure performed has been altered. CPT modifiers are reported as two-digit numeric codes added to the five digit CPT code. (HCPCS level Il national modifiers are reported as two character alphabetical and alphanumeric codes added to the five-digit CPT or HCPCS level Il code.) Instructions Circle the most appropriate response 1. Dr. Marshall...
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