CODING 001 Outpatient Coding Exam Set A Questions and Correct Answers Graded Highest 100% A++
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Course
Medical Billing and Coding
Institution
Medical Billing And Coding
How long are the payment blocks for home health services? - CORRECT ANSWER -30
days
How many payment groups does the PDGM create? - CORRECT ANSWER -a lot more
than the previous model (better).
- 432 possible payment groups
In contrast to non-outpatient settings, how is the outpatient secto...
CODING 001 Outpatient Coding Exam Set A
Questions and Correct Answers Graded Highest 100%
A++
How long are the payment blocks for home health services? - CORRECT ANSWER ✔✔ -30
days
How many payment groups does the PDGM create? - CORRECT ANSWER ✔✔ -a lot more
than the previous model (better).
- 432 possible payment groups
In contrast to non-outpatient settings, how is the outpatient sector reimbursed? - CORRECT
ANSWER ✔✔ -the outpatient sector is a 'fee for service' structure, where reimbursement is
based on the CARE provided
In contrast to outpatient settings, how is the inpaitent sector reimbursed? - CORRECT ANSWER
✔✔ -based on characteristics of the pt and the resources (on average) those pts with those
characteristics require.
Payment for home health services (PDGM model) are based on: - CORRECT ANSWER ✔✔ --
ICD-10 codes (diagnosis) and OASIS (outcome & assessment information set)
- it is based on clinical characteristics and complexity (comorbidities) of the pts diagnosis.
T/F a patient can leave the home infrequently for short durations and still be considered
'homebound'. - CORRECT ANSWER ✔✔ -T
T/F a patient can receive both outpatient and home-health PT at the the same time. - CORRECT
ANSWER ✔✔ -F
What 5 criteria need to be certified by a physician before a patient qualifies for home health care
via Medicare? - CORRECT ANSWER ✔✔ -1. pt is confined to the home ***(most important to
know)
2. pt needs skilled services
3. is under the care of a physician
4. receives services under a plan of care established and reviewed by a physician
5. had a face-to-face encounter with a physician or allowed non-physical practitioner
What are the first two criteria of being 'confined to be the home'? (one of the following must be
met) - CORRECT ANSWER ✔✔ -1. needs supportive device, use of special transportation, or
assistance by another person to leave the home
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