HCM 425 Final Exam Questions with Correct
Solutions
1. The Resource-Based Relative Value Scale (RBRVS) system is also known as: -
Medicare Physician Fee Schedule.
2. Which reimbursement system establishes rates in advance of services and is based on
reported charges from which a per diem rate is determined?: prospective cost-based
3. The Deficit Reduction Act of established the
Medicare clinical laboratory fee schedule.: 1984
4. Sally Brown registered as an outpatient at the hospital for three encounters: chest x-ray, gait
training physical therapy, and excision of lesion from right up- per arm. Ambulatory patient
classification (APC) reimbursement will be based on the: assignment of multiple APCs that reflect all services
provided, with discounting.
5. An episode of care in the home health prospective payment system (HHPPS) is
days.: 60
6. In which year was the inpatient prospective payment system implemented?-
: 1983
7. Which type of hospital is excluded from the inpatient prospective payment system?:
cancer
8. The IPPS window requires outpatient preadmission services provided by a hospital up
to prior to a patient's inpatient admission to be covered by the IPPS MS-DRG
payment.: 72 hours
1/
10
, 9. Which is a relative value unit (RVU) in the Medicare physician fee schedule payment
system?: practice expense
10. Medicare Part B radiology services payments vary according to: place of service
11. The physician fee schedule for CPT code 99214 is $75. Calculate the nonPAR
limiting charge for this service.: $81.94
12. The physician fee schedule for CPT code 99214 is $75. Calculate the nonPAR
allowed charge for this service.: $81.94
13. The intent of establishing a limiting charge for nonPARs is to: protect Medicare enrolls
financially
14. Which is classified as a nonphysician practitioner?: physician assistant
15. Which publication communicates new or changed policies and procedures that
are being incorporated into a specific CMS manual?: program transmittal
16. When an office-based service is performed in a health care facility, payment is
affected by the use of: a site of service differential
17. Medicare Secondary Payer (MSP) refers to situations in which the Medicare program
does not have primary responsibility for paying a beneficiary's med- ical expenses. For
which of the following payers would Medicare be considered primary?: medicaid
18. Diagnosis and procedure codes that are entered incorrectly during billing and
claims processing result in by the third-party payer.: denied and rejected claims
19. The analysis of reimbursement received from third-party payers identifies
variations in expected payments or contracted rates and may result in submis- sion of to
third-party payers.: appeal letters
2/
10
Solutions
1. The Resource-Based Relative Value Scale (RBRVS) system is also known as: -
Medicare Physician Fee Schedule.
2. Which reimbursement system establishes rates in advance of services and is based on
reported charges from which a per diem rate is determined?: prospective cost-based
3. The Deficit Reduction Act of established the
Medicare clinical laboratory fee schedule.: 1984
4. Sally Brown registered as an outpatient at the hospital for three encounters: chest x-ray, gait
training physical therapy, and excision of lesion from right up- per arm. Ambulatory patient
classification (APC) reimbursement will be based on the: assignment of multiple APCs that reflect all services
provided, with discounting.
5. An episode of care in the home health prospective payment system (HHPPS) is
days.: 60
6. In which year was the inpatient prospective payment system implemented?-
: 1983
7. Which type of hospital is excluded from the inpatient prospective payment system?:
cancer
8. The IPPS window requires outpatient preadmission services provided by a hospital up
to prior to a patient's inpatient admission to be covered by the IPPS MS-DRG
payment.: 72 hours
1/
10
, 9. Which is a relative value unit (RVU) in the Medicare physician fee schedule payment
system?: practice expense
10. Medicare Part B radiology services payments vary according to: place of service
11. The physician fee schedule for CPT code 99214 is $75. Calculate the nonPAR
limiting charge for this service.: $81.94
12. The physician fee schedule for CPT code 99214 is $75. Calculate the nonPAR
allowed charge for this service.: $81.94
13. The intent of establishing a limiting charge for nonPARs is to: protect Medicare enrolls
financially
14. Which is classified as a nonphysician practitioner?: physician assistant
15. Which publication communicates new or changed policies and procedures that
are being incorporated into a specific CMS manual?: program transmittal
16. When an office-based service is performed in a health care facility, payment is
affected by the use of: a site of service differential
17. Medicare Secondary Payer (MSP) refers to situations in which the Medicare program
does not have primary responsibility for paying a beneficiary's med- ical expenses. For
which of the following payers would Medicare be considered primary?: medicaid
18. Diagnosis and procedure codes that are entered incorrectly during billing and
claims processing result in by the third-party payer.: denied and rejected claims
19. The analysis of reimbursement received from third-party payers identifies
variations in expected payments or contracted rates and may result in submis- sion of to
third-party payers.: appeal letters
2/
10
