THE BUSINESS OF MEDICINE
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
What is coding? - ANSWER Process of translating written or dictated medical records into a series of
numeric or alpha-numeric codes.
What three things do separate code sets describe? - ANSWER Diagnoses, medical and surgical
services/procedures and supplies
Codes sets serve as a common language for doing what three things? - ANSWER data
collection(ie.tracking disease), evaluate the quality of care and to determine costs and reimbursements
What is another name for a mid-level provider? - ANSWER Physician extenders
What are two examples of physician extenders? - ANSWER Physician assistants or PA and nurse
practitioners or NP
What are the two primary types of insurers? - ANSWER Private insurance plans and government
insurance plans
Who administers Medicare? - ANSWER Centers for Medicare and Medicaid Services or CMS
Name the three groups that Medicare covers? - ANSWER People over 65, blind or disabled individuals
and people with permanent kidney failure or end stage renal disease (ESRD)
How many parts does Medicare have? - ANSWER Four, A, B, C, D
Explain Medicare Part A? - ANSWER Covers inpatient hospital care, including skilled nursing facilities,
hospice care and home health care
, Medicare Part B? - ANSWER Covers medically necessary physicians' services, outpatient care and other
medical services including some preventative services not covered under Part A. This is an optional
benefit where the patient must pay a premium and typically requires a deductible and co-insurance
Part C? - ANSWER Also called Medicare Advantage, combines Part A, Part B and sometimes Part D. The
plans are managed by private insurers approved by Medicare
Part D? - ANSWER Prescription drug coverage available to all Medicare beneficiaries. Private companies
approved by Medicare provide coverage.
Medicare uses RBRVS for payments for physicians services. What does RBRVS mean? - ANSWER Because
the rates are standardized, they use a resource-based relative value scale or (RBRVS)
Resources costs are divided into what three components? - ANSWER Physician work,practice expense
and professional liability insurance
What percent of the total relative values does the physician work component have? - ANSWER 52%,
which is measured by the time it takes to perform the service, technical/physical effort, mental effort
and judgement and stress due to potential risk to the patient
What percent does practice expense account for? - ANSWER 44%,these are resource-based and differ by
site of service as the expense of providing a service is different in a hospital than it is in a doctor's office
What percent does the professional liability insurance (PLI) component account for? - ANSWER 4% for
each service
When is the Physician Fee Schedule (PFS) published? - ANSWER annually
What does PE stand for? - ANSWER Physician Expense
What does MP stand for? - ANSWER Malpractice
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
What is coding? - ANSWER Process of translating written or dictated medical records into a series of
numeric or alpha-numeric codes.
What three things do separate code sets describe? - ANSWER Diagnoses, medical and surgical
services/procedures and supplies
Codes sets serve as a common language for doing what three things? - ANSWER data
collection(ie.tracking disease), evaluate the quality of care and to determine costs and reimbursements
What is another name for a mid-level provider? - ANSWER Physician extenders
What are two examples of physician extenders? - ANSWER Physician assistants or PA and nurse
practitioners or NP
What are the two primary types of insurers? - ANSWER Private insurance plans and government
insurance plans
Who administers Medicare? - ANSWER Centers for Medicare and Medicaid Services or CMS
Name the three groups that Medicare covers? - ANSWER People over 65, blind or disabled individuals
and people with permanent kidney failure or end stage renal disease (ESRD)
How many parts does Medicare have? - ANSWER Four, A, B, C, D
Explain Medicare Part A? - ANSWER Covers inpatient hospital care, including skilled nursing facilities,
hospice care and home health care
, Medicare Part B? - ANSWER Covers medically necessary physicians' services, outpatient care and other
medical services including some preventative services not covered under Part A. This is an optional
benefit where the patient must pay a premium and typically requires a deductible and co-insurance
Part C? - ANSWER Also called Medicare Advantage, combines Part A, Part B and sometimes Part D. The
plans are managed by private insurers approved by Medicare
Part D? - ANSWER Prescription drug coverage available to all Medicare beneficiaries. Private companies
approved by Medicare provide coverage.
Medicare uses RBRVS for payments for physicians services. What does RBRVS mean? - ANSWER Because
the rates are standardized, they use a resource-based relative value scale or (RBRVS)
Resources costs are divided into what three components? - ANSWER Physician work,practice expense
and professional liability insurance
What percent of the total relative values does the physician work component have? - ANSWER 52%,
which is measured by the time it takes to perform the service, technical/physical effort, mental effort
and judgement and stress due to potential risk to the patient
What percent does practice expense account for? - ANSWER 44%,these are resource-based and differ by
site of service as the expense of providing a service is different in a hospital than it is in a doctor's office
What percent does the professional liability insurance (PLI) component account for? - ANSWER 4% for
each service
When is the Physician Fee Schedule (PFS) published? - ANSWER annually
What does PE stand for? - ANSWER Physician Expense
What does MP stand for? - ANSWER Malpractice
