CCA medical billing and reimbursement
ACTUAL QUESTIONS AND CORRECT
ANSWERS
the case mix management system that utilizes information from the minimum data set in
longterm care settings is called - CORRECT ANSWERS✅✅resource utilization groups
(rug)
the prospective payment system used to reimburse home health agencies for patients with
medicare utilizes data from the - CORRECT ANSWERS✅✅Oasis(outcome and assessment
information set
under APCs, the payment status indicator N means that the payment - CORRECT
ANSWERS✅✅is packaged into the payment for other services
all of the following items are packaged under the medicare asc payments except..implanted
prosthetic devices, medical supplies, splints and casts - CORRECT
ANSWERS✅✅brachytherapy
under the rbrvs, each hcpcs/cpt code contains threee components, each having assigned
relative value units, these are - CORRECT ANSWERS✅✅physician work, practice
expense, and malpractice insurance expense
the prospective payment system used to reimburse hospitals for medicare hospital outpatients
is called - CORRECT ANSWERS✅✅APC's
the medicare patient was seen by dr. Zachary, who is a nonparticipating physician. the charge
for the office visit was 125. the medicare beneficiary had already met his deductible the
medicare fee schedule amount is 100. dr zachary does not accept assignment. the office
manager will apply a practice termed as balance billing, which means the patient is -
CORRECT ANSWERS✅✅financially liable for charges in excess of the medicare fee
schedule, up to a limit
, the prospective payment system based on resource utilization groups (rugs) is used for
reimbursement to_________for patients with medicare - CORRECT ANSWERS✅✅skilled
nursing facilities
the ________ is a statement sent to the provider to explain payments made by third party
payers - CORRECT ANSWERS✅✅remittance advice
hipaa administrative simplification provisions require all of the following code sets to be used
except......ICD-10-cm, CDT, CPT - CORRECT ANSWERS✅✅DSM
the computer to computer transfer of data between providers and third party payers in a data
format agreed upon by both parties is called - CORRECT ANSWERS✅✅edi electronic data
interchange
a computer software program that assigns appropriate Ms-DRGs according to the information
provided for each episode of care is called - CORRECT ANSWERS✅✅grouper
the standard claim form used by hospitals to request reimbursement for inpatient and
outpatient procedures performed or services provided is called the - CORRECT
ANSWERS✅✅UB-04
under ASC PPS, when multiple procedures are performed during the same surgical session, a
payment reduction is applied. the procedure in the highest level group is reimbursed at_____
and all remaining procedures are reimbursed at_____ - CORRECT ANSWERS✅✅100%
50%
the _________ refers to a statement sent to the patient to show how much the provider billed,
how much medicare reimbursed the provider, and what the patient must pay the provider -
CORRECT ANSWERS✅✅medicare summary notice
currently, which prospective payment system is used to determine the payment to the
physician for physician services covered under medicare part B, such as outpatient surgery
performed on a medicare pt - CORRECT ANSWERS✅✅ASC PPS
ACTUAL QUESTIONS AND CORRECT
ANSWERS
the case mix management system that utilizes information from the minimum data set in
longterm care settings is called - CORRECT ANSWERS✅✅resource utilization groups
(rug)
the prospective payment system used to reimburse home health agencies for patients with
medicare utilizes data from the - CORRECT ANSWERS✅✅Oasis(outcome and assessment
information set
under APCs, the payment status indicator N means that the payment - CORRECT
ANSWERS✅✅is packaged into the payment for other services
all of the following items are packaged under the medicare asc payments except..implanted
prosthetic devices, medical supplies, splints and casts - CORRECT
ANSWERS✅✅brachytherapy
under the rbrvs, each hcpcs/cpt code contains threee components, each having assigned
relative value units, these are - CORRECT ANSWERS✅✅physician work, practice
expense, and malpractice insurance expense
the prospective payment system used to reimburse hospitals for medicare hospital outpatients
is called - CORRECT ANSWERS✅✅APC's
the medicare patient was seen by dr. Zachary, who is a nonparticipating physician. the charge
for the office visit was 125. the medicare beneficiary had already met his deductible the
medicare fee schedule amount is 100. dr zachary does not accept assignment. the office
manager will apply a practice termed as balance billing, which means the patient is -
CORRECT ANSWERS✅✅financially liable for charges in excess of the medicare fee
schedule, up to a limit
, the prospective payment system based on resource utilization groups (rugs) is used for
reimbursement to_________for patients with medicare - CORRECT ANSWERS✅✅skilled
nursing facilities
the ________ is a statement sent to the provider to explain payments made by third party
payers - CORRECT ANSWERS✅✅remittance advice
hipaa administrative simplification provisions require all of the following code sets to be used
except......ICD-10-cm, CDT, CPT - CORRECT ANSWERS✅✅DSM
the computer to computer transfer of data between providers and third party payers in a data
format agreed upon by both parties is called - CORRECT ANSWERS✅✅edi electronic data
interchange
a computer software program that assigns appropriate Ms-DRGs according to the information
provided for each episode of care is called - CORRECT ANSWERS✅✅grouper
the standard claim form used by hospitals to request reimbursement for inpatient and
outpatient procedures performed or services provided is called the - CORRECT
ANSWERS✅✅UB-04
under ASC PPS, when multiple procedures are performed during the same surgical session, a
payment reduction is applied. the procedure in the highest level group is reimbursed at_____
and all remaining procedures are reimbursed at_____ - CORRECT ANSWERS✅✅100%
50%
the _________ refers to a statement sent to the patient to show how much the provider billed,
how much medicare reimbursed the provider, and what the patient must pay the provider -
CORRECT ANSWERS✅✅medicare summary notice
currently, which prospective payment system is used to determine the payment to the
physician for physician services covered under medicare part B, such as outpatient surgery
performed on a medicare pt - CORRECT ANSWERS✅✅ASC PPS
