CDEO - Chapter 5, Coding and Reimbursement Exam Questions and Answers Graded A+
RBRVS - Answers Resource-Based Relative Value Scale
What is RBRVS? - Answers RBRVS is a system established by Medicare to reimburse physicians
based on the CPT code submitted (FFS). (e.g. the more codes, the more money paid to
providers)
RVU - Answers Relative Value Unit
What is the RVU? - Answers Each CPT code has a RVU assigned to it.
What 3 components comprise the RVU? - Answers The RVU is comprised of:
Physician Work (doctor's work)
Practice Expense (office's overhead)
Professional Liability/Malpractice Insurance
What does the RVU do? - Answers When RVU is multiplied by a conversion factor and a
geographic region adjustment allowance, the reimbursement amount for a medical service is
created.
RVU * CF * GRAA = reimbursement to provider
What is the Global Surgery Package? - Answers The Global Surgery Package is a bundled
payment for the time, effort and services required to complete a procedure.
What are the preop and postop periods for a Minor Surgical Procedure? - Answers Preop - 0
days preoperative period
Postop - 10-day postoperative period
What are the preop and postop periods for a Major Surgical Procedure? - Answers Preop - 1 day
preoperative period
Postop - 90-day postoperative period
NCCI - Answers National Correct Coding Initiative
What is the NCCI? - Answers NCCI is implemented by CMS to promote correct coding
methodologies and to control improper assignment of codes (which would make
reimbursement incorrect).
NCCI includes CCM. What is CCM? - Answers CCM is Correct Coding Modifier, which is a 0 or 1
or 9.
RBRVS - Answers Resource-Based Relative Value Scale
What is RBRVS? - Answers RBRVS is a system established by Medicare to reimburse physicians
based on the CPT code submitted (FFS). (e.g. the more codes, the more money paid to
providers)
RVU - Answers Relative Value Unit
What is the RVU? - Answers Each CPT code has a RVU assigned to it.
What 3 components comprise the RVU? - Answers The RVU is comprised of:
Physician Work (doctor's work)
Practice Expense (office's overhead)
Professional Liability/Malpractice Insurance
What does the RVU do? - Answers When RVU is multiplied by a conversion factor and a
geographic region adjustment allowance, the reimbursement amount for a medical service is
created.
RVU * CF * GRAA = reimbursement to provider
What is the Global Surgery Package? - Answers The Global Surgery Package is a bundled
payment for the time, effort and services required to complete a procedure.
What are the preop and postop periods for a Minor Surgical Procedure? - Answers Preop - 0
days preoperative period
Postop - 10-day postoperative period
What are the preop and postop periods for a Major Surgical Procedure? - Answers Preop - 1 day
preoperative period
Postop - 90-day postoperative period
NCCI - Answers National Correct Coding Initiative
What is the NCCI? - Answers NCCI is implemented by CMS to promote correct coding
methodologies and to control improper assignment of codes (which would make
reimbursement incorrect).
NCCI includes CCM. What is CCM? - Answers CCM is Correct Coding Modifier, which is a 0 or 1
or 9.
