CCA medical billing and reimbursement Exam Questions with Complete Solutions

CCA medical billing and reimbursement Exam Questions with Complete Solutions the case mix management system that utilizes information from the minimum data set in longterm care settings is called - ANSWER resource utilization groups (rug) the prospective payment system used to reimburse home health agencies for patients with medicare utilizes data from the - ANSWER Oasis(outcome and assessment information set under APCs, the payment status indicator N means that the payment - ANSWER 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 - ANSWER brachytherapy under the rbrvs, each hcpcs/cpt code contains threee components, each having assigned relative value units, these are - ANSWER physician work, practice expense, and malpractice insurance expense the prospective payment system used to reimburse hospitals for medicare hospital outpatients is called - ANSWER 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 - ANSWER 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 - ANSWER skilled nursing facilities the ________ is a statement sent to the provider to explain payments made by third party payers - ANSWER remittance advice hipaa administrative simplification provisions require all of the following code sets to be used except......ICD-10-cm, CDT, CPT - ANSWER 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 - ANSWER 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 - ANSWER grouper the standard claim form used by hospitals to request reimbursement for inpatient and outpatient procedures performed or services provided is called the - ANSWER 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_____ - ANSWER 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 - ANSWER 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 - ANSWER ASC PPS when the Ms-drg payment received by the hospital is lower than the actual charges for providing the inpatient services for a patient with medicare, then the hospital - ANSWER absorbs the loss under ASC PPS, bilateral procedures are reimbursed at ______ - ANSWER 150% the health insurance portability and accountability act requires the retention of health insurance claims and accounting records for a min of ___years, unless state law specifies a longer period - ANSWER 6 _______is knowingly making false statements or representation of material facts to obtain a benefit or payment for which no entitlement would otherwise exist - ANSWER fraud these are assigned to every hcpcs-cpt code under the medicare hospital outpatient prospective payment system to identify how the service or procedure described by the code would be paid - ANSWER payment status indicator