CCA EXAM PREP-Medical billing and Reimbursement Systems 100%

The case-mix management system that utilizes information from the Minimum Data Set (MDS) in long term care settings is called - ANSWERResource Utilization Groups (RUGs) The prospective payment system used to reimburse home health agencies for patients with Medicare utilizes data from the - ANSWEROASIS (Outcome and Assessment Information Set Under APCs, the payment status indicator "N" means that the payment - ANSWERis packaged into the payment for other services All of the following items are "packaged" under the Medicare outpatient prospective payment system, EXCEPT for - ANSWERmedical visits Under the RBRVS, each HCPCS/CPT code contains three components, each having assigned relative value units, These three components are - ANSWERphysician work, practice expense, and malpractice insurance expense The prospective payment system used to reimburse hospitals for Medicare hospital outpatients is called - ANSWERAPCs A 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 that the patient is - ANSWERfinancially 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. - ANSWERskilled nursing facilities The ________________ is a statement sent to the provider to explain payments made by third party payers - ANSWERremittance advice HIPPA administrative simplification provisions require all of the following code sets to be used EXCEPT - ANSWERDSM The computer-to-computer transfer of data between providers and third party payers in a data format agreed upon by both parties is called - ANSWERelectronic data interchange (EDI) A computer software program that assigns appropriate MS-DRGs according to the information provided for each episode of care is called a(n) - ANSWERgrouper