CCA Exam Prep - Reimbursement
Methodologies
Which of the following is not reimbursed according to the Medicare outpatient prospective payment
system?
a. CMHC partial hospitalization services
b. Critical access hospitals
c. Hospital outpatient departments
d. Vaccines provided by CORFs - Answer-b. Critical access hospitals
Effective October 16, 2003, under the Administrative Simplification Compliance section of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA), all healthcare providers must electronically
submit claims to Medicare. Which is the electronic format for hospital technical fees?
a. 837I
b. 837P
c. UB-04
d. 1500 - Answer-a. 8371
Which of the following fails to meet the CMS classification of a hospital-acquired condition?
a. Foreign object retained after surgery
b. Air embolism
,c. Gram-negative pneumonia
d. Blood incompatibility - Answer-c. Gram-negative pneumonia
Which governmental agency develops an annual work plan that delineates the specific target areas for
Medicare that will be monitored in a given year?
a. Centers for Medicare and Medicaid (CMS)
b. Federal Bureau of Investigation (FBI)
c. Office of Inspector General (OIG)
d. Defense Criminal Investigative Service (DCIS) - Answer-c. Office of Inspector General (OIG)
Which of the following types of hospitals are excluded from the Medicare inpatient prospective
payment system?
a. Children's
b. Rural
c. State supported
d. Tertiary - Answer-a. Children's
Which of the following situations would be identified by the NCCI edits?
a. Determining the MS-DRG
b. Billing for two services that are prohibited from being billed on the same day
c. Whether data submitted electronically were successfully submitted
d. Receiving the remittance advice - Answer-b. Billing for two services that are prohibited from being
billed on the same day
What healthcare organizations collect UHDDS data?
a. All outpatient settings including physician clinics and ambulatory surgical centers
b. All outpatient settings including cancer centers, independent testing facilities, and nursing homes
, c. All non outpatient settings including acute care, short-term care, long-term care, and psychiatric
hospitals; home health agencies; rehabilitation facilities; and nursing homes
d. All inpatient settings and outpatient settings with a focus on ambulatory surgical centers - Answer-c.
All non outpatient settings including acute care, short-term care, long-term care, and psychiatric
hospitals; home health agencies; rehabilitation facilities; and nursing homes
Sometimes hospital departments must work together to solve claims issue errors to prevent them from
happening over and over again. What departments would need to work together if an audit found that
the claim did not contain the procedure code or charge for a pacemaker insertion?
a. Health Information and Business Office
b. Health Information and Materials Management
c. Health Information, Business Office, and Cardiac Department
d. Health Information and Radiology - Answer-c. Health Information, Business Office, and Cardiac
Department
A provision of the law that established the resource-based relative value scale (RBRVS) stipulates that
refinements to relative value units (RVUs) must maintain ________.
a. Moderate rate increases
b. Market basket increases
c. Budget neutrality
d. Sustainable growth rate - Answer-c. Budget neutrality
What is a chargemaster?
a. Cost-sharing in which the policy or certificate holder pays a preestablished percentage of eligible
expenses after the deductible has been met
b. A plan that converts the organization's goals and objectives into targets for revenue and spending
c. A financial management system that contains information about the organization's charges for the
healthcare services it provides to patients
Methodologies
Which of the following is not reimbursed according to the Medicare outpatient prospective payment
system?
a. CMHC partial hospitalization services
b. Critical access hospitals
c. Hospital outpatient departments
d. Vaccines provided by CORFs - Answer-b. Critical access hospitals
Effective October 16, 2003, under the Administrative Simplification Compliance section of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA), all healthcare providers must electronically
submit claims to Medicare. Which is the electronic format for hospital technical fees?
a. 837I
b. 837P
c. UB-04
d. 1500 - Answer-a. 8371
Which of the following fails to meet the CMS classification of a hospital-acquired condition?
a. Foreign object retained after surgery
b. Air embolism
,c. Gram-negative pneumonia
d. Blood incompatibility - Answer-c. Gram-negative pneumonia
Which governmental agency develops an annual work plan that delineates the specific target areas for
Medicare that will be monitored in a given year?
a. Centers for Medicare and Medicaid (CMS)
b. Federal Bureau of Investigation (FBI)
c. Office of Inspector General (OIG)
d. Defense Criminal Investigative Service (DCIS) - Answer-c. Office of Inspector General (OIG)
Which of the following types of hospitals are excluded from the Medicare inpatient prospective
payment system?
a. Children's
b. Rural
c. State supported
d. Tertiary - Answer-a. Children's
Which of the following situations would be identified by the NCCI edits?
a. Determining the MS-DRG
b. Billing for two services that are prohibited from being billed on the same day
c. Whether data submitted electronically were successfully submitted
d. Receiving the remittance advice - Answer-b. Billing for two services that are prohibited from being
billed on the same day
What healthcare organizations collect UHDDS data?
a. All outpatient settings including physician clinics and ambulatory surgical centers
b. All outpatient settings including cancer centers, independent testing facilities, and nursing homes
, c. All non outpatient settings including acute care, short-term care, long-term care, and psychiatric
hospitals; home health agencies; rehabilitation facilities; and nursing homes
d. All inpatient settings and outpatient settings with a focus on ambulatory surgical centers - Answer-c.
All non outpatient settings including acute care, short-term care, long-term care, and psychiatric
hospitals; home health agencies; rehabilitation facilities; and nursing homes
Sometimes hospital departments must work together to solve claims issue errors to prevent them from
happening over and over again. What departments would need to work together if an audit found that
the claim did not contain the procedure code or charge for a pacemaker insertion?
a. Health Information and Business Office
b. Health Information and Materials Management
c. Health Information, Business Office, and Cardiac Department
d. Health Information and Radiology - Answer-c. Health Information, Business Office, and Cardiac
Department
A provision of the law that established the resource-based relative value scale (RBRVS) stipulates that
refinements to relative value units (RVUs) must maintain ________.
a. Moderate rate increases
b. Market basket increases
c. Budget neutrality
d. Sustainable growth rate - Answer-c. Budget neutrality
What is a chargemaster?
a. Cost-sharing in which the policy or certificate holder pays a preestablished percentage of eligible
expenses after the deductible has been met
b. A plan that converts the organization's goals and objectives into targets for revenue and spending
c. A financial management system that contains information about the organization's charges for the
healthcare services it provides to patients
