CCS EXAM - MEDICAL BILLING AND
REIMBURSEMENT SYSTEM
The prospective payment system used to reimburse home health agencies - Correct
Answers -OASIS (Outcome and Assessment Information Set).
Home Health Agencies (HHAs) utilize a data entry software system called - Correct
Answers -HAVEN (Home Assessment Validation and Entry)
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 - Correct Answers -payment status indicator
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 -
Correct Answers -absorbs the loss; this is commonly known as a write-off.
Code used to identify the procedure, service, or treatment - Correct Answers
-HCPCS/CPT code
When health care providers are found guilty under any of the civil false claims statutes,
the Office of Inspector General is responsible for negotiating these settlements and the
provider is placed under a - Correct Answers -Corporate Integrity Agreement
This information is the numerical identification of the service or supply - Correct
Answers -charge/service code
This law prohibits a physician from referring Medicare patients to clinical laboratory
services where the doctor or a member of his family has a financial interest - Correct
Answers -the Stark I Law
The following type of hospital is considered excluded when it applies for, and receives,
a waiver from CMS. This means that the hospital does not participate in the inpatient
prospective payment system (IPPS) - Correct Answers -cancer hospital
The prospective payment system used to reimburse hospitals for Medicare hospital
outpatients is called - Correct Answers -APCs
, This is a 10-digit, intelligence-free, numeric identifier designed to replace all previous
provider legacy numbers. This number identifies the physician universally to all payers.
This number is issued to all HIPAA-covered entities. It is mandatory on the CMS-1500
and UB-04 claim forms - Correct Answers -National Provider Identifier (NPI)
This prospective payment system replaced the Medicare physician payment system of
"customary, prevailing, and reasonable (CPR)" charges whereby physicians were
reimbursed according to their historical record of the charge for the provision of each
service - Correct Answers -Medicare Physician Fee Schedule (MPFS)
Under APCs, payment status indicator "V" means - Correct Answers -clinic or
emergency department visit (medical visits)
When a provider, knowingly or unknowingly, uses practices that are inconsistent with
accepted medical practice and that directly or indirectly result in unnecessary costs to
the Medicare program, this is called - Correct Answers -abuse
When a patient is discharged from the inpatient rehabilitation facility and returns within
three calendar days (prior to midnight on the third day) this is called a(n) - Correct
Answers -interrupted stay
This information provides a narrative name of the services provided - Correct Answers -
item/service description
Capitation - Correct Answers -System of payment used by managed care plans in which
physicians and hospitals are paid a fixed, per capita amount for each patient enrolled
over a stated period regardless of the type and number of services provided;
reimbursement to the hospital on a per-member/per-month basis to cover costs for the
members of the plan.
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 -electronic data
interchange (EDI)
This information is published by the Medicare Administrative Contractors (MACs) to
describe when and under what circumstances Medicare will cover a service. The ICD-
10-CM, ICD-10-PCS, and CPT/HCPCS codes are listed in the memoranda - Correct
Answers -LCD (Local Coverage Determinations)
The following coding system(s) is/are utilized in the MS-DRG prospective payment
methodology for assignment and proper reimbursement - Correct Answers -ICD-10-
CM/ICD-10-PCS codes
Under APCs, payment status indicator "S" means - Correct Answers -a. significant
procedure, multiple procedure reduction does not apply
REIMBURSEMENT SYSTEM
The prospective payment system used to reimburse home health agencies - Correct
Answers -OASIS (Outcome and Assessment Information Set).
Home Health Agencies (HHAs) utilize a data entry software system called - Correct
Answers -HAVEN (Home Assessment Validation and Entry)
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 - Correct Answers -payment status indicator
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 -
Correct Answers -absorbs the loss; this is commonly known as a write-off.
Code used to identify the procedure, service, or treatment - Correct Answers
-HCPCS/CPT code
When health care providers are found guilty under any of the civil false claims statutes,
the Office of Inspector General is responsible for negotiating these settlements and the
provider is placed under a - Correct Answers -Corporate Integrity Agreement
This information is the numerical identification of the service or supply - Correct
Answers -charge/service code
This law prohibits a physician from referring Medicare patients to clinical laboratory
services where the doctor or a member of his family has a financial interest - Correct
Answers -the Stark I Law
The following type of hospital is considered excluded when it applies for, and receives,
a waiver from CMS. This means that the hospital does not participate in the inpatient
prospective payment system (IPPS) - Correct Answers -cancer hospital
The prospective payment system used to reimburse hospitals for Medicare hospital
outpatients is called - Correct Answers -APCs
, This is a 10-digit, intelligence-free, numeric identifier designed to replace all previous
provider legacy numbers. This number identifies the physician universally to all payers.
This number is issued to all HIPAA-covered entities. It is mandatory on the CMS-1500
and UB-04 claim forms - Correct Answers -National Provider Identifier (NPI)
This prospective payment system replaced the Medicare physician payment system of
"customary, prevailing, and reasonable (CPR)" charges whereby physicians were
reimbursed according to their historical record of the charge for the provision of each
service - Correct Answers -Medicare Physician Fee Schedule (MPFS)
Under APCs, payment status indicator "V" means - Correct Answers -clinic or
emergency department visit (medical visits)
When a provider, knowingly or unknowingly, uses practices that are inconsistent with
accepted medical practice and that directly or indirectly result in unnecessary costs to
the Medicare program, this is called - Correct Answers -abuse
When a patient is discharged from the inpatient rehabilitation facility and returns within
three calendar days (prior to midnight on the third day) this is called a(n) - Correct
Answers -interrupted stay
This information provides a narrative name of the services provided - Correct Answers -
item/service description
Capitation - Correct Answers -System of payment used by managed care plans in which
physicians and hospitals are paid a fixed, per capita amount for each patient enrolled
over a stated period regardless of the type and number of services provided;
reimbursement to the hospital on a per-member/per-month basis to cover costs for the
members of the plan.
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 -electronic data
interchange (EDI)
This information is published by the Medicare Administrative Contractors (MACs) to
describe when and under what circumstances Medicare will cover a service. The ICD-
10-CM, ICD-10-PCS, and CPT/HCPCS codes are listed in the memoranda - Correct
Answers -LCD (Local Coverage Determinations)
The following coding system(s) is/are utilized in the MS-DRG prospective payment
methodology for assignment and proper reimbursement - Correct Answers -ICD-10-
CM/ICD-10-PCS codes
Under APCs, payment status indicator "S" means - Correct Answers -a. significant
procedure, multiple procedure reduction does not apply
