CCA EXAM PREP Domain # 2
Reimbursement methodologies
Code assignment - ANS-2nd step in reimbursement process
Documentation - medical/ financial record - ANS-1st step in reimbursement process
Claim preparation - ANS-3rd step in reimbursement process
Claim to payer(s) - ANS-4th step in reimbursement process
Claim review - ANS-5th step in reimbursement process
Claim resolution - ANS-6th step in reimbursement process
1. Coding for physicians
2. Coding for facilities - ANS-What are the 2 types of outpatient coding situations
Demographic information - ANS-What does medical biller use as foundation for
determining who should receive bills and who has responsibility for payment?
Front office during pre-regristration - ANS-When is demographic information collected
Charge Description Master - ANS-CDM stands for
Charge Description Master - ANS-List of all supplies, services, equipment, usage fees
for patient care
Soft Coding - ANS-Coders perform the coding on procedures that vary from patient to
patient.
Hard coding - ANS-Done by CDM. Automatically assigns codes based on a unique
identifier number of routine services
Charge Master Contents - ANS-- CPT/HCPCS procedure code
- Charge descripition
- Revenue Code
- Charge
- Department code
- Charge Code
- Charge Status
, Fee/ Charge - ANS-Price established and assigned to a unit of medical/ other service in
facility
Annually - ANS-How often is Chargemaster updated
Routine services - ANS-What does chargemaster code by using the service identifier
Charge / item description - ANS-Identifies procedure, service, product (incl. meds),
other items provided to patient
Procedure, service, product code - ANS-CPT/ HCPCS level II codes identify specific
_____ supplied to patient. Not all ____ have corresponding CPT/ HCPCS II codes.
Revenue code - ANS-Unique 4-digit number that represents descriptions and dollar
amounts charges for hospital services provided to patient. Must accompany valid
procedure codes to be accepted
Revenue Code - ANS-Used to identify location in facility where procedure was
performed. Must accompany valid procedure codes to be accepted
CMS and The National Uniform Billing Committee - ANS-Revenue codes are updated
by___
Department code - ANS-Identifies department that revenue should be allocated to for
accounting purposes.
Charge Code/ Charge description/ item code - ANS-Each item in chargemaster is
uniquely identified by a ____ assigned by organization.
Charge status - ANS-Active assignment of charge and can be used for tracking when
and how often an item has been charged.
Inpatient Superbill parts - ANS-1. Provider info
2. Patient info
3. Service info
4. Additional info
UB-04 - ANS-What claim for are revenue codes only used for
Components for revenue codes - ANS-1. Demographics, incl. payer info
2. fee for each service from chargemaster
3. charge list with description
4. Correct diagnosis, procedure, supply code
Reimbursement methodologies
Code assignment - ANS-2nd step in reimbursement process
Documentation - medical/ financial record - ANS-1st step in reimbursement process
Claim preparation - ANS-3rd step in reimbursement process
Claim to payer(s) - ANS-4th step in reimbursement process
Claim review - ANS-5th step in reimbursement process
Claim resolution - ANS-6th step in reimbursement process
1. Coding for physicians
2. Coding for facilities - ANS-What are the 2 types of outpatient coding situations
Demographic information - ANS-What does medical biller use as foundation for
determining who should receive bills and who has responsibility for payment?
Front office during pre-regristration - ANS-When is demographic information collected
Charge Description Master - ANS-CDM stands for
Charge Description Master - ANS-List of all supplies, services, equipment, usage fees
for patient care
Soft Coding - ANS-Coders perform the coding on procedures that vary from patient to
patient.
Hard coding - ANS-Done by CDM. Automatically assigns codes based on a unique
identifier number of routine services
Charge Master Contents - ANS-- CPT/HCPCS procedure code
- Charge descripition
- Revenue Code
- Charge
- Department code
- Charge Code
- Charge Status
, Fee/ Charge - ANS-Price established and assigned to a unit of medical/ other service in
facility
Annually - ANS-How often is Chargemaster updated
Routine services - ANS-What does chargemaster code by using the service identifier
Charge / item description - ANS-Identifies procedure, service, product (incl. meds),
other items provided to patient
Procedure, service, product code - ANS-CPT/ HCPCS level II codes identify specific
_____ supplied to patient. Not all ____ have corresponding CPT/ HCPCS II codes.
Revenue code - ANS-Unique 4-digit number that represents descriptions and dollar
amounts charges for hospital services provided to patient. Must accompany valid
procedure codes to be accepted
Revenue Code - ANS-Used to identify location in facility where procedure was
performed. Must accompany valid procedure codes to be accepted
CMS and The National Uniform Billing Committee - ANS-Revenue codes are updated
by___
Department code - ANS-Identifies department that revenue should be allocated to for
accounting purposes.
Charge Code/ Charge description/ item code - ANS-Each item in chargemaster is
uniquely identified by a ____ assigned by organization.
Charge status - ANS-Active assignment of charge and can be used for tracking when
and how often an item has been charged.
Inpatient Superbill parts - ANS-1. Provider info
2. Patient info
3. Service info
4. Additional info
UB-04 - ANS-What claim for are revenue codes only used for
Components for revenue codes - ANS-1. Demographics, incl. payer info
2. fee for each service from chargemaster
3. charge list with description
4. Correct diagnosis, procedure, supply code
