Exam 4 Reimbursement
Methodologies-Graded A
In Medicare's resource-based relative value scale payment system, to which type of
code has a relative value unit been assigned?
a) International Classification of Diseases
b) Health Insurance Prospective Payment System
c) Healthcare Common Procedure Coding System
d) Revenue - ANS-c) Healthcare Common Procedure Coding System
For which clinician is Medicare's resource-based relative value scale payment system
modified by a formula that includes base units and time?
a) Anesthesiologists
b) Nonparticipating providers
c) Nonphysician providers
d) Participating provider - ANS-a) Anesthesiologists
In Medicare's resource-based relative value scale payment system, which factor adjusts
payments to physicians and health professionals for price differences among various
parts of the country?
a) Conversion factor
b) Geographic practice cost index
c) Party liability
d) Scaling - ANS-b) Geographic practice cost index
Which of the following is not a standard that must be met to qualify as a Medicare-
certified ASC?
a) The ASC must be a separate entity distinguishable from any other entity or type of
facility
b) The ASC may share a national identifier or supplier number under Medicare with
another entity
c) The ASC must maintain its own licensure and accreditation
d) The ASC must have a sole purpose of delivering services in connection with surgical
procedures that do not require inpatient hospitalization - ANS-b) The ASC may share a
national identifier or supplier number under Medicare with another entity
Under the ASC payment system multiple procedures performed during the same
surgical session are reimbursed at which of the following rate?
a) All procedures receive full (100 percent) payment.
b) The procedure in the highest APC receives full payment and the remaining
procedures receive half (50 percent) payment.
, c) The procedure in the lowest APC receives full payment and the remaining
procedures receive half (50 percent) payment.
d) The procedure in the highest APC receives full payment and the remaining
procedures receive one-third (33 percent) payment. - ANS-b) The procedure in the
highest APC receives full payment and the remaining procedures receive half (50
percent) payment.
Under the ASC PS Medicare payment equals ____ percent and the beneficiary
copayment equals ____ of the total reimbursement for services provided.
a) 100/0
b) 90/10
c) 80/20
d) 70/30 - ANS-c) 80/20
What is the term for healthcare providers that, by mandate or mission, organize and
deliver a significant level of healthcare and other health-related services to uninsured,
underinsured, low-income, Medicaid, and other vulnerable populations or patients?
a) Safety-net provider
b) Disproportionate share organization
c) Medical underservice group
d) Health inequity entity - ANS-a) Safety-net provider
What is the term for an urban, nonprofit, patient-governed, and community-directed
healthcare entities receiving federal grant funding under Section 330?
a) Rural health clinics
b) Federally-qualified health centers
c) Look-Alikes
d) Health Department clinics - ANS-b) Federally-qualified health centers
In Medicare's prospective payment system for federally qualified health centers, which
factor is a risk adjustment?
a) New patient status
b) Mental health visit
c) Health professional shortage area
d) Mid-level practitioner provider - ANS-a) New patient status
What status does not characterize medically underserved areas?
a) High infant mortality
b) High poverty
c) Small elderly population
d) Shortage of health professionals - ANS-c) Small elderly population
Which provision is included in the hospice services payment system?
a) High cost outlier
b) Wage index adjustment
c) Rural area
Methodologies-Graded A
In Medicare's resource-based relative value scale payment system, to which type of
code has a relative value unit been assigned?
a) International Classification of Diseases
b) Health Insurance Prospective Payment System
c) Healthcare Common Procedure Coding System
d) Revenue - ANS-c) Healthcare Common Procedure Coding System
For which clinician is Medicare's resource-based relative value scale payment system
modified by a formula that includes base units and time?
a) Anesthesiologists
b) Nonparticipating providers
c) Nonphysician providers
d) Participating provider - ANS-a) Anesthesiologists
In Medicare's resource-based relative value scale payment system, which factor adjusts
payments to physicians and health professionals for price differences among various
parts of the country?
a) Conversion factor
b) Geographic practice cost index
c) Party liability
d) Scaling - ANS-b) Geographic practice cost index
Which of the following is not a standard that must be met to qualify as a Medicare-
certified ASC?
a) The ASC must be a separate entity distinguishable from any other entity or type of
facility
b) The ASC may share a national identifier or supplier number under Medicare with
another entity
c) The ASC must maintain its own licensure and accreditation
d) The ASC must have a sole purpose of delivering services in connection with surgical
procedures that do not require inpatient hospitalization - ANS-b) The ASC may share a
national identifier or supplier number under Medicare with another entity
Under the ASC payment system multiple procedures performed during the same
surgical session are reimbursed at which of the following rate?
a) All procedures receive full (100 percent) payment.
b) The procedure in the highest APC receives full payment and the remaining
procedures receive half (50 percent) payment.
, c) The procedure in the lowest APC receives full payment and the remaining
procedures receive half (50 percent) payment.
d) The procedure in the highest APC receives full payment and the remaining
procedures receive one-third (33 percent) payment. - ANS-b) The procedure in the
highest APC receives full payment and the remaining procedures receive half (50
percent) payment.
Under the ASC PS Medicare payment equals ____ percent and the beneficiary
copayment equals ____ of the total reimbursement for services provided.
a) 100/0
b) 90/10
c) 80/20
d) 70/30 - ANS-c) 80/20
What is the term for healthcare providers that, by mandate or mission, organize and
deliver a significant level of healthcare and other health-related services to uninsured,
underinsured, low-income, Medicaid, and other vulnerable populations or patients?
a) Safety-net provider
b) Disproportionate share organization
c) Medical underservice group
d) Health inequity entity - ANS-a) Safety-net provider
What is the term for an urban, nonprofit, patient-governed, and community-directed
healthcare entities receiving federal grant funding under Section 330?
a) Rural health clinics
b) Federally-qualified health centers
c) Look-Alikes
d) Health Department clinics - ANS-b) Federally-qualified health centers
In Medicare's prospective payment system for federally qualified health centers, which
factor is a risk adjustment?
a) New patient status
b) Mental health visit
c) Health professional shortage area
d) Mid-level practitioner provider - ANS-a) New patient status
What status does not characterize medically underserved areas?
a) High infant mortality
b) High poverty
c) Small elderly population
d) Shortage of health professionals - ANS-c) Small elderly population
Which provision is included in the hospice services payment system?
a) High cost outlier
b) Wage index adjustment
c) Rural area
