CCA Exam Reimbursement Methodologies - 109 Exam Study Questions with 100% Correct Answers

How does Medicare or other third party payers determine whether the patient has medical necessity for the tests, procedures, or treatment billed on a claim form? - by reviewing all the diagnosis codes assigned to explain the reasons the services were provided What is the name of the organization that develops the billing form that hospitals are required to use? - National Uniform Billing Committee What healthcare organization collect UHDDS data? - all non-outpatient settings including acute-care, short-term care, long-term care, and psychiatric hospitals; home health agencies; rehabilitation facilities; and nursing homes What was the goal of the MS-DRG system? - To improve Medicare's capability to recognize severity of illness in its inpatient hospital payments. The new system is projected to increase payments to hospitals for services provided to sicker patients and decrease payments for treating less severely ill patients What is the basic formula for calculating each MS-DRG hospital payment? - Hospital payment = DRG relative weight x hospital base rate What are possible add-on payment that a hospital could receive in addition to the basic Medicare DRG payment? - Additional payments may be made to disproportionate share hospitals for indirect medical education, new technologies, and cost outlier cases What is the name of the national program to detect and correct improper payments in the Medicare Fee for Service (FSS) program? - Recovery Audit contractors (RACS) What is the maximum number of procedure codes that can appear on a UB-04 institutional claim form via electronic transmission? - 25