4.1 Medical Billing And Reimbursement Systems
Final Quiz – Questions & Answers
Which individual MS-DRG has the highest reimbursement? see image
247
470
293
871 ✔️Ans - 247
A four-digit code that describes a classification of a product or service
provided to a patient is a
ICD-10-CM code.
CPT code.
HCPCS Level II code.
revenue code. ✔️Ans - revenue code.
State Medicaid programs are required to offer medical assistance for
individuals with qualified financial need.
all individuals age 65 and over.
patients with end-stage renal disease.
patients with a permanent disability. ✔️Ans - individuals with qualified
financial need.
This information is used to assign each item to a particular section of the
general ledger in a particular facility's accounting section. Reports can be
generated from this information to include statistics related to volume in
terms of numbers, dollars, and payer types. see image
revenue code
HCPCS code
general ledger key
charge/service code ✔️Ans - general ledger key
, Based on CMS's DRG system, other systems have been developed for payment
purposes. The one that classifies the non-Medicare population, such as HIV
patients, neonates, and pediatric patients, is known as
AP-DRGs.
IR-DRGs.
APR-DRGs.
RDRGs. ✔️Ans - APR-DRGs.
Which of the following best describes the situation of a provider who agrees
to accept assignment for Medicare Part B services?
The provider is paid according to the Medicare Physician Fee Schedule (MPFS)
plus 10%.
The provider is a nonparticipating provider.
The provider cannot bill the patients for the balance between the MPFS
amount and the total charges.
The provider is reimbursed at 15% above the allowed charge. ✔️Ans - The
provider cannot bill the patients for the balance between the MPFS amount
and the total charges.
Terminally ill patients with life expectancies of ______ may opt to receive
hospice services.
1 year or less
6 months to a year
1 year or more
6 months or less ✔️Ans - 6 months or less
ICD-10-PCS procedure codes are used on which of the following forms to
report services provided to a patient?
UB-04
MDC 02
CMS-1500
CMS-1491 ✔️Ans - UB-04
This is the amount collected by the facility for the services it bills.
Final Quiz – Questions & Answers
Which individual MS-DRG has the highest reimbursement? see image
247
470
293
871 ✔️Ans - 247
A four-digit code that describes a classification of a product or service
provided to a patient is a
ICD-10-CM code.
CPT code.
HCPCS Level II code.
revenue code. ✔️Ans - revenue code.
State Medicaid programs are required to offer medical assistance for
individuals with qualified financial need.
all individuals age 65 and over.
patients with end-stage renal disease.
patients with a permanent disability. ✔️Ans - individuals with qualified
financial need.
This information is used to assign each item to a particular section of the
general ledger in a particular facility's accounting section. Reports can be
generated from this information to include statistics related to volume in
terms of numbers, dollars, and payer types. see image
revenue code
HCPCS code
general ledger key
charge/service code ✔️Ans - general ledger key
, Based on CMS's DRG system, other systems have been developed for payment
purposes. The one that classifies the non-Medicare population, such as HIV
patients, neonates, and pediatric patients, is known as
AP-DRGs.
IR-DRGs.
APR-DRGs.
RDRGs. ✔️Ans - APR-DRGs.
Which of the following best describes the situation of a provider who agrees
to accept assignment for Medicare Part B services?
The provider is paid according to the Medicare Physician Fee Schedule (MPFS)
plus 10%.
The provider is a nonparticipating provider.
The provider cannot bill the patients for the balance between the MPFS
amount and the total charges.
The provider is reimbursed at 15% above the allowed charge. ✔️Ans - The
provider cannot bill the patients for the balance between the MPFS amount
and the total charges.
Terminally ill patients with life expectancies of ______ may opt to receive
hospice services.
1 year or less
6 months to a year
1 year or more
6 months or less ✔️Ans - 6 months or less
ICD-10-PCS procedure codes are used on which of the following forms to
report services provided to a patient?
UB-04
MDC 02
CMS-1500
CMS-1491 ✔️Ans - UB-04
This is the amount collected by the facility for the services it bills.
