CCA Exam Preparation Domain II
Reimbursement methodologies Questions
and Answers
1. A fee schedule is: - ANS-Developed by third-party payers and includes a list of
healthcare services, procedures, and charges associated with each.
2. A hospital needs to know how much Medicare paid on a claim so they can bill the
secondary insurance. What should the hospital refer to? - ANS-Remittance advice
3. A patient has two health insurance policies: Medicare and Medicare supplement. Which
of the following statements is true? - ANS-Monies paid to the healthcare provider
cannot exceed charges.
4. A provision of the law that established the resource-based relative value scale (RBRVS)
stipulates that refinements to relative value units (RVUs) must maintain: - ANS-Budget
neutrality
5. Assignment of benefits is a contract between a physician and Medicare in which the
physician agrees to bill Medicare directly for covered services and to bill the beneficiary
only for ________ , and to accept the Medicare payment as payment in full. -
ANS-Coinsurance or deductible
6. CMS developed medically unlikely edits (MUEs) to prevent providers from billing units of
services greater than the norm would indicate. These MUEs were implemented on
January, 2007, and are applied to which code set? - ANS-HCPCS/CPT codes
7. CMS identified conditions that are not present on admission and could be "reasonably
preventable", and therefore hospitals are not allowed to receive additional payment for
these conditions that do present. What are these conditions called? -
ANS-Hospital-acquired conditions
8. 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? -
ANS-By reviewing all the diagnosis codes assigned to explain the reasons the
services were provided.
9. If a provider believes a service may be denied by Medicare because it could be
considered unnecessary, the provider must notify the patient before the treatment begins
by using a(n): - ANS-Advance beneficiary notice (ABN)
10. In the laboratory section of CPT, if a group of tests overlaps two or more panels, report
the panel that incorporates the greatest number of tests to fulfill the code definition. What
would a coder do with the remaining test codes that are not part of a panel? -
ANS-Report the remaining test using individual test codes, according to CPT.
11. MS diagnostic-related groups are organized into: - ANS-Major diagnostic categories.
Reimbursement methodologies Questions
and Answers
1. A fee schedule is: - ANS-Developed by third-party payers and includes a list of
healthcare services, procedures, and charges associated with each.
2. A hospital needs to know how much Medicare paid on a claim so they can bill the
secondary insurance. What should the hospital refer to? - ANS-Remittance advice
3. A patient has two health insurance policies: Medicare and Medicare supplement. Which
of the following statements is true? - ANS-Monies paid to the healthcare provider
cannot exceed charges.
4. A provision of the law that established the resource-based relative value scale (RBRVS)
stipulates that refinements to relative value units (RVUs) must maintain: - ANS-Budget
neutrality
5. Assignment of benefits is a contract between a physician and Medicare in which the
physician agrees to bill Medicare directly for covered services and to bill the beneficiary
only for ________ , and to accept the Medicare payment as payment in full. -
ANS-Coinsurance or deductible
6. CMS developed medically unlikely edits (MUEs) to prevent providers from billing units of
services greater than the norm would indicate. These MUEs were implemented on
January, 2007, and are applied to which code set? - ANS-HCPCS/CPT codes
7. CMS identified conditions that are not present on admission and could be "reasonably
preventable", and therefore hospitals are not allowed to receive additional payment for
these conditions that do present. What are these conditions called? -
ANS-Hospital-acquired conditions
8. 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? -
ANS-By reviewing all the diagnosis codes assigned to explain the reasons the
services were provided.
9. If a provider believes a service may be denied by Medicare because it could be
considered unnecessary, the provider must notify the patient before the treatment begins
by using a(n): - ANS-Advance beneficiary notice (ABN)
10. In the laboratory section of CPT, if a group of tests overlaps two or more panels, report
the panel that incorporates the greatest number of tests to fulfill the code definition. What
would a coder do with the remaining test codes that are not part of a panel? -
ANS-Report the remaining test using individual test codes, according to CPT.
11. MS diagnostic-related groups are organized into: - ANS-Major diagnostic categories.
