CMS Reimbursement Methodologies
Exam Questions and Answers Graded A+
Allowable Charge - Correct answer-The maximum amount the payer will
reimburse for each procedure or service, according to the patient's policy.
All-Patient diagnosis related group (AP-DRG) - Correct answer-DRG system
adapted for use by third-party payers to reimburse hospitals for inpatient care
provided to non-medicare beneficiaries (e.g., commercial payers) DRG assignment
is based on intensity of resources.
Ambulance Fee Schedule - Correct answer-Payment system for ambulance
services provided to Medicare beneficiaries
Ambulatory surgical center (ASC) - Correct answer-state licensed, Medicare
certified supplier of surgical health care services that must accept assignment on
Medicare Claims
Ambulatory surgical center payment rate - Correct answer-Predetermined amount
for which ASC services are reimbursed, at 80% after adjustment for regional wage
variations
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
, Balance Billing - Correct answer-billing beneficiaries for amounts not reimbursed
by payers (not including copayments and coinsurance amounts): this practice is
prohibited by Medicare regulations
Case Mix - Correct answer-the types and categories of patients treated by a health
care facility or provider
Chargemaster - Correct answer-document that contains a computer generated list
of procedures, services, and supplies wit charges for each; chargemaster data are
entered in the facility's patient accounting system, and charges are automatically
posted to the patient's bill (UB-04)
Chargemaster maintenance - Correct answer-the process of updating and revising
key elements of the chargemaster or description master to ensure accurate
reimbursement
Chargemaster team - Correct answer-jointly shares the responsibility of updating
and revising the chargemaster to ensure its accuracy and consists of representatives
of a variety of departments, such as coding compliance financial services, health
information management, information services and other departments, and
physicians
Clinical laboratory fee schedule - Correct answer-data set based on local fee
schedules (for outpatient clinical diagnostic laboratory services.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
Exam Questions and Answers Graded A+
Allowable Charge - Correct answer-The maximum amount the payer will
reimburse for each procedure or service, according to the patient's policy.
All-Patient diagnosis related group (AP-DRG) - Correct answer-DRG system
adapted for use by third-party payers to reimburse hospitals for inpatient care
provided to non-medicare beneficiaries (e.g., commercial payers) DRG assignment
is based on intensity of resources.
Ambulance Fee Schedule - Correct answer-Payment system for ambulance
services provided to Medicare beneficiaries
Ambulatory surgical center (ASC) - Correct answer-state licensed, Medicare
certified supplier of surgical health care services that must accept assignment on
Medicare Claims
Ambulatory surgical center payment rate - Correct answer-Predetermined amount
for which ASC services are reimbursed, at 80% after adjustment for regional wage
variations
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
, Balance Billing - Correct answer-billing beneficiaries for amounts not reimbursed
by payers (not including copayments and coinsurance amounts): this practice is
prohibited by Medicare regulations
Case Mix - Correct answer-the types and categories of patients treated by a health
care facility or provider
Chargemaster - Correct answer-document that contains a computer generated list
of procedures, services, and supplies wit charges for each; chargemaster data are
entered in the facility's patient accounting system, and charges are automatically
posted to the patient's bill (UB-04)
Chargemaster maintenance - Correct answer-the process of updating and revising
key elements of the chargemaster or description master to ensure accurate
reimbursement
Chargemaster team - Correct answer-jointly shares the responsibility of updating
and revising the chargemaster to ensure its accuracy and consists of representatives
of a variety of departments, such as coding compliance financial services, health
information management, information services and other departments, and
physicians
Clinical laboratory fee schedule - Correct answer-data set based on local fee
schedules (for outpatient clinical diagnostic laboratory services.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
