Week 3 - Ch. 6

Question 1

fees that the provider normally charges for each particular service

Answer 1

usual

Question 2

fees thar are charged by other providers of the same training and experience in the same geographic area

Answer 2

customary

Question 3

fees that would justify an increase due to being exceptionally difficult or with special circumstances

Answer 3

reasonable

Question 4

relative value scale for establishing Medicare charges

Answer 4

resource based relative value scale (RBRVs)

Question 5

a system of analyzing conitions and treatments for similar groups of patients used to establish Medicare fees for hospital inpatient services

Answer 5

Diagnosis related groups (DRGs)

Question 6

computerized medicare sstem that prevents overpayment

Answer 6

Correct Coding Initiative (CCI)

Question 7

computerized system that identifies improper or incorrect codes

Answer 7

edits

Question 8

medicare code edit where CPT codes in colum 2 will not be paid if reported in the same day as the column 1 code

Answer 8

CCI column 1/column 2 code pair edit

Question 9

both services represented by MEC codes that could not have been done during one encounter

Answer 9

CCI mutuslly exclusive code (MEC) edit

Question 10

number showing if the use of a modifier can bypass a CCI edit

Answer 10

CCI modifier indicator

Question 11

units of service edits used to lower the medicare fee-for-service paid claims error rate

Answer 11

medically unlikely edits (MUEs)

Question 12

use of a procedure code that provides a higher payment

Answer 12

upcoding

Question 13

physician set in relateion to the fees that other providers charge for similar services

Answer 13

physician fee schedules