Billing

Question 0

What organization develops the UB claim form?

Answer 0

National uniform billing committee, NUBC

Question 1

How many procedures may be listed on the UB claim form?

Answer 1

Five

Question 2

What organization develops the HCFA?

Answer 2

National uniform claims committee , NUCc

Question 3

What is a vital component for determining when the reimbursement from insurance company is less than what was expected?

Answer 3

The remittance advice

Question 4

Max #of diagnoses that can fit on a UB?

Answer 4

18

Question 5

What is a computer to computer transfer data between providers and third-party payers?

Answer 5

EDI electronic data interchange

Question 6

Which prospective payment system is used to determine the payment to the physician for outpatient surgery?

Answer 6

RB RVS

Question 7

What is the MPFS?

Answer 7

Medicare physician fee schedule for

Question 8

When the Medicare MS DRG payment receipt by the hospital is lower than the actual charge for providing inpatient service for a patient what can The hospital do?

Answer 8

Bill Medicare the difference

Question 9

HIPPA requires the retention health insurance claims and accounting records for how many years?

Answer 9

Six years

Question 10

What is a payment status indicator?

Answer 10

Code assigned to each hcpcs and cpt to identify how thethe service or procedure described by the code would be paid

Question 11

What is a never event?

Answer 11

And Error medical care that is clearly identifiable preventable in serious consequences for patients.

Question 12

What a provider in order to increase the reimbursement reports codes the payer that are not supported by the documentation in the medical record this is called what?

Answer 12

Abuse

Question 13

What percentage is Medicare’s limiting charge?

Answer 13

15% above Medicare’s approved payment amount for physicians not excepting assignment

Question 14

True or false: hospital acquired conditions mean that when the diagnosis is not POA it is reasonably preventable.

Answer 14

True

Question 15

One type of hospital that is not participate in the inpatient prospective payment system

Answer 15

Cancer hospitals are excluded when they apply for and receive a waiver from CMS

Question 16

What is a hold harmless?

Answer 16

Financial protection to ensure that certain types of facilities recoup all their losses due to The differences between there APC payments and their pre-APC payments

Question 17

What is the medical insurance percentage?

Answer 17

20%

Question 18

What does status indicator V mean?

Answer 18

Clinic or emergency department visit, medical visits

Question 19

What does status indicator c mean?

Answer 19

Inpatient procedure/service

Question 20

True or false: in the capitation agreement each service is paid based on the actual charges

Answer 20

Foals capitation means paying a fixed amount per month per member

Question 21

Which type of facility utilizes a patient assessment instrument?

Answer 21

Inpatient rehab facility

Question 22

Inpatient rehab facilities use what to classify patient into case mix groups, CMG’s

Answer 22

Patient assessment instrument

Question 23

What is the name of the software used by home health agencies?

Answer 23

PAC E, patient assessment comprehensive evaluation

Question 24

This accounting method attributes a dollar figure to every input required to provide a service

Answer 24

Cost accounting

Question 25

How many MSDRGs can a patient's claim have?

Answer 25

One

Question 26

How are Hospital emergency department and outpatient evaluation and management code assignment methodologies determine for each facility?

Answer 26

Each facility is accountable for developing its own methodology

Question 27

When does CMS I just the Medicare severity DRGs reimbursement rates?

Answer 27

At the beginning of every fiscal year October 1

Question 28

What are the three relative value units multiplied by in calculating the fee for a physician's reimbursement, by Medicare

Answer 28

Geographic practice cost indices

Question 29

True or false a rejected claims it sent back to the provider, the errors may be corrected in the claim resubmitted

Answer 29

True

Question 30

Describe incident to billing

Answer 30

What a physicians assistant provides services under direct supervision of the physician. The initial visit must be performed by the physician

Question 31

When is a present on admission indicator required

Answer 31

On the principal and secondary diagnosis, for Medicare patients, any inpatient

Question 32

What is the term assigned to each MS DRG which is used as a multiplier to determine reimbursement

Answer 32

Relative weight

Question 33

The physician bills $250 for an office visit the patients deductible has been met and the Medicare PAR few schedule amount is $200. How much will the patient owe? What is the total amount the physician receives?

Answer 33

Patient pays $40, mcr $160 total rcvd $200 The par fee schedule should match the total the physician will receive from both the pt and mcr