Question 1

The prospective payment system based upon resource utilization groups (RUGs) is used for reimbursement to ________________ for Medicare patients.

Accepted Answer

The RUGs system is used for reimbursement to skilled nursing facilities for Medicare patients.

Question 2

Currently, payment to the physician for outpatient surgery performed ona Medicare patient is based upon which prospective payment system?

Accepted Answer

The answer of Currently, payment to the physician for outpatient...

Question 3

The case-mix management system that utilizes information from the minimum data set (MDS) in long-term care settings is called

Accepted Answer

The case-mix management system that utilizes information from the minimum data set (MDS) in long-term care settings is called Resource utilization groups (RUGs). Medicare severity diagnosis related groups (MS-DRGs) are used for acute care hospital settings, Resource based relative value system (RBRVS) is used for physician reimbursement, and Ambulatory patient classification (APCs) are used for outpatient hospital services.

Question 4

The prospective payment system used to reimburse  home  health agencies for Medicare patients utilizes data from

Accepted Answer

The prospective payment system used to reimburse home health agencies for Medicare patients utilizes data from the Outcome and Assessment Information Set (OASIS). OASIS is a comprehensive assessment tool for home health patients that measures patient outcomes and provides data for payment and quality measurement purposes. The other options listed (MDS, UHDDS, and UACDS) are assessment tools used in other healthcare settings but are not specific to home health agencies.

Question 5

Under ASCs, when multiple procedures are performed during the same surgical session, a payment reduction is applied. The procedure in the highest level group is reimbursed at ____ (percent) and all remaining procedures are reimbursed at ____(percent).

Accepted Answer

Under the Ambulatory Surgical Center (ASC) payment system, the procedure in the highest level group is reimbursed at 100%, and all remaining procedures are reimbursed at 50%.

Question 6

Prolonged pregnancy is a pregnancy that has advanced beyond _______ completed weeks of gestation.

Accepted Answer

Prolonged pregnancy is a pregnancy that has advanced beyond 42 completed weeks of gestation.

Question 7

____________ indicates that the claim has been  released as a complete for submission to the insurer for payment.

Accepted Answer

Bill drop indicates that the claim has been finalized and is ready to be submitted to the insurer for payment. This term is often used in medical billing and coding to signal that the billing process for a particular patient or encounter has been completed.

Question 8

All of following items are packaged under the Medicare outpatient prospective payment system, EXCEPT for

Accepted Answer

All of the other items listed (recovery room, supplies, and anesthesia) are typically packaged under the Medicare outpatient prospective payment system, which bundles together services and supplies related to a specific procedure or condition. Medical visits, however, are generally billed and reimbursed separately.

Question 9

Under the RBRVS, each HCPCS/CPT code contains 3 components, each having assigned relative value units. These 3 components are

Accepted Answer

The RBRVS system consists of three components: physician work, practice expense, and malpractice insurance expense. The physician work component represents the relative amount of time, effort, and skill required to provide a particular service, while the practice expense component reflects the costs of maintaining a medical practice, such as rent, supplies, and non-physician staff salaries. The malpractice insurance expense component considers the potential liability costs associated with a particular service. Each component is assigned a relative value unit, which is then multiplied by a conversion factor to determine the Medicare payment for that service.

Question 10

How many major diagnostic categories are there in the MS-DRG system?

Accepted Answer

The answer of How many major diagnostic categories are there...

Question 11

The ______________ is a statement sent to the provider to explain payments made by third party payers.

Accepted Answer

A remittance advice is a statement sent to the provider explaining payments made by third party payers. It typically includes information such as the amount paid, the patient's name and ID number, the date of service, and any adjustments made to the payment.

Question 12

The ________________ refers to a statement sent to the patient to clarify which services were provided, amount billed, and amount of payments made by the health plan.

Accepted Answer

The answer of The ________________ refers to a statement sent...

Question 13

The prospective payment system to hospitals for Medicare hospital s outpatients is called ___ and became effective on _________

Accepted Answer

The prospective payment system to hospitals for Medicare hospital outpatients is called APCs (Ambulatory Payment Classifications) and became effective on August 1, 2000. The other options are either unrelated or incorrect as DRGs (Diagnosis Related Groups) is the payment system for inpatient hospital stays and RBRVS (Resource-Based Relative Value Scale) is for physician services. Only option C matches the correct system and effective date.

Question 14

A patient was seen by Dr. Zachary. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The Medicare fee schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termed as "balance billing," which means that the patient is

Accepted Answer

When a provider does not accept assignment, they are allowed to charge up to 15% more than the Medicare fee schedule amount. This additional amount is known as "excess charges." In this scenario, Dr. Zachary charged $125, which is $25 more than the Medicare fee schedule amount of $100. The patient is responsible for paying the $25 excess charge, making them financially liable for charges in excess of the Medicare fee schedule.

Question 15

Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare Part B services?

Accepted Answer

When a provider accepts assignment for Medicare Part B services, they agree to accept the Medicare-approved amount as full payment and cannot bill the patient for any balance beyond the Medicare fee schedule amount.

Question 16

What ICD-9-CM coding scheme is used to show that a therapeutic abortion resulted in a live fetus?

Accepted Answer

Code 644.21 indicates the early onset of delivery, which is appropriate for a therapeutic abortion resulting in a live fetus. The V27 code is used to indicate the outcome of delivery, which in this case would be the live birth of a newborn.

Question 17

A computer software program that assigns appropriate MS-DRGs according to the information provided for each episode of care is called a(n)

Accepted Answer

A grouper is a computer software program that assigns appropriate MS-DRGs according to the information provided for each episode of care. An encoder refers to a tool used to assign codes to diagnoses and procedures. A case-mix analyzer is a tool used to analyze and group patients according to their clinical characteristics and resource needs. DRG creeper is not a recognized term in the healthcare industry.

Question 18

The MS-DRG (Medicare Severity-Diagnosis-Related Group) system was designed to pay

Accepted Answer

The MS-DRG system was designed to pay only one amount (group) of reimbursement per hospitalization, based on the patient's diagnosis and other factors such as age, gender, and any additional conditions they may have. This single payment system aims to simplify the payment process and reduce costs for both hospitals and Medicare.

Question 19

A PEG procedure would most likely be done to facilitate

Accepted Answer

PEG procedure stands for percutaneous endoscopic gastrostomy. It involves placing a feeding tube directly into the stomach through the skin of the abdomen. This procedure is typically done to facilitate eating when a person is unable to swallow or digest food properly.

Question 20

The standard claim from used by hospitals to request reimbursement for inpatient and outpatient procedures performed or services provided is called the

Accepted Answer

The UB-04 (Uniform Billing 04) is the standard claim form used by hospitals to request reimbursement for inpatient and outpatient procedures performed or services provided. The CMS-1500 is used for physician and professional services billing, the CMS-1491 and CMS-1600 are not standard claim forms used for reimbursement requests.

Exam 1: Registered Health Information Administrator

The prospective payment system based upon resource utilization groups (RUGs) is used for reimbursement to ________________ for Medicare patients.

Currently, payment to the physician for outpatient surgery performed ona Medicare patient is based upon which prospective payment system?

The case-mix management system that utilizes information from the minimum data set (MDS) in long-term care settings is called

The prospective payment system used to reimburse home health agencies for Medicare patients utilizes data from

Under ASCs, when multiple procedures are performed during the same surgical session, a payment reduction is applied. The procedure in the highest level group is reimbursed at (percent) and all remaining procedures are reimbursed at (percent) .

Prolonged pregnancy is a pregnancy that has advanced beyond _______ completed weeks of gestation.

____________ indicates that the claim has been released as a complete for submission to the insurer for payment.

All of following items are packaged under the Medicare outpatient prospective payment system, EXCEPT for

Under the RBRVS, each HCPCS/CPT code contains 3 components, each having assigned relative value units. These 3 components are

How many major diagnostic categories are there in the MS-DRG system?

The ______________ is a statement sent to the provider to explain payments made by third party payers.

The ________________ refers to a statement sent to the patient to clarify which services were provided, amount billed, and amount of payments made by the health plan.

The prospective payment system to hospitals for Medicare hospital s outpatients is called _ and became effective on _______

Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare Part B services?

What ICD-9-CM coding scheme is used to show that a therapeutic abortion resulted in a live fetus?

A computer software program that assigns appropriate MS-DRGs according to the information provided for each episode of care is called a(n)

The MS-DRG (Medicare Severity-Diagnosis-Related Group) system was designed to pay

A PEG procedure would most likely be done to facilitate

The standard claim from used by hospitals to request reimbursement for inpatient and outpatient procedures performed or services provided is called the

Exam 1: Registered Health Information Administrator

The prospective payment system based upon resource utilization groups (RUGs) is used for reimbursement to ________________ for Medicare patients.

Currently, payment to the physician for outpatient surgery performed ona Medicare patient is based upon which prospective payment system?

The case-mix management system that utilizes information from the minimum data set (MDS) in long-term care settings is called

The prospective payment system used to reimburse home health agencies for Medicare patients utilizes data from

Under ASCs, when multiple procedures are performed during the same surgical session, a payment reduction is applied. The procedure in the highest level group is reimbursed at ____ (percent) and all remaining procedures are reimbursed at ____(percent) .

Prolonged pregnancy is a pregnancy that has advanced beyond _______ completed weeks of gestation.

____________ indicates that the claim has been released as a complete for submission to the insurer for payment.

All of following items are packaged under the Medicare outpatient prospective payment system, EXCEPT for

Under the RBRVS, each HCPCS/CPT code contains 3 components, each having assigned relative value units. These 3 components are

How many major diagnostic categories are there in the MS-DRG system?

The ______________ is a statement sent to the provider to explain payments made by third party payers.

The ________________ refers to a statement sent to the patient to clarify which services were provided, amount billed, and amount of payments made by the health plan.

The prospective payment system to hospitals for Medicare hospital s outpatients is called ___ and became effective on _________

Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare Part B services?

What ICD-9-CM coding scheme is used to show that a therapeutic abortion resulted in a live fetus?

A computer software program that assigns appropriate MS-DRGs according to the information provided for each episode of care is called a(n)

The MS-DRG (Medicare Severity-Diagnosis-Related Group) system was designed to pay

A PEG procedure would most likely be done to facilitate

The standard claim from used by hospitals to request reimbursement for inpatient and outpatient procedures performed or services provided is called the

Under ASCs, when multiple procedures are performed during the same surgical session, a payment reduction is applied. The procedure in the highest level group is reimbursed at (percent) and all remaining procedures are reimbursed at (percent) .

The prospective payment system to hospitals for Medicare hospital s outpatients is called _ and became effective on _______