Question 1

Revenue codes are two-digit codes that identify department services.

Accepted Answer

Revenue codes are typically three or four-digit codes used in healthcare billing to identify specific services or departments within a hospital or healthcare facility.

Question 2

The term DRG refers to a reimbursement methodology employed by Medicare for inpatient services.

Accepted Answer

DRG stands for Diagnosis-Related Group, which is a system used by Medicare to determine how much to pay hospitals for inpatient care based on the patient's diagnosis and treatment.

Question 3

APC refers to a payment methodology utilized by Medicare for inpatient facility services.

Accepted Answer

APC (Ambulatory Payment Classification) is a payment methodology used by Medicare for outpatient facility services, not inpatient services.

Question 4

The Medicare Remittance Advice indicates how a claim was processed by Medicare; for example, Paid/Denied, Allowance Amount, and Amount Paid.

Accepted Answer

The Medicare Remittance Advice provides detailed information on how a claim was processed, including whether it was paid or denied, the allowance amount, and the amount paid.

Question 5

When patient balances are not satisfied within a specified period of time and regulatory requirements for patient notification have been met, the account will be sent directly to the credit bureau.

Accepted Answer

Accounts are typically sent to collections agencies first, not directly to credit bureaus, after attempts to collect the debt have been made and regulatory requirements are met.

Question 6

A Preferred Provider Organization (PPO) is a type of managed care plan.

Accepted Answer

A Preferred Provider Organization (PPO) is a type of managed care plan that offers a network of healthcare providers and allows members to see any doctor or specialist without a referral, often at a higher cost if they go outside the network.

Question 7

Under Health Maintenance Organization (HMO) managed care plan, the patient must utilize the HMO network, and, if so, no authorizations are necessary.

Accepted Answer

In an HMO plan, patients must use the HMO network, but they often still need authorizations for certain services or specialist visits.

Question 8

The Medicare Part D program is free to all Medicare recipients.

Accepted Answer

Medicare Part D is not free; it requires premiums, deductibles, and copayments, although costs can vary based on the plan and income level.

Question 9

The guarantor is the individual responsible for ultimate payment for services performed.

Accepted Answer

The guarantor is the person who agrees to be responsible for the payment of a debt or obligation if the primary party fails to pay.

Question 10

Patient accounts that are outstanding are referred to as accounts receivable.

Accepted Answer

Accounts receivable refer to the money owed to a company or individual by customers for goods or services provided on credit, which includes outstanding patient accounts in a medical context.

Question 11

When a Medicare Advance Beneficiary Notice (ABN) has been obtained, what modifier code should be appended to the service to indicate the appropriate form has been received and was signed by the patient in accordance with Medicare guidelines?

Accepted Answer

Modifier GA is used to indicate that a Medicare Advance Beneficiary Notice (ABN) has been issued and signed by the patient, acknowledging that they may be responsible for payment if Medicare denies the claim.

Question 12

Patients eligible for Medicare usually qualify as the result of:

Accepted Answer

Medicare eligibility is primarily based on reaching the age of 65, although there are other criteria such as certain disabilities or conditions.

Question 13

The name given to the insurance carriers that process Medicare claims under guidelines from CMS are referred to as:

Accepted Answer

Medicare Administrative Contractors (MACs) are the entities that process Medicare claims and perform related functions under the guidelines of the Centers for Medicare & Medicaid Services (CMS).

Question 14

What services would be covered under Medicare Part A?

Accepted Answer

Medicare Part A primarily covers hospital inpatient services, including stays in hospitals, skilled nursing facilities, hospice, and some home health care.

Question 15

The Medicare program that functions as a Medicare HMO and may be selected by Medicare recipients in lieu of their traditional Medicare coverage is known as:

Accepted Answer

Medicare Part C, also known as Medicare Advantage, is a program that allows beneficiaries to choose a Medicare HMO or other private health plan instead of traditional Medicare.

Question 16

The Medicaid program is intended for individuals who:

Accepted Answer

Medicaid is designed to assist individuals who are indigent or medically needy, providing healthcare coverage to those with low income and limited resources.

Question 17

The name given to any type of insurance carrier that implements methods to control healthcare costs such as co-payments, primary care physicians, and/or the need for authorization for services to be performed is a(n):

Accepted Answer

A managed care plan is designed to control healthcare costs through various methods such as co-payments, requiring primary care physicians, and needing authorization for services.

Question 18

Formerly known as CHAMPUS/CHAMPVA, the type of carrier available to active and/or retired military and their qualifying family members is:

Accepted Answer

TRICARE is the healthcare program for active duty and retired military personnel and their families, previously known as CHAMPUS/CHAMPVA.

Question 19

The computerized summary of services provided by the facility, including such information as CPT codes, revenue codes, charges, and department numbers is known as the:

Accepted Answer

The Charge Description Master (CDM) is a comprehensive list used by healthcare facilities that includes all the services provided, along with their corresponding CPT codes, revenue codes, charges, and department numbers.

Question 20

When the facility participates with the insurance carrier, what are their obligations? (Select all that apply.)

Accepted Answer

When a facility participates with an insurance carrier, they agree to accept the insurance's allowance as full payment, file claims on behalf of the patient, and write off any difference between their charges and the insurance's allowance. However, they may still bill the patient for any applicable co-pays, deductibles, or non-covered services.

Quiz 3: Hospital Billing Overview