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Under the RBRVS, each HCPCS/CPT code contains three componets, each having assinged relative value units. They are:
Physician work, Practice expense, and Malpractice Insurance expense
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All of the following elements are found in the charge description master, EXCEPT for?
ICD-9-CM code
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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__% and all remaining procedures are reimbursed at__%
100% and 50%
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How many major diagnostic categories are there in the MS-DRG system?
25
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The standard claim form used by hospitals to request reimbursement for inpatient and outpatient procedures peformed or services provided is called the
UB-04
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The prospective payment system used to reimburse Home Health Agencies for Medicare patients utilizes data form
OASIS (Outcome and Assessment Information Set)
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___indicates that the claim has been released as complete for submission to the insurer for payment.
Bill Drop
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A patient was seen by Dr. Zachary. The charge for the office visit was $125. The Medicare beneficiary already met his deductible. The Medicare fee schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termeed as "ballance billing", which means?
the patient is financially liable for charges in excess of the Medicare fee schedule
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Home Health Agencies are reimbursed on a prospective payment system (PPS) for Medicare patients. This PPS is called
Home Health Resourse Groups (HHRGs)
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The __ refers to a statement sent to the patient to clarify which services were provided, amount billed and amount of payments made by the healht plan.
Medicare summary notice
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A computer software program that assigns appropriate MS-DRGs according to the information provided for each episode of care is called?
Grouper
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All of the following items are packaged under the Medicare outpatient prospective payment system, EXCEPT: Recorvery room? Supplies? Anesthesia? or Medical visits?
Medical visits
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The MS-DRG system was designed to pay?
Only one amount (group) of reimbursement per hospitalization
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The __is a statement sent to the provider to explain payments made by third party payers.
Remittance advice
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The case mix management system that utilizes information from the minimum data set (MDS) in long term care setting is
Resourse Utilization Groups (RUGs)
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Currently payment to the physician for outpatient surgery performed on a medicare patient is based upon which prosepective payment syetem?
RBRVS
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According to the federal register, the defiinition of a NEW patient when assigning a CPT evaluation and meanagement code to a medicare hospital outpatient under the prospective patyment systemm is a patient that has
not already been assigned a medical record number
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Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare part B services?
the provider can not bill the patients for the balance between the MPFS amount and the total charges.
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The prospective payment system based upon resource utilization groups (RUGs) is used for reimbursement to _____for medicare patients.
skilled nursing facilities
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Under ASCs bilater procedures are reimbursed at ___% of the payment rate for their group.
150%
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