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CCA II Reimbursement
| Question | Answer |
|---|---|
| Which service is reimbursed by Medicare under the outpatient prospective payment system (2 phys visits, radiology exam, clinical lab tests or take home dressings)? | |
| What type of hospital is excluded form the Medicare inpatient prospective payment system | Childrens |
| DRG's are organized into | Major Diagnostic Categories |
| A hospital would receive payment under what payment system for processing a Medicare payment for outpatient radiology examinations | |
| What is NOT reimbursed according to the Medicare outpatient prospective payment system | |
| Fee schedules are updated by third-party payers | Annually |
| What form is used to perform the billing function for a physicians office | CMS-1500 |
| A method of payment for Medicare hospital insurance based on DRGs | PPS Prospective Payment System |
| A system that ranks physician services by units and provides a formula to determine a Medicare fee schedule | RBRVS Resource Based Relative Value Scale |
| A list of procedure codes for professional services and procedures that are assinged unit values that indicate the relative value of onr procedure over another | RVS Relative Value Studies or Scale |
| A monetary value assigned to each service on the basis of the amount of physician work, practice expenses and professional liability insurance | RVU Relative Value Units |
| Physician work, practice expenses and professional liability insurance are then adjusted according to the geographic area and used in a formula to determine | Medicare fees |
| Classification of services treatments and diagnoses in a SNF or Long Term Care Facility | RUG Resource Utilization Group |
| To address the issue of income disparity between physician specialists and GPs. Specialists were higher paid than GPs; more medical students in specialty fields. A shortage of family doctors; especially in rural areas. Save Govt MCR Funds. | Development of RVU System |
| PE is the overhead costs of the practice. The SMS included six categories of PE costs: Clinical Payroll; Administrative Payroll; Office Expenses; Medical Material and supply expenses; Medical equipment expense | PE Expenses |
| PE is the overhead costs of the practice. The SMS included six categories of PE costs: Clinical Payroll; Admin Payroll; Office Expenses; Medical Material and supply expenses; Medical equipment expense | Physician Practice Expenses |
| (Includes fringe benefits) for nonphysician clinical personnel (such as physician assistants, nurse practitioners, etc.) | Clinical Payroll |
| (Including fringe benefits) for nonphysician administrative | Administrative Payroll |
| rent, mortgage interest, depreciation on medical buildings, utilities, telephones, and other related costs | Office Expenses |
| Drugs, x-ray films, disposable medical products, and other related cost | Medical Material & Supply Expenses |
| Including depreciation leases, and rentals for medical equipment used in the diagnosis | Medical Equipment Expenses |
| Legal services, accounting, office management, professional association membership and expenses | Other Expenses |
| The maximum amount of reimbursement that Medicare will allow for a service | MPFS (Medicare Physician Fee Schedule) |
| This factor is a constant that applies to the entire RVU. The conversion factor transforms the geographic-adjusted RVU into a PFS payment amount for Medicare reimbursement. CMS raises or lowers the conversion factor to raise or lower physician payments | Conversion Factor (CF) |
| Geographic Practice Cost Index (GPCI) established and maintained for Medicare physician fee schedule (MPFS) Index based on relative difference in the cost of a market basket of goods across geographical areas. | Geographic Practice Cost Index (GPCI) |
| The 1989 Omnibus Budget reconciliation Act, Congress required the government to reform the physician payment system. Effective January 1, 1992 the federal government instituted RBRVS for reimbursement of physicians. | Who created the RBRVS |
| Participating Physician Accepting Assignment (80/20) Non-Participating Accepting Assignment (5% less F.S.) Non-Participating and does not Accepting Assignment (Limi Charge of 15% of Allowable and check goes to PT) | Different Medicare Payment Schedules |
| Primary coding system used in physicians offices for professional services and procedures and updated ANNUALLY by the AHA | Current Procedural Terminology (CPT) |
| HCPCS means | Healthcare Common Procedure Coding System |
| Selecting a procedure code that describes physicians or provider services is | Level 1 HCPCS CPT |
| Selecting procedure A through V Code Categories describe Medicare services | Level II HCPCS National Codes |
| Which of the following would a health record technician use to perform the billing function for a physicians office? | CMS-1500 |
| When the provider agrees to accept as payment in full the allowed charge from the fee schedule this means to | Accept Assignment |
| Prospective Payment Systems (PPS) were developed by the federal government to | Manage medicare and medicaid costs |
| NCCI edits are updated | quarterly |
| The goals of coding compliance programs is to prevent | inaccurate code assignments |
Created by:
Denjack