the difficult chaper in my CCA Prep book
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| 1002422386 | The Computer-tocomputer transfer of data between providers and third-party payers in a data format agreed upon by both parties is called | Electronic data interchange (EDI) | 0 | |
| 1002422387 | The standard claim form used by hospitals to request reimbursement for inpatient and outpatient procedures performed or services provided is called the | UB-04 | 1 | |
| 1002422388 | The _________ refers to a statement sent to the patient to show how much the provider billed, how much Medicare reimbursed the provider, and what the patient must pay the provider. | Medicare summary notice | 2 | |
| 1002422389 | Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare Part B services. | The provider cannot bill the patients for the balance between the MPFS amount and the total charges. | 3 | |
| 1002422390 | When a provider, in order to increase their reimbursement, reports codes to payer that are not supported by documentation is the medical record, this is called. | Abuse | 4 | |
| 1002422391 | What prospective payment system reimburses the provider according to prospectively determined rates for 60-day episode of care? | home health resource groups | 5 | |
| 1002422392 | Formula for nonPar doctor who does not accept assignement | 128 x 1.15 = $147.20 | 6 | |
| 1002422393 | Under the inpatient prospective payment system (IPPS), there is a 3-day payment window (formerly referred to as the 72-hour rule). This rule requires that outpatient preadmission services that are provided by a hospital up to three calendar days prior to a patient's inpatient admission be covered by the IPPS MS-DRG payment for | diagnostic AND therapeutic | 7 | |
| 1002422394 | Changes in case-mix idex (CMI) may be attributed to all of the following factors EXCEPT | changes in coding productivity | 8 | |
| 1002422395 | This process involves the gathering of charge documents from all departments within the facility that have provided services to patients. The purpose is to make certain that all charges are coded and entered into the billing system | charge capturing | 9 | |
| 1002422396 | This information is used because it provides a uniform system of identifying procedures, services or supplies. Multiple columns can be available for various financial classes. | HCPCS code | 10 | |
| 1002422397 | This information provides a narrative name of the services provided. This information should be presented in a clear and concise manner. When possible, the narratives from the HCPCS/CPT book should be utilized | item description/service description | 11 | |
| 1026156864 | This information is the numerical identification of the service or supply. Each item has a unique number with a prefix and indicates the department number (the number assigned by the accounting department or the business office) for a specific procedure or service represented on the chargemaster | charge code/ service code | 12 | |
| 1026156865 | This information is used to assign each item to a particular section of the general ledger in a particular facility's accounting section. Reports can sbe generated from this information to include statistics related to volume in terms of number, dollars, and payer types. | general ledger key | 13 | |
| 1026223518 | The DNFB report includes all patients who have been discharged from the facility but for whom, for one reason or another , the billing process is not complete. | discharged not final billed | 14 | |
| 1026223519 | Under APCs payment status indicator "x" means | Ancillary | 15 | |
| 1026223520 | Under APCs, payment status indicator "v" means | Clinic or emergency | 16 | |
| 1026223521 | Under APCs, payment status indicator "s" means | Significant procedure, multiple procedure reduction does NOT apply. | 17 | |
| 1026223522 | Under APCs, payment status indicator "T" means | Significant procedure multiple procedure reduction applies. | 18 | |
| 1026223523 | Under APCs, payment status indicator "c" means | Patient procedure/services | 19 | |
| 1026223524 | Accounts receivable (A/R) refers to | cases that have not yet been paid | 20 | |
| 1026223525 | What coding system (s) is/are utilized in the MS-DRG prospective payment methodology for assignment and proper reimbursement. | ICD-9-CM codes | 21 | |
| 1026223526 | What coding systems (s) is/are utilized in the Inpatient Psychiatric Facilities (IPFs) prospective payment methodology for assignment and proper reimbursement. | ICD-9-CM codes | 22 | |
| 1026265357 | The term used to describe a diagram depicting grouper logic in assignming MS-DRGs is | decision tree | 23 | |
| 1026265358 | Under the APC methodology, discounted payments occur when | there are two or more (multiple) procedures that are assigned to status indicator "T" AND modifier -73 used to indicate a procedure is terminated after the patient is prepared but before anesthesia is started. | 24 | |
| 1026265359 | This prospective payment system is for _______ and utilizes a Patient Assessment Instrument (PAI) to classify patients into case-mix groups (CMGs). | inpatient rehabilitation facilities | 25 | |
| 1026276957 | Home Health Agencies (HHAs) utilize a data entry software system developed by the Centers for Medicare and Medicaid Services (CMS). This softwre is available to HHAs at no cost through the CMS Web site or on a CD-ROM | HAVEN (Home Assessment Validation and Entry) | 26 | |
| 1028982642 | This information is published by the Medicare Administrative contractors (MACS) to describe when and under what circumstances Medicare will cover a service. The ICD-9-CM and CPT/HCPCS codes are listed in the memoranda. | LCD (Local Coverage Determinations) | 27 | |
| 1028982643 | The term "Hard Coding" refers to | HCPCs/CPT codes that appear in the hospital's chargemaster and will be included automatically on the patient's bill. | 28 | |
| 1028982644 | This is the amount collected by the facility for the services it bills. | reimbursement | 29 | |
| 1028982645 | This accounting method attributes a dollar figure to every input requred to provide a service. | Cost accounting | 30 | |
| 1028982646 | This is the amount the facility actually bills for the services it provides. | Charges | 31 | |
| 1028982647 | This is the difference between what is charged and what is paid | Contractual allowance | 32 | |
| 1028982648 | When appropriate, under the outpatient PPC, a hospital can use this CPT code in place of, but not inaadition to, a code for medical visit or emergency department service. | CPT Code 99291 Critical Care. | 33 | |
| 1029199551 | CMS assigns one ______ to each APC and each ________ code. | payment status indicator, HCPCs | 34 | |
| 1029199552 | This program, formerly called CHAMPUS (Civilian Health and Medical Program-Uniformed services) is a health care program for active members of the military and other qualified family members | Tricare | 35 | |
| 1029199553 | Under Medicare Part B, Medicare participating (PAR) providers | accept, as payment in full, the allowed charge from the PAR fee schedule. | 36 | |
| 1029199554 | Regarding hospital emergency department and hospital outpatient evaluation and management CPT code assignent, which statement is true? | Each facility is accountable for developing and implementing its own methodology. | 37 | |
| 1029199555 | In calculating the fee for a physician's reimbursement, the three relative value units are multiplied by the | geographic practice cost indices. (after the three relative value units are each multiplied by the fpci, then the total is multiplied by the national conversion factor). | 38 | |
| 1029199556 | Health plans that use _____ reimbursement methods issue lump-sum payments to providers to compensate them for all the health care services delivered to a patient for a specific illness and/or over a specific period of time. | episode-of-care (EOC) | 39 | |
| 1029545073 | Commercial insurance plans usually reimburse health care providers under some type of __ payment system, whereas the federal Medicare program uses some type of _ payment system. | retrospective, prospective. | 40 | |
| 1029545074 | Some service are performed by nonphysician practioner.A physician must have personally performed an intitial visit and must remain actively involved in the continuing care. Medicare requires direct supervision for these services to be billed. This is called | "Incident to" billing | 41 | |
| 1029545075 | The term used to describe the information-gathering fields on the UB-04 billing form is | form locator | 42 | |
| 1029579104 | The following services are excluded under the Hospital Outpatient Prospective Payment System (OPPS) Ambulatory payment Classification (APC) methodology. | clinical lab services | 43 | |
| 1029579105 | CMS will make an adjustment to the MS-DRG payment or certain conditions that were not present on hospital admission but were acquired during the hospital stay. Therefore, hospitals are required to report an indicator for each diagnosis. This indicatior is referred to as | present on admission | 44 | |
| 1029579106 | The present onf admission (POA) indicator is required to be assigned to the ______ diagnosis(es) for ________claims on____admissions. | principal and secondary, Medicare, inpatient | 45 |
