3.1

Question 1

Define the term grouper

Answer 1

evaluates a patient’s principal diagnosis, any secondary diagnosis, surgical procedures, age, sex, and discharge status. displays the cost weight associated with the assigned MS-DRG for each patient record

Question 2

What is an ambulatory payment classification?

Answer 2

Classification system for payment of services under the Medicare outpatient prospective payment system

Question 3

Define the function of the business office

Answer 3

responsible for claims generation, processing of remittance documents, filing incomplete or rejecting claims, payment posting appeals, and other reimbursement issues

Question 4

What do revenue codes identify?

Answer 4

the revenue center, whether the service is inpatient or outpatient, the bill type, validates the HCPCS code assignment, and drivers reimbursement calculations

Question 5

Name the seven elements of a compliance plan

Answer 5

1. Written standards of conduct along with policies and procedures
2. Designation of a chief compliance officer
3. Education and training program
4. Maintenance of reporting process to receive complaints
5. Development of a system to respond to allegations of improper or illegal activities along with enforcement of disciplinary action
6. Auditing and monitoring
7. Investigation and remediation of systemic problems with development of policies to address non-employment or retention of sanction individuals

Question 6

What is the purpose of a status indicator?

Answer 6

determines under which payment system the services are paid

Question 7

How are claims paid with the status indicator of N?

Answer 7

are paid under OPPS. Payment is packaged into payment for other services, including outliners. There is no separate APC payment.

Question 8

CMS defines the criteria in which services must be reported on an inpatient basis. Name the criteria

Answer 8

1. Invasive nature of the procedure
2. Need for postoperative care (at least 24 hours)
3. Underlying physical condition of the patient requiring surgery

Question 9

What is the definition of a composite APC?

Answer 9

Medicare pays a single rate for a service that is reported with a combination of HCPCS codes on the same date or different date of service rather than paying for each procedure or service under a specific APC.

Question 10

Services grouped for payment mandated through the Omnibus Reconciliation Act is called??

Answer 10

Ambulatory Payment Classification