Billing Flashcards
What organization develops the UB claim form?
National uniform billing committee, NUBC
How many procedures may be listed on the UB claim form?
Five
What organization develops the HCFA?
National uniform claims committee , NUCc
What is a vital component for determining when the reimbursement from insurance company is less than what was expected?
The remittance advice
Max #of diagnoses that can fit on a UB?
18
What is a computer to computer transfer data between providers and third-party payers?
EDI electronic data interchange
Which prospective payment system is used to determine the payment to the physician for outpatient surgery?
RB RVS
What is the MPFS?
Medicare physician fee schedule for
When the Medicare MS DRG payment receipt by the hospital is lower than the actual charge for providing inpatient service for a patient what can The hospital do?
Bill Medicare the difference
HIPPA requires the retention health insurance claims and accounting records for how many years?
Six years
What is a payment status indicator?
Code assigned to each hcpcs and cpt to identify how thethe service or procedure described by the code would be paid
What is a never event?
And Error medical care that is clearly identifiable preventable in serious consequences for patients.
What a provider in order to increase the reimbursement reports codes the payer that are not supported by the documentation in the medical record this is called what?
Abuse
What percentage is Medicare’s limiting charge?
15% above Medicare’s approved payment amount for physicians not excepting assignment
True or false: hospital acquired conditions mean that when the diagnosis is not POA it is reasonably preventable.
True
One type of hospital that is not participate in the inpatient prospective payment system
Cancer hospitals are excluded when they apply for and receive a waiver from CMS
What is a hold harmless?
Financial protection to ensure that certain types of facilities recoup all their losses due to The differences between there APC payments and their pre-APC payments
What is the medical insurance percentage?
20%
What does status indicator V mean?
Clinic or emergency department visit, medical visits
What does status indicator c mean?
Inpatient procedure/service
True or false: in the capitation agreement each service is paid based on the actual charges
Foals capitation means paying a fixed amount per month per member
Which type of facility utilizes a patient assessment instrument?
Inpatient rehab facility
Inpatient rehab facilities use what to classify patient into case mix groups, CMG’s
Patient assessment instrument
What is the name of the software used by home health agencies?
PAC E, patient assessment comprehensive evaluation
This accounting method attributes a dollar figure to every input required to provide a service
Cost accounting
How many MSDRGs can a patient’s claim have?
One
How are Hospital emergency department and outpatient evaluation and management code assignment methodologies determine for each facility?
Each facility is accountable for developing its own methodology
When does CMS I just the Medicare severity DRGs reimbursement rates?
At the beginning of every fiscal year October 1
What are the three relative value units multiplied by in calculating the fee for a physician’s reimbursement, by Medicare
Geographic practice cost indices
True or false a rejected claims it sent back to the provider, the errors may be corrected in the claim resubmitted
True
Describe incident to billing
What a physicians assistant provides services under direct supervision of the physician. The initial visit must be performed by the physician
When is a present on admission indicator required
On the principal and secondary diagnosis, for Medicare patients, any inpatient
What is the term assigned to each MS DRG which is used as a multiplier to determine reimbursement
Relative weight
The physician bills $250 for an office visit the patients deductible has been met and the Medicare PAR few schedule amount is $200. How much will the patient owe? What is the total amount the physician receives?
Patient pays $40, mcr $160 total rcvd $200
The par fee schedule should match the total the physician will receive from both the pt and mcr
