NIS chapter 5 - reimbursement

Question 1

What does CPT stand for?

Answer 1

Current procedural terminology

Question 2

Who has full editorial control of CPT codes?

Answer 2

CPT Editorial panel

Question 3

What does RVU stand for?

Answer 3

relative value unit

Question 4

What are three things that an RVU encompasses

Answer 4

Work, practice expense, malpractice

Question 5

denials based on medical necessity are usually the result of

Answer 5

mismatched ICD and CPT codes

Question 6

Medicare uses which process as the basis for physician payment determination:

Answer 6

resource based relative value system. The Resource Based Relative Value System was implement by Medicare approximately 25 years ago as a national system to objectively and uniformly establish the fee schedule for physician payments. The Current Procedural Terminology and International Classification of Diseases Systems are both essential for claims submission, but are not themselves used as the basis for Medicare payments.

Question 7

CPT codes are used to report:

Answer 7

what service was rendered.

Current Procedural Terminology codes are used by physicians to report what services they performed. Separate codes are used to report why a service was rendered (ICD), where a service was rendered (site of service codes), and who rendered a service (national provider identification codes).

Question 8

ICD codes are used to report:

Answer 8

WHY a service was rendered

Question 9

physician procedural services are valued by Medicare based on:

Answer 9

the typical physician time involved

Question 10

how is medical necessity defined?

Answer 10

the concordance between ICD and CPT codes = medical necessity

Question 11

CPT codes for radiography are based on:

Answer 11

number of views performed

Question 12

CPT codes for CT and MRI are based on:

Answer 12

details of contrast administration

Question 13

CPT codes for US are based on:

Answer 13

number of body regions assessed

Question 14

The CPT code set is maintained by:

Answer 14

The AMA officially oversees all CPT codes……The American College of Radiology, like many other physician professional societies, participates in the CPT code development process through the CPT Advisory Committee.

Question 15

What organization develops and maintains ICD codes

Answer 15

World Health Organization

Question 16

For radiology services, which group or entity is the final arbitrator of CPT codes?

Answer 16

CPT editorial panel

Question 17

optimize appropriate ICD code assignments for radiology services:

Answer 17

what, when, where

Question 18

Medicare pays radiologists in teaching hospitals for their clinical professional services through which payment pathway:

Answer 18

physician fee schedule. ……Medicare pays radiologists in teaching hospitals—just like radiologists in non-teaching settings—for their professional services through the Part B Medicare Physician Fee Schedule. Direct graduate medical education and indirect medical education payments are made by Medicare to hospitals and health systems to support resident education. Medicare pays hospitals for inpatient hospitalizations through its inpatient prospective payment system.

Question 19

If a resident interprets an imaging study and prepares a report, Medicare will only pay his/her attending radiologist for that interpretation if that attending physician:

Answer 19

personally reviewed those images and that interpretation and documented accordingly

Question 20

In order to bill for a surgical, high-risk, or other complex procedure performed by a trainee, an attending interventional radiologist must:

Answer 20

be present during all key and critical portions of the procedure

Question 21

process by which individual components of a complicated procedure are combined into one code for the purposes of billing is known as what

Answer 21

Bundling

Question 22

What is the purpose of a CPT code

Answer 22

to document medical, surgical, or diagnostic services. It is a code set used to report medical surgical and diagnostic procedures and services to physicians, insurance companies, and accreditation organizations.

Question 23

The total RVU has three components:

Answer 23

the work RVU, the practice expense RVU, and the malpractice RVU.

Question 24

work RVU takes into account

Answer 24

work RVU takes into account encounter time, intensity, effort, and skill.

Question 25

practice expense RVU accounts for

Answer 25

practice expense RVU accounts for the cost of maintaining a practice such as equipment, nonphysician staff, and supplies.

Question 26

malpractice RVU encompasses

Answer 26

malpractice RVU encompasses professional liability expenses.

Question 27

RVU that encompasses professional liability expenses.

Answer 27

malpractice RVU

Question 28

RVU that accounts for the cost of maintaining a practice such as equipment, nonphysician staff, and supplies.

Answer 28

practice expense RVU

Question 29

RVU that accounts for practice expense RVU, and the malpractice RVU.

Answer 29

practice expense RVU