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Which of the following is a reason for physicians to participate in Medicare Quizlet

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skilled nursing facilities

The prospective payment system based on resource utilization groups [RUGs] is used for reimbursement to ____________________ for patients with Medicare

All modifiers will alter [increase or decrease] the reimbursement of the procedure

Which of the following statements is FALSE regarding the use of modifiers with the CPT codes?

will not receive additional payment for these conditions when they are not present on admission.

CMS identified Hospital-Acquired Conditions [HACs]. Some of these HACs include foreign objects retained after surgery, blood incompatibility, and catheter-associated urinary tract infection. The importance of the HAC payment provision is that the hospital

reimbursement

This is the amount collected by the facility for the services it bills.

TRICARE

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.

charges

This is the amount the facility actually bills for the services it provides.

general ledger key

Use the following table to answer the question.

HCPCS Code
Charge Service Code Item Service Description General Ledger Key Medicare Medicaid Charges Revenue Code Activity Date
49683105 CT scan; head; w/out contrast 3 70450 70450 500.00 0351 1/1/2013
49683106 CT scan; head; with contrast 3 70460 70460 675.00 0351 1/1/2013

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 be generated from this information to include statistics related to volume in terms of numbers, dollars, and payer types.

HAVEN.

A patient is being cared for in her home by a qualified agency participating in Medicare. The data-entry software used to conduct all patient assessments is known as

"Incident to" billing.

Some services are performed by a nonphysician practitioner [such as a Physician Assistant]. These services are an integral yet incidental component of a physician's treatment. A physician must have personally performed an initial visit and must remain actively involved in the continuing care. Medicare requires direct supervision for these services to be billed. This is called

HAVEN [Home Assessment Validation and Entry]

Home Health Agencies [HHAs] utilize a data entry software system developed by the Centers for Medicare and Medicaid Services [CMS]. This software is available to HHAs at no cost through the CMS Web site or on a CD-ROM.

skilled nursing facilities [SNFs] and inpatient rehabilitation facilities [IRFs]

A HIPPS [Health Insurance Prospective Payment System] code is a five-character alphanumeric code. A HIPPS code is used by home health agencies [HHA] and

discharged no final bill

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. DNFB is an acronym for _

Medicare Physician Fee Schedule [MPFS]

This prospective payment system replaced the Medicare physician payment system of "customary, prevailing, and reasonable [CPR]" charges whereby physicians were reimbursed according to their historical record of the charge for the provision of each service.

financially liable for charges in excess of the Medicare Fee Schedule, up to a limit.

A Medicare patient was seen by Dr. Zachary, who is a nonparticipating physician. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The Medicare Fee Schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termed as "balance billing," which means that the patient is

$40.00

A patient with Medicare is seen in the physician's office.
The total charge for this office visit is $250.00.
The patient has previously paid his deductible under Medicare Part B.
The PAR Medicare fee schedule amount for this service is $200.00.
The nonPAR Medicare fee schedule amount for this service is $190.00.

If this physician is a participating physician who accepts assignment for this claim, the total amount of the patient's financial liability [out-of-pocket expense] is

20%

Under ASC-PPS, the patient is responsible for paying the coinsurance amount based upon ____ of the national median charge for the services rendered.

N = Not present at the time of inpatient admission.

A patient is admitted to the hospital for a coronary artery bypass surgery. Postoperatively, he develops a pulmonary embolism. The present on admission [POA] indicator is

capitation

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 over a specific period of time.

CPT Code 99291 [critical care]

When appropriate, under the outpatient PPS, a hospital can use this CPT code in place of, but not in addition to, a code for a medical visit or emergency department service.

local coverage determinations and national coverage determinations

LCDs and NCDs are review policies that describe the circumstances of coverage for various types of medical treatment. They advise physicians which services Medicare considers reasonable and necessary and may indicate the need for an advance beneficiary notice. They are developed by the Centers for Medicare and Medicaid Services [CMS] and Medicare Administrative Contractors. LCD and NCD are acronyms that stand for

medical necessity.

The term used to indicate that the service or procedure is reasonable and necessary for the diagnosis or treatment of illness or injury consistent with generally accepted standards of care is

1.278.

The case-mix index [CMI] for the top 10 MS-DRGs above is

Use the following table to answer the question.

MS-DRG Description Number of Patients CMS Relative Weight
470 Major joint replacement or reattachment of lower extremity w/o MCC 2,750 1.9871
392 Esophagitis, gastroent & misc. digestive disorders w/o MCC 2,200 0.7121
194 Simple pneumonia & pleurisy w CC 1,150 1.0235
247 Perc cardiovasc proc 2 drug-eluting stent w/o MCC 900 2.1255
293 Heart failure & shock w/o CC/MCC 850 0.8765
313 Chest pain 650 0.5489
292 Heart failure & shock w CC 550 1.0134
690 Kidney & urinary tract infections w/o MCC 400 0.8000
192 Chronic obstructive pulmonary disease w/o CC/MCC 300 0.8145
871 Septicemia w/o MV 96+ hours w MCC 250 1.7484

The case-mix index [CMI] for the top 10 MS-DRGs above is

ANSI ASC X12N 837 format

Health care claims transactions use one of three electronic formats, including which one of those listed below?

247

Use the following table to answer the question.

home health resource groups

What prospective payment system reimburses the provider according to prospectively determined rates for a 60-day episode of care?

UB-04

ICD-10-PCS procedure codes are used on which of the following forms to report services provided to a patient?

clinic or emergency department visit [medical visits].

Under APCs, payment status indicator "V" means

The provider cannot bill the patients for the balance between the MPFS amount and the total charges.

Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare Part B services?

patients [beneficiaries]

A Medicare Summary Notice [MSN] is sent to ________ as their EOB.

each service is paid based on the actual charges.

In the managed care industry, there are specific reimbursement concepts, such as "capitation." All of the following statements are true in regard to the concept of "capitation," EXCEPT

electronic data interchange [EDI].

The computer-to-computer transfer of data between providers and third-party payers in a data format agreed upon by both parties is called

remittance advice

The _______________ is a statement sent to the provider to explain payments made by third-party payers.

Y = Present at the time of inpatient admission.

A patient is admitted for a diagnostic workup for cachexia. The final diagnosis is malignant neoplasm of lung with metastasis. The present on admission [POA] indicator is

six

The Health Insurance Portability and Accountability Act [HIPAA] requires the retention of health insurance claims and accounting records for a minimum of ____ years, unless state law specifies a longer period.

Resource Utilization Groups [RUGs].

The case-mix management system that utilizes information from the Minimum Data Set [MDS] in long-term care settings is called

100%, 50%

Under ASC PPS, when multiple procedures are performed during the same surgical session, a payment reduction is applied. The procedure in the highest level group is reimbursed at _____ and all remaining procedures are reimbursed at ______.

DNFB [discharged, no final bill].

To monitor timely claims processing in a hospital, a summary report of "patient receivables" is generated frequently. Aged receivables can negatively affect a facility's cash flow; therefore, to maintain the facility's fiscal integrity, the HIM manager must routinely analyze this report. Though this report has no standard title, it is often called the

inpatient hospital stays

The prospective payment system [PPS] requiring the use of DRGs for inpatient care was implemented in 1983. This PPS is used to manage the costs for

OASIS [Outcome and Assessment Information Set]

The prospective payment system used to reimburse home health agencies for patients with Medicare utilizes data from the:

cancer hospital

The following type of hospital is considered excluded when it applies for and receives a waiver from CMS. This means that the hospital does not participate in the inpatient prospective payment system [IPPS]

Corporate Integrity Agreement.

When health care providers are found guilty under any of the civil false claims statutes, the Office of Inspector General is responsible for negotiating these settlements and the provider is placed under a

changes in coding productivity.

Changes in case-mix index [CMI] may be attributed to all of the following factors EXCEPT

geographic practice cost indices.

In calculating the fee for a physician's reimbursement, the three relative value units are each multiplied by the

cost accounting

This accounting method attributes a dollar figure to every input required to provide a service.

Medicaid

is a joint federal and state program that provides health care coverage to low-income populations and certain aged and disabled individuals.

inpatient procedures/services.

Under APCs, payment status indicator "C" means

item/service description

Use the following table to answer the question.

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.

significant procedure, multiple procedure reduction applies.

Under APCs, payment status indicator "T" means

the OIG's Workplan

This document is published by the Office of Inspector General [OIG] every year. It details the OIG's focus for Medicare fraud and abuse for that year. It gives health care providers an indication of general and specific areas that are targeted for review. It can be found on the Internet on CMS's Web site.

Durable Medical Equipment

The following services are excluded under the Hospital Outpatient Prospective Payment System [OPPS] Ambulatory Payment Classification [APC] methodology.

15%.

The limiting charge is a percentage limit on fees specified by legislation that the nonparticipating physician may bill Medicare beneficiaries above the non-PAR fee schedule amount. The limiting charge is

nonparticipating providers have a higher fee schedule than that for participating providers.

Under Medicare Part B, all of the following statements are true and are applicable to nonparticipating physician providers, EXCEPT

DSM

HIPAA administrative simplification provisions require all of the following code sets to be used EXCEPT

LCD [Local Coverage Determinations]

This information is published by the Medicare Administrative Contractors [MACs] to describe when and under what circumstances Medicare will cover a service. The ICD-10-CM, ICD-10-PCS, and CPT/HCPCS codes are listed in the memoranda.

IPPS Transfer

For those qualified, the ____ rule states that hospitals are paid a graduated per diem rate for each day of the patient's stay, not to exceed the prospective payment DRG rate.

ASC PPS

Currently, which prospective payment system is used to determine the payment to the "physician" for physician services covered under Medicare Part B, such as outpatient surgery performed on a Medicare patient?

individuals with qualified financial need.

State Medicaid programs are required to offer medical assistance for

the Stark I Law

This law prohibits a physician from referring Medicare patients to clinical laboratory services where the doctor or a member of his family has a financial interest.

ICD-10-CM/ICD-10-PCS codes

The following coding system[s] is/are utilized in the Inpatient Psychiatric Facilities [IPFs] prospective payment methodology for assignment and proper reimbursement.

code only the comprehensive code.

The Correct Coding Initiative [CCI] edits contain a listing of codes under two columns titled "comprehensive codes" and "component codes." According to the CCI edits, when a provider bills Medicare for a procedure that appears in both columns for the same beneficiary on the same date of service,

significant procedure, multiple procedure reduction does not apply.

Under APCs, payment status indicator "S" means

Fraud

is knowingly making false statements or representation of material facts to obtain a benefit or payment for which no entitlement would otherwise exist.

unbundling.

When a provider bills separately for procedures that are a part of the major procedure, this is called

physician services.

In a global payment methodology, which is sometimes applied to radiological and similar types of procedures that involve professional and technical components, all of the following are part of the "technical" components EXCEPT

U = Documentation is insufficient to determine if condition was present at the time of admission.

The nursing initial assessment upon admission documents the presence of a decubitus ulcer. There is no mention of the decubitus ulcer in the physician documentation until several days after admission. The present on admission [POA] indicator is

revenue cycle management.

The process by which health care facilities and providers ensure their financial viability by increasing revenue, improving cash flow and enhancing the patient's experience is called

contractual allowance

This is the difference between what is charged and what is paid.

payment status indicator, HCPCS

CMS assigns one _______________ to each APC and each ______________ code.

diganostic services and therapeutic [or nondiagnostic] services whereby the inpatient principal diagnosis code [ICD-10-CM] exactly matches the code used for preadmission services.

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

$250.00

If a participating provider's usual fee for a service is $700.00 and Medicare's allowed amount is $450.00, what amount is written off by the physician?

physician work, practice expense, and malpractice insurance expense.

Under the RBRVS, each HCPCS/CPT code contains three components, each having assigned relative value units. These three components are

there are two or more [multiple] procedures that are assigned to status indicator "T."

Under the APC methodology, discounted payments occur when

covered [by third-party payer].

There are seven criteria for high-quality clinical documentation. All of these elements are included EXCEPT

Chargemaster

In a hospital, a document that contains a computer-generated list of procedures, services, and supplies, along with their revenue codes and charges for each item, is known as a[n]

Each facility is accountable for developing and implementing its own methodology.

Regarding hospital emergency department and hospital outpatient evaluation and management CPT code assignment, which statement is true?

hold harmless

These are financial protections to ensure that certain types of facilities [e.g., children's hospitals] recoup all of their losses due to the differences in their APC payments and the pre-APC payments.

charge capturing

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.

is packaged into the payment for other services.

Under APCs, the payment status indicator "N" means that the payment

a global payment.

A lump-sum payment distributed among the physicians who performed the procedure or interpreted its results and the health care facility that provided equipment, supplies, and technical support is known as

APR-DRGs.

Based on CMS's DRG system, other systems have been developed for payment purposes. The one that classifies the non-Medicare population, such as HIV patients, neonates, and pediatric patients, is known as

Medicare summary notice

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.

$218.50.

Use the following case scenario to answer the question.

If this physician is a nonparticipating physician who does NOT accept assignment for this claim, the total amount the physician will receive is

fiscal year beginning October 1.

CMS adjusts the Medicare Severity DRGs and the reimbursement rates every

employer-based group health insurers.

The category "Commercial payers" includes private health information and

470

Use the following table to answer the question.

reasonably preventable.

CMS-identified "Hospital-Acquired Conditions" mean that when a particular diagnosis is not "present on admission," CMS determines it to be

abuse

When a provider, knowingly or unknowingly, uses practices that are inconsistent with accepted medical practice and that directly or indirectly result in unnecessary costs to the Medicare program, this is called

patient [insured]

Coinsurance payments are paid by the _______ and determined by a specified ratio

organ transplantation

APCs are groups of services that the OPPS will reimburse. Which one of the following services is not included in APCs?

absorbs the loss.

When the MS-DRG payment received by the hospital is lower than the actual charges for providing the inpatient services for a patient with Medicare, then the hospital

revenue code

Use the following table to answer the question.

This information is printed on the UB-04 claim form to represent the cost center [e.g., lab, radiology, cardiology, respiratory, etc.] for the department in which the item is provided. It is used for Medicare billing.

present on admission.

The Centers for Medicare and Medicaid Services [CMS] will make an adjustment to the MS-DRG payment for certain conditions that the patient was not admitted with, but were acquired during the hospital stay. Therefore, hospitals are required to report an indicator for each diagnosis. This indicator is referred to as

payment status indicator

These are assigned to every HCPCS/CPT code under the Medicare hospital outpatient prospective payment system to identify how the service or procedure described by the code would be paid.

Never events or Sentinel events

____ are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients.

HCPCS/CPT codes that appear in the hospital's chargemaster and will be included automatically on the patient's bill.

The term "hard coding" refers to

grouper

A computer software program that assigns appropriate MS-DRGs according to the information provided for each episode of care is called a[n]

$147.20

If the Medicare non-PAR approved payment amount is $128.00 for a proctoscopy, what is the total Medicare approved payment amount for a doctor who does not accept assignment, applying the limiting charge for this procedure?

$200

If a physician is a participating physician who accepts assignment, he will receive the lesser of "the total charges" or "the PAR Medicare Fee Schedule amount." In this case, the Medicare Fee Schedule amount is less; therefore, the total received by the physician is $200.00.

Use the following case scenario to answer the question.

If this physician is a participating physician who accepts assignment for this claim, the total amount the physician will receive is

6 months or less

Terminally ill patients with life expectancies of ______ may opt to receive hospice services.

denied claim.

When the third-party payer refuses to grant payment to the provider, this is called a

ICD-10-CM/ICD-10-PCS codes

The following coding system[s] is/are utilized in the MS-DRG prospective payment methodology for assignment and proper reimbursement.

20%.

Use the following case scenario to answer the question.

The patient is financially liable for the coinsurance amount, which is

Recovery Audit Contractors [RAC]

This initiative was instituted by the government to eliminate fraud and abuse and recover overpayments, and involves the use of ______________. Charts are audited to identify Medicare overpayments and underpayments. These entities are paid based on a percentage of money they identify and collect on behalf of the government.

interrupted stay.

When a patient is discharged from the inpatient rehabilitation facility and returns within three calendar days [prior to midnight on the third day] this is called a[n]

150%

Under ASC PPSs, bilateral procedures are reimbursed at _______ of the payment rate for their group.

principal and secondary, Medicare, inpatient

The present on admission [POA] indicator is required to be assigned to the ___________ diagnosis[es] for __________________claims on __________________admissions.

HCPCS code

Use the following table to answer the question.

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.

Y = Present at the time of inpatient admission.

A patient undergoes outpatient surgery. During the recovery period, the patient develops atrial fibrillation and is subsequently admitted to the hospital as an inpatient. The present on admission [POA] indicator is

National Provider Identifier [NPI]

This is a 10-digit, intelligence-free, numeric identifier designed to replace all previous provider legacy numbers. This number identifies the physician universally to all payers. This number is issued to all HIPAA-covered entities. It is mandatory on the CMS-1500 and UB-04 claim forms.

$66.50.

If a physician is a nonparticipating physician who does not accept assignment, he may collect a maximum of 15% [the limiting charge] over the non-PAR Medicare fee schedule amount.

$190.00 = non-PAR Medicare schedule amount
$190.00 x 0.20 = $38.00 = patient liable for 20% coinsurance [patient previously met the deductible]
$190.00 x 0.80 = $152.00 = Medicare pays 80%
$190.00 x 0.15 = $28.50 = 15% [limiting charge] over non-PAR Medicare fee schedule amount

Physician can balance bill and collect from the patient the difference between the non-PAR
Medicare fee schedule amount and the total charge amount. Therefore, the patient's financial liability is $38.00 [coinsurance] + 28.50 [limiting charge] = $66.50.

Use the following case scenario to answer the question.

If this physician is a nonparticipating physician who does NOT accept assignment for this claim, the total amount of the patient's financial liability [out-of-pocket expense] is

using physician query forms.

There are times when documentation is incomplete or insufficient to support the diagnoses found in the chart. The most common way of communicating with the physician for answers is by

Revenue code.

A three-digit code that describes a classification of a product or service provided to a patient is a

APCs

The prospective payment system used to reimburse hospitals for Medicare hospital outpatients is called

inpatient rehabilitation facilities

This prospective payment system is for ____________________ and utilizes a Patient Assessment Instrument [PAI] to classify patients into case-mix groups [CMGs].

$ 48.00

If the physician is a participating physician [PAR] who accepts the assignment, he will receive the lesser of the "total charges" or the "PAR amount" [on the Medicare Physician Fee Schedule]. Since the PAR amount is lower, the physician collects 80% of the PAR amount [$60.00] x .80 =$48.00, from Medicare. The remaining 20% [$60.00 x .20 = $12.00] of the PAR amount is paid by the patient to the physician. Therefore, the physician will receive $48.00 directly from Medicare.

Assume the patient has already met his or her deductible and that the physician is a Medicare participating [PAR] provider. The physician's standard fee for the services provided is $120.00. Medicare's PAR fee is $60.00. How much reimbursement will the physician receive from Medicare?

claims for which money has not yet come in.

Accounts Receivable [A/R] refers to

DRG

______ classifies inpatient hospital cases into groups that are expected to consume similar hospital resources.

$45.60

Since the physician is a nonparticipating physician, he will receive the nonPAR fee.
The Medicare nonPAR fee is $57.00.
Medicare will pay 80% of the nonPAR fee [$57.00 x 0.80 = $45.60].
The patient will pay 20% of the nonPAR fee [$57.00 x 0.20 = $11.40].
Since the physician is accepting assignment on this claim, he cannot charge the patient any more than the 20% co-payment. Therefore, the physician will receive $45.60 directly from Medicare.

Assume the patient has already met his or her deductible and that the physician is a nonparticipating Medicare provider but does accept assignment. The standard fee for the services provided is $120.00. Medicare's PAR fee is $60.00 and Medicare's non-PAR fee is $57.00. What is the amount Medicare will pay the beneficiary on this claim?

a patient claim may have multiple MS-DRGs.

*Only one MS-DRG is assigned per inpatient hospitalization.

All of the following statements are true of MS-DRGs, EXCEPT

brachytherapy

All of the following items are "packaged" under the Medicare ASC payments, EXCEPT for

Medicare Part B

_______________________ offers voluntary, supplemental medical insurance to help pay for physician's services, outpatient hospital services, medical services, and medical-surgical supplies not covered by the hospitalization plan.

ancillary services.

*Under the APC system, there exists a list of status indicators [also called service indicators, payment status indicators, or payment indicators]. This indicator is provided for every HCPCS/CPT code and identifies how the service or procedure would be paid [if covered] by Medicare for hospital outpatient visits.

Under APCs, payment status indicator "X" means

air embolism

Of the following, which is a hospital-acquired condition [HAC]?

patient indicating whether he/she wants to receive services that Medicare probably will not pay for.

An Advance Beneficiary Notice [ABN] is a document signed by the

retrospective, prospective

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.

lifetime reserve days are paid under Medicare Part B.

Under Medicare, a beneficiary has lifetime reserve days. All of the following statements are true, EXCEPT

directly deposited into the provider's bank account.

When payments can be made to the provider by EFT, this means that the reimbursement is

It cannot be determined from this information.

se the following table to answer the question.

Based on this patient volume, the MS-DRG that brings in the highest total profit to the hospital is

charge/service code

Use the following table to answer the question.

This information is the numerical identification of the service or supply. Each item has a unique number with a prefix that indicates the department number [the number assigned to a specific ancillary department] and an item number [the number assigned by the accounting department or the business office] for a specific procedure or service represented on the chargemaster.

UB-04.

The standard claim form used by hospitals to request reimbursement for inpatient and outpatient procedures performed or services provided is called the

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