CCA EXAM PREP Domain # 2 Reimbursement methodologies, Questions and answers, 100% Accurate, rated A+

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CCA EXAM PREP Domain # 2 Reimbursement methodologies, Questions and answers, 100% Accurate, rated A+ Code assignment - ✔✔-2nd step in reimbursement process Documentation - medical/ financi... al record - ✔✔-1st step in reimbursement process Claim preparation - ✔✔-3rd step in reimbursement process Claim to payer(s) - ✔✔-4th step in reimbursement process Claim review - ✔✔-5th step in reimbursement process Claim resolution - ✔✔-6th step in reimbursement process 1. Coding for physicians 2. Coding for facilities - ✔✔-What are the 2 types of outpatient coding situations Demographic information - ✔✔-What does medical biller use as foundation for determining who should receive bills and who has responsibility for payment? Front office during pre-regristration - ✔✔-When is demographic information collected Charge Description Master - ✔✔-CDM stands for Charge Description Master - ✔✔-List of all supplies, services, equipment, usage fees for patient care Soft Coding - ✔✔-Coders perform the coding on procedures that vary from patient to patient. Hard coding - ✔✔-Done by CDM. Automatically assigns codes based on a unique identifier number of routine services Charge Master Contents - ✔✔-- CPT/HCPCS procedure code - Charge descripition - Revenue Code - Charge - Department code - Charge Code - Charge Status Fee/ Charge - ✔✔-Price established and assigned to a unit of medical/ other service in facility Annually - ✔✔-How often is Chargemaster updated Routine services - ✔✔-What does chargemaster code by using the service identifier Charge / item description - ✔✔-Identifies procedure, service, product (incl. meds), other items provided to patient Procedure, service, product code - ✔✔-CPT/ HCPCS level II codes identify specific _____ supplied to patient. Not all ____ have corresponding CPT/ HCPCS II codes. Revenue code - ✔✔-Unique 4-digit number that represents descriptions and dollar amounts charges for hospital services provided to patient. Must accompany valid procedure codes to be accepted Revenue Code - ✔✔-Used to identify location in facility where procedure was performed. Must accompany valid procedure codes to be accepted CMS and The National Uniform Billing Committee - ✔✔-Revenue codes are updated by___ Department code - ✔✔-Identifies department that revenue should be allocated to for accounting purposes. Charge Code/ Charge description/ item code - ✔✔-Each item in chargemaster is uniquely identified by a ____ assigned by organization. Charge status - ✔✔-Active assignment of charge and can be used for tracking when and how often an item has been charged. Inpatient Superbill parts - ✔✔-1. Provider info 2. Patient info 3. Service info 4. Additional info UB-04 - ✔✔-What claim for are revenue codes only used for Components for revenue codes - ✔✔-1. Demographics, incl. payer info 2. fee for each service from chargemaster 3. charge list with description 4. Correct diagnosis, procedure, supply code Revenue Code - ✔✔-4- digit code indicates inpatient/ outpatient, department, and range of services. Services incl. room, ancillary service. CMS-1500 Form - ✔✔-When physician provides care in an office where physician owns equipment and facility, professional services of physician, and equipment, and supply charges are bundled and billed on ____ CMS-1500 form - ✔✔-Form that includes both physician's services and provider practice expense costs such as electricity Coding and Billing for healthcare services at Physician's office - ✔✔-- Diagnosis codes: ICD-10-CM - Procedure codes: CPT - Supply Codes: HCPCS - Billing : CMS-1500 form Coding and Billing for healthcare services in independent facility - outside facility - ✔✔-- Diagnosis code: ICD-10-CM - Procedure codes: CPT - Supply code: HCSPCS level II - Billing: CMS-1500 form Coding and Billing for healthcare independent facility- traveling doctor - ✔✔-- Diagnosis codes: ICD-10- CM - Procedure codes: CPT -Supply codes: HCPCS - Billing: CMS-1500 Coding and Billing Physician Professional services - ✔✔-- Diagnosis code: ICD-10-CM - Procedure code: CPT - Billing - CMS-1500 form Coding and Billing non-physician professional services at independent facility - ✔✔-- Daignosis code: ICD-10-CM - Procedure code: CPT - Supply: HCPCS - BILLING: CMS-1500 form Coding and Billing for Outpatient Healthcare institutions - ✔✔-- Diagnosis code: ICD-10-CM - Procedure code: CPT (billing) - Supply: HCPCS - Billing: UB-04 form Coding and Billing for Medicare patients for outpatient surgery - ✔✔-- Diagnosis code: ICD-10 - Procedure code: CPT - Supply: HCPCS - Billing: CMS-1500 form 1. Fee for service 2. Episode of care - ✔✔-What are the two primary types of healthcare reimbursement methodologies Fee-for-service - ✔✔-Provider receives payment for each service provide to patient Episode of care - ✔✔-Reimbursement system under which payments based on services provided for conditions for which patient is treated Global Package - ✔✔-10-90 days of care after surgery where physician is NOT paid additionally for office visit pertaining to surgery. Fee-For-Service - ✔✔-1. Self-pay 2. Retrospective payment 3. Managed Care Episode of care - ✔✔-1. Managed-care -capitation 2. Global payment 3. Prospective Payment Self-pay - ✔✔-Patients without 3rd party coverage/ restrictive 3rd party coverage pay for healthcare services on a fee-for-service basis Retrospective payment - ✔✔-Fee-for-service reimbursed to providers AFTER health service has been given Resource-Based Relative Value Scale - ✔✔-what does RBRVS stand for RBRVS - ✔✔-Method used to reimburse physicians RBRVS System base - ✔✔-1. Physician work 2. Practice expense (overhead) 3. Professional liability (malpractice insurance) Each of these factors translated into "relative value unit" [Show More]

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