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Under the RBRVS, each HCPCS/CPT code contains three componets, each having assinged relative value units. They are:
Physician work, Practice expense, and Malpractice Insurance expense
All of the following elements are found in the charge description master, EXCEPT for?
Under ASCs, 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__%
100% and 50%
How many major diagnostic categories are there in the MS-DRG system?
The standard claim form used by hospitals to request reimbursement for inpatient and outpatient procedures peformed or services provided is called the
The prospective payment system used to reimburse Home Health Agencies for Medicare patients utilizes data form
OASIS (Outcome and Assessment Information Set)
___indicates that the claim has been released as complete for submission to the insurer for payment.
A patient was seen by Dr. Zachary. The charge for the office visit was $125. The Medicare beneficiary already met his deductible. The Medicare fee schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termeed as "ballance billing", which means?
the patient is financially liable for charges in excess of the Medicare fee schedule
Home Health Agencies are reimbursed on a prospective payment system (PPS) for Medicare patients. This PPS is called
Home Health Resourse Groups (HHRGs)
The __ refers to a statement sent to the patient to clarify which services were provided, amount billed and amount of payments made by the healht plan.
Medicare summary notice
A computer software program that assigns appropriate MS-DRGs according to the information provided for each episode of care is called?
All of the following items are packaged under the Medicare outpatient prospective payment system, EXCEPT: Recorvery room? Supplies? Anesthesia? or Medical visits?
The MS-DRG system was designed to pay?
Only one amount (group) of reimbursement per hospitalization
The __is a statement sent to the provider to explain payments made by third party payers.
The case mix management system that utilizes information from the minimum data set (MDS) in long term care setting is
Resourse Utilization Groups (RUGs)
Currently payment to the physician for outpatient surgery performed on a medicare patient is based upon which prosepective payment syetem?
According to the federal register, the defiinition of a NEW patient when assigning a CPT evaluation and meanagement code to a medicare hospital outpatient under the prospective patyment systemm is a patient that has
not already been assigned a medical record number
Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare part B services?
the provider can not bill the patients for the balance between the MPFS amount and the total charges.
The prospective payment system based upon resource utilization groups (RUGs) is used for reimbursement to _____for medicare patients.
skilled nursing facilities
Under ASCs bilater procedures are reimbursed at ___% of the payment rate for their group.
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