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hit215
reimbursement
| Question | Answer |
|---|---|
| Relative value units (RVUs) are payment components that consist of | a. work expense, practice expense, malpractice expense |
| Each relative value component is multiplied by the geographic practice cost index (GPCI), and then each is further multiplied by a variable figure called the | d. conversion factor |
| Nonparticipating (nonPAR) providers are restricted to billing at or below the | d. limiting charge |
| Medicare makes relative payment weights what, to ensure that changes in the relative payment weights from year to year do not cause the estimated amount of expenditures to ASCs to increase or decrease as a function of those changes? | d. budget neutral |
| Medicare-participating providers commonly report actual fees to Medicare but adjust fees after payment is received. The difference between the fee reported and the payment received is a | Write off |
| When other insurers are initially liable for payment on a medical service or supply provided to a patient, Medicare classifies them as what? | a. primary payer |
| "Incident to" relates to services provided by nonPARs that are defined as services | a. provided incidental to other services provided by a physician |
| When office-based services are performed at a facility other than the physician's office, Medicare payments are reduced, because the physician did not provide the supplies, drugs, utilities, or overhead. This payment reduction is called a(n) | d. site of service differential |
| The prospective payment system that is dependent on the patient's principal diagnosis, comorbidities, complications, and principal and secondary procedures is called | c. diagnosis related groups (DRGs) Correct |
| Prospective price-based rates are established by the | d. payer, based on a particular category of patient |
| A state-licensed, Medicare-certified supplier of surgical health care services that must accept assignment on Medicare claims is a(n) | c. ambulatory surgery center |
| What term is used to describe the types and categories of patients treated by a health care facility or provider? | case mix |
| The inpatient prospective payment system (IPPS) was designed to | a. provide hospitals with an incentive to manage their operations more efficiently without affecting quality of care Correct |
| Anesthesia services payments are based on the American Society of Anesthesiologists' relative value system and the | a. actual time an anesthesiologist spends with a patient |
| The document formerly known as the Explanation of Medicare Benefits is now known as the | c. Medicare Summary Notice |
| The Medicare physician fee schedule amount for code 99213 is $100. Calculate the nonPAR allowed charge. | 95 |
| The Medicare physician fee schedule amount for code 99213 is $100. Calculate the nonPAR limiting charge. | 109.25 |
| The Medicare physician fee schedule amount for code 99213 is $100. The participating provider's usual charge for this service is $125. Calculate the Medicare reimbursement amount. | 80 |
| The Medicare physician fee schedule amount for code 99213 is $100. The participating provider's usual charge for this service is $125. Calculate the patient's coinsurance amount. | 20 |
| The Medicare physician fee schedule amount for code 99213 is $100. The nonparticipating provider's usual charge for this service is $150. Calculate the Medicare reimbursement amount. | 76 |
| The Medicare physician fee schedule amount for code 99213 is $100. The nonparticipating provider's usual charge for this service is $150. Calculate the amount the patient owes the nonPAR. | 33.25 |
| The Medicare physician fee schedule amount for codeis $100. The par provider's usual charge for this service is $125. The nonpar provider's charge for this service is $150. Calcu the difference in the amount paid by the patient to the PAR and the nonPAR. | 2375 |
| The Medicare physician fee schedule amount for code 32562 is $2500. The nonparticipating provider usually charges $3200 for this procedure. Calculate the nonPAR limiting charge. | 2731.25 |
| The Medicare physician fee schedule amount for code 32562 is $2500. The nonparticipating provider usually charges $3200 for this procedure. Calculate the Medicare reimbursement amount. | 1900 |
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