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HCCA CHC - Enterprise Wide Billing and Reimbursement – questions with correct answers
Typology: Exams
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Medicare |- |Part |A |Insurance |- |CORRECT |ANSWERS |✔✔Inpatient Medicare |- |Part |C |Insurance |(Medicare |Advantage) |- |CORRECT | ANSWERS |✔✔Government |managed |care. |Must |be |paying |Part |B | Premiums |to |qualify. Medicare |- |Part |B |Insurance |- |CORRECT |ANSWERS |✔✔Outpatient/ | MD |Payment |(members |pay |premium) Medicare |- |Part |D |Coverage |- |CORRECT |ANSWERS |✔✔Prescription | Drug |Coverage Def: |Fiscal |Intermediary |(FI) |- |CORRECT |ANSWERS |✔✔Process |for | Medicare |Part |A Def: |Carrier |- |CORRECT |ANSWERS |✔✔Part |B, |administers |MD |claims
Def: |Medicare |Administrative |Contractor |(MAC) |- |CORRECT | ANSWERS |✔✔Applies |to |Fiscal |Intermediary |and |Carriers Terminology: |FMR |- |CORRECT |ANSWERS |✔✔Focused |Medical |Review Terminology: |COPs |- |CORRECT |ANSWERS |✔✔Conditions |of | Participation Terminology |- |ICD-10-CM |- |CORRECT |ANSWERS |✔✔International | Classification |of |Disease, |Tenth |Edition, |Clinical |Modification Terminology |- |DRGs |- |CORRECT |ANSWERS |✔✔Diagnosis |Related | Groups Terminology |- |CPT |- |CORRECT |ANSWERS |✔✔Current |Procedural | Terminology |(CPT) Terminology |- |HCPSC |- |CORRECT |ANSWERS |✔✔Health |Care | Common |Procedure |Coding |System Def: |Modifiers |- |CORRECT |ANSWERS |✔✔ 2 |digit |alpha-numeric |code | to |modify |payment
Def: |Coordination |of |Benefits |- |CORRECT |ANSWERS |✔✔Determining | in |what |order |a |claim |will |be |paid Def: |Health |Professional |Shortage |Area |- |CORRECT |ANSWERS | ✔✔Government |recognized |shortage |of |PCPs; |MDs |are |given |an | incentive |payment |to |work |in |these |areas. Def: |Local |Coverage |Determination |- |CORRECT |ANSWERS |✔✔Region | that |is |determined |by |CMS Def: |National |Coverage |Determination |- |CORRECT |ANSWERS | ✔✔National |Coverage |Determination |trumps |Regional/Local | determination Def: |Medicare |Code |Editor |- |CORRECT |ANSWERS |✔✔As |san | electronic |claim |is |being |processed, |it |goes |through |the |editor |for | accuracy. Def: |Grouper |- |CORRECT |ANSWERS |✔✔Group |codes |for |DRGs | (diagnosis |related |groups) Def: |Pricer |- |CORRECT |ANSWERS |✔✔Determines |how |much |will |be | paid |for |DRG |reimbursement
Def: |Remittance |Advice |- |CORRECT |ANSWERS |✔✔Tells |you | everything |about |payment |(ex: |reduced. |paid, |reason |not |paid, |etc.) Two |Billing |Forms |- |CORRECT |ANSWERS |✔✔CMS | 1500 |Form |and | CMS | 1450 |(UB-40) |are |the |paper |version |of |the |billing |forms. |837P | and |837i |are |the |electronic |version |of |the |paper |forms, |respectively. CMS | 1500 |Paper |Billing |Form/837P |Electronic |Billing |Form |- | CORRECT |ANSWERS |✔✔Used |by |Physicians |to |bill CMS |1450(UB-40) |Paper |Billing |Form/837i |Electronic |Billing |Form |- | CORRECT |ANSWERS |✔✔Used |by |Inpatients/Hospitals |to |bill Three |Components |of |Evaluation |& |Management |Documentation |- | CORRECT |ANSWERS |✔✔1) |History |2) |Examination |3) |Medical | Decision |Making Four |Types |of |Evaluation |& |Management |History |- |CORRECT | ANSWERS |✔✔1) |Problem |focused |history |2) |Expanded |problem | focused |history |3) |Detailed |History |4) |Comprehensive |History