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Quiz for billing and coding

Methods used by the govenment programs to provide reimbursement to hospitals for outpatient and inpatient services

a. APC b. DRG c. RBRVS

Reimbersement methods commonly used by commercial payers for inpatient services

a. Fee Schedule b. UCR Case Rate c. Per Diem d. Contract Rate

Contract Rate and Capitaiton

reimbursment methods commonly utilized by managed care plans for outpatient and inpatient hospital services

Chargemaster

a computerized system designed to capture charges to the patient's account and billing those charges on the claim

CMS-1500

the universal claim form used to submit charges to the outpatient professional services provided by a hospital-employed provider

Balance billing

the INAPPROPRIATE billing sent to the patient for balances in excess of the payer's approved contractual amount

Reason codes

codes contained on a remittance advice of explanation of benefits sent to the hospital that describes how the claim was processed

Common reasons for claim denials

a. Service is only payable for a specific diagnosis b. Services does not meet standards of medical necessity with diagnosis submitted c. The procedure is bundled in a more comprehensive procedure

Accounts Receivable Aging Report

a report used to identify and analyze outstanding accounts

Fair Debt Collection Practice Act

a law designed to protect consumers from unfair collection activities

Advantages of electronic claim submission include

a. tracking b. Proof of receipt c. Processing time is reduced

Optical scanning

improved claim processing by replacing the process of having to input data manually from the claim form into a computer system

What is the relationship between the claim form and reimbursement

a. The claim form is submitted to payers b. Reimbursement is determined based on information reported on the claim form c. submission

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