AHIMA Reimbursement Methodology Questions and Answers Already Graded A
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AHIMA Reimbursement Methodology
AHIMA Reimbursement Methodology
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The financial manager of the physician group practice explained that the healthcare insurance
company would be reimbursing the practice for its treatment of the exacerbation of congestive
heart failure that Mrs. Zale ex...
AHIMA Reimbursement Methodology Questions and Answers Already Graded A The financial manager of the physician group practice explained that the healthcare insurance company would b e reimbursing the practice for its treatment of the exacerbation of congestive heart failure that Mrs. Zale experienced. The exacerbation, treatment, and resolution covered approximately five weeks. The payment covered *All The Services That Mrs. Zale Incu rred During The Period*. What method of reimbursement was the physician group practice receiving? ✔✔Episode -of-care The notice from the healthcare insurance plan used the abbreviation "PMPM." How should the insurance analyst interpret this abbreviation? ✔✔Per member per month The ICD -10-CM/PCS Coordination and Maintenance Committee is composed of representatives from __________ and __________ ✔✔NCHS and CMS In which type of reimbursement methodology do healthcare insurance companies reimburse providers a fter the costs have been incurred? ✔✔Retrospective payment The health plan reimburses Dr. Tan $15 per patient per month. In January, Dr. Tan was contracted with the health plan to serve 300 members, of which he provided services to 100. He received $4,500 from the health plan. What method is the health plan using to reimburse Dr. Tan? ✔✔Capitated rate In which type of healthcare payment method does the healthcare plan pay for each service that a provider renders? ✔✔Fee-for-service reimbursement All of the following are discounted fee -for-service healthcare payment methods except: CRG CPR 10 RBRVS UCR ✔✔CRG CPT Category III codes represent: ✔✔Emerging technologies In which type of reimbursement methodology does the health insurance company have the greatest degree of risk? ✔✔Retrospective ____was created for reporting procedures and services performed by physicians in clinical practice? ✔✔CPT The coding system that is used for reporting diagnoses for hospital inpatients is known as __________. ✔✔ICD-10-CM The Health Insurance Portability and Accountability Act (HIPPA) was enacted in __________. ✔✔1996 _________maintains the International Classification of Diseases (ICD) ✔✔the World Health Organization (WHO) HCPCS Level II codes begin with ✔✔an alpha character followed by four numbers (A1234) The official publication for CPT® coding issues and guidance is called the: ✔✔CPT Assistant by the AMA In the IPPS, ____________ is the term for each hospital's unique standardized amount based on its co sts per Medicare discharge ✔✔"base payment rate"
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