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CIC - CH 12 - Review Exam questions fully solved & updated
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CIC - CH 12 - Review Exam questions fully solved & updated
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CIC - CH 12 - ReviewExam questions fully
solved & updated
What payment methodology is used to reimburse inpatient rehabilitation
groups? - answer Case-mix groups
Response Feedback:
Inpatient rehabilitation hospitals are reimbursed under Case-Mix Groups
(CMGs)
What payment methodology is used by Medicare to reimburse inpatient acute
care hospitals? - answer MS-DRGs
Response Feedback:
Inpatient acute care hospitals are reimbursed under MS-DRGs
A condition code is defined as: - answer A two-digit code entered on the claim
form to indicate that a condition applies to the bill that affects processing and
payment of the claim
Condition codes are reported on the UB-04 to describe any conditions or events
that apply to the billing period for Medicare claims. Condition codes are
mandatory when filing claims when the ABN is signed or when the item or
, service is statutorily not covered, and/or the patient demands the facility file
the claim.
Medicare statutory denials include: - answer I, II, III. IV
The following are examples in which Medicare payment is denied based on
statutory provisions.
Routine physicals and most tests for screening
Most vaccinations
Routine eye care, most eyeglasses and examinations
Hearing aids and hearing examinations
Cosmetic surgery
Orthopedic shoes and foot supports (orthotics)
Dental care and dentures (in most cases)
Routine foot care and flat foot care
Services under a physician's private contract
Services paid under a government entity that is not Medicare
Healthcare received outside the United States not covered by Medicare
Services by immediate relatives
Services required as a result of war
Services for which there is no legal obligation to pay
Home health services furnished under a plan of care, if the agency does not
submit the claim
Items or services excluded under the Assisted Suicide Funding Restriction Act
of 1997
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