RHIA Domain 4 Exam Study Guide Questions Solved 100% Correct
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Course
RHIA Domain 4
Institution
RHIA Domain 4
what is the limiting charge amount? - Answer 115
The limiting charge does not apply to: (3) - Answer immunizations, supplies, or
ambulance services
Two main types of coverage plans in Medicare - Answer fee-for-service or managed care
The Medicare fee-for-service plan - Answer Original Medicare ...
RHIA Domain 4 Exam Study Guide Questions
Solved 100% Correct
what is the limiting charge amount? - Answer 115
The limiting charge does not apply to: (3) - Answer immunizations, supplies, or
ambulance services
Two main types of coverage plans in Medicare - Answer fee-for-service or managed care
The Medicare fee-for-service plan - Answer Original Medicare Plan
The Medicare Summary Notice (MSN) was once referred to as - Answer Explanation of
Medicare Benefits (EOMB)
The managed care plan of Medicare is called - Answer Medicare Advantage
responsible for providing all Medicare covered services except hospice care in return for
a predetermined capitated payment - Answer Medicare Advantage
Disadvantage of Medicare Advantage (2) - Answer Limited provider networks so may
require referrals and do not pay for out of network visits
Three different major plans of Medicare Advantage - Answer Medicare coordinated care
plans, medicare private fee for service plans, medicare savings accounts
, plan offered by a private insurance carrier to supplement coverage. Can be purchased to
fill in some of the gaps (unpaid amounts) in medicare coverage such as annual
deductible, any coinsurance, and payment for some non covered services - Answer
Medigap
A list of CPT code combinations that, if used, would cause a claim to be rejected. List is
updated every quarter and must be followed closely for compliant billing - Answer
Medicare's Correct Coding Initiatives (CCI)
In 2010 Medicare stopped paying for all __________ codes from the CPT E/m codes,
except for _____________ G-codes - Answer consultation, telehealth consultation
designed to identify and address fraud, waste, and abuse - Answer Medicare Integrity
Program
MIP acronym - Answer Medicare Integrity Program
ZPIC acronym - Answer Zone Program Integrity Contractor
Medicare postpayment claim review program - Answer Recovery auditor program
antifraud agency that conducts both prepayment and postpayment audits based on the
rules for medical necessity that LCDs set. - Answer Zone Program Integrity Contractor
(ZPIC)
Medicare life expectancy to receive hospice care - Answer 6 months or less
ASC-PPS acronym - Answer ambulatory surgery center prospective payment system
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