Revenue Cycle Management PASSED Exam Questions and CORRECT Answers
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Course
Medical Insurance
Institution
Medical Insurance
Revenue Cycle Management PASSED
Exam Questions and CORRECT Answers
What PPS is used by Medicare to reimburse inpatient psychiatric hospitals?
IPPS
RUGS III
IPF PPS
CMG - Correct Answer- IPF PPS
Which is not typically an HIM department function?
Coding
Data Quality auditing
Coordination of...
Medical Insurance 7e-A Revenue Cycle
Process Approach UPDATED Exam
Questions and CORRECT Answers
billing provider - Correct Answer- provider of health services reported on a claim, usually a
physician practice
clean claim - Correct Answer- claim accepted by a health plan for adjudication
CMS-1500 - Correct Answer- Paper claim for physician services
HIPAA X12 837 Health Care Claim - Correct Answer- electronic form used to send a claim
for physician services to primary & secondary payers
CMS-1500 (02/12) - Correct Answer- current paper claim form approved by NUCC
destination payer - Correct Answer- In HIPAA claims, the health plan receiving the claim.
National Uniform Claim Committee (NUCC) - Correct Answer- Organization responsible for
the content of health care claims.
pay-to provider - Correct Answer- entity that will receive payment for a claim
rendering provider - Correct Answer- healthcare professional who provides health services
reported on a claim
Place of Service (POS) - Correct Answer- administrative code indicating where medical
services were provided
National Provider Identifier (NPI) - Correct Answer- unique ten-digit identifier assigned to
each provider-doctors license number
, subscriber - Correct Answer- The insurance policyholder or guarantor for the claim
the NPI is used to report the ___ on a claim - Correct Answer- provider identifier
list the 5 major actions of the HIPAA claim - Correct Answer- 1.Provider
2.Subscriber
3.Payer info
4.Claim details info
5.Services line info
EMG - Correct Answer- emergency
POS - Correct Answer- place of service
NUCC - Correct Answer- National Uniform Claim Committee
DDE - Correct Answer- Direct Data Entry
carve out - Correct Answer- part of a standard health plan changed under an employer-
sponsored plan
Discounted fee-for-service - Correct Answer- A negotiated payment schedule for health care
services based on a reduced percentage of a provider's usual charges.
elective surgery - Correct Answer- Nonemergency surgical procedure that can be scheduled
in advance.
monthly enrollment list - Correct Answer- Document of eligible members of a capitated plan
registered with a particular PCP for a monthly period.
open enrollment period - Correct Answer- time when a policyholder selects from offered
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