Ch. 6 – Assignment Writing – Flashcards

question
To compute the reimbursement to a particular hospital for a particular MS-DRG, multiply the hospital's base payment rate by the
answer
relative weight for the MS-DRG.
question
These are financial protections to ensure that certain types of facilities (e.g., children's hospitals) recoup all of their losses due to the differences in their APC payments and the pre-APC payments.
answer
hold harmless
question
Under APCs, payment status indicator "T" means
answer
ancillary services
question
Changes in case-mix index (CMI) may be attributed to all of the following factors EXCEPT
answer
changes in coding productivity
question
________ is knowingly making false statements or representation of material facts to obtain a benefit or payment for which no entitlement would otherwise exist.
answer
Fraud
question
How many major diagnostic categories are there in the MS-DRG system?
answer
25
question
Under ASCs, bilateral procedures are reimbursed at ________ of the payment rate for their group.
answer
150%
question
The nursing initial assessment upon admission documents the presence of a decubitus ulcer. There is no mention of the decubitus ulcer in the physician documentation until several days after admission. The present on admission (POA) indicator is
answer
U = Documentation is insufficient to determine if condition was present at the time of admission.
question
This prospective payment system is for ________ and utilizes a Patient Assessment Instrument (PAI) to classify patients into case-mix groups (CMGs).
answer
inpatient rehabilitation facilities
question
The following type of hospital is considered excluded when it applies for and receives a waiver from CMS. This means that the hospital does not participate in the inpatient prospective payment system (IPPS)
answer
cancer hospital
question
All of the following items are "packaged" under the Medicare outpatient prospective payment system, EXCEPT for
answer
medical visits
question
Regarding hospital emergency department and hospital outpatient evaluation and management CPT code assignment, which statement is true?
answer
Each facility is accountable for developing and implementing its own methodology.
question
The Health Insurance Portability and Accountability Act (HIPAA) requires the retention of health insurance claims and accounting records for a minimum of ________ years, unless state law specifies a longer period.
answer
six
question
All of the following statements are true of MS-DRGs, EXCEPT
answer
a patient claim may have multiple MS-DRGs.
question
This prospective payment system replaced the Medicare physician payment system of "customary, prevailing, and reasonable (CPR)" charges whereby physicians were reimbursed according to their historical record of the charge for the provision of each service.
answer
Medicare Physician Fee Schedule (MPFS)
question
Assume the patient has already met his or her deductible and that the physician is a nonparticipating Medicare provider but does accept assignment. The standard fee for the services provided is $120.00. Medicare's PAR fee is $60.00 and Medicare's nonPAR fee is $57.00. How much reimbursement will the physician receive from Medicare?
answer
$45.60
question
What prospective payment system reimburses the provider according to prospectively determined rates for a 60-day episode of care?
answer
home health resource groups
question
Once all data are posted to a patient's account, the claim can be reviewed for accuracy and completeness. Many facilities have internal auditing systems. The auditing systems run each claim through a set of edits specifically designed for the various third-party payers. The auditing system identifies data that have failed edits and flags the claim for correction. These "internal" auditing systems are called
answer
scrubbers
question
A patient is admitted for a diagnostic workup for cachexia. The final diagnosis is malignant neoplasm of lung with metastasis. The present on admission (POA) indicator is
answer
Y = Present at the time of inpatient admission.
question
In a global payment methodology, which is sometimes applied to radiological and similar types of procedures that involve professional and technical components, all of the following are part of the "technical" components EXCEPT
answer
physician services.
question
In the managed care industry, there are specific reimbursement concepts, such as "capitation." All of the following statements are true in regard to the concept of "capitation," EXCEPT
answer
each service is paid based on the actual charges
question
Under APCs, payment status indicator "C" means
answer
inpatient procedures/services
question
Under the inpatient prospective payment system (IPPS), there is a 3-day payment window (formerly referred to as the 72-hour rule). This rule requires that outpatient preadmission services that are provided by a hospital up to three calendar days prior to a patient's inpatient admission be covered by the IPPS MS-DRG payment for
answer
both diagnostic services and therapeutic (or nondiagnostic) services whereby the inpatient principal diagnosis code (ICD-9-CM) exactly matches the code used for preadmission services.
question
The following services are excluded under the Hospital Outpatient Prospective Payment System (OPPS) Ambulatory Payment Classification (APC) methodology.
answer
clinical lab services
question
Under the RBRVS, each HCPCS/CPT code contains three components, each having assigned relative value units. These three components are
answer
physician work, practice expense, and malpractice insurance expense
question
Health plans that use ________ reimbursement methods issue lump-sum payments to providers to compensate them for all the health care services delivered to a patient for a specific illness and/or over a specific period of time.
answer
episode-of-care (EOC)
question
When appropriate, under the outpatient PPS, a hospital can use this CPT code in place of, but not in addition to, a code for a medical visit or emergency department service.
answer
CPT Code 99291 (critical care)
question
CMS identified Hospital-Acquired Conditions (HACs). Some of these HACs include foreign objects retained after surgery, blood incompatibility, and catheter-associated urinary tract infection. The importance of the HAC payment provision is that the hospital
answer
will not receive additional payment for these conditions when they are not present on admission.
question
Accounts Receivable (A/R) refers to
answer
cases that have not yet been paid.
question
When the MS-DRG payment received by the hospital is lower than the actual charges for providing the inpatient services for a patient with Medicare, then the hospital
answer
absorbs the loss.
question
The term "hard coding" refers to
answer
HPCS/CPT codes that appear in the hospital's chargemaster and will be included automatically on the patient's bill.
question
Under the APC methodology, discounted payments occur when
answer
there are two or more (multiple) procedures that are assigned to status indicator "T", and modifier-73 is used to indicate a procedure is terminated after the patient is prepared but before anesthesia is started.
question
Under APCs, payment status indicator "V" means
answer
clinic or emergency department visit (medical visits).
question
This document is published by the Office of Inspector General (OIG) every year. It details the OIG's focus for Medicare fraud and abuse for that year. It gives health care providers an indication of general and specific areas that are targeted for review. It can be found on the Internet on CMS'Web site.
answer
the OIG's Workplan
question
The prospective payment system used to reimburse hospitals for Medicare hospital outpatients is called
answer
APCs.
question
A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The nonPAR Medicare fee schedule amount for this service is $190.00.
answer
$66.50.
question
Under APCs, payment status indicator "S" means
answer
significant procedure, multiple procedure reduction does not apply.
question
Under APCs, the payment status indicator "N" means that the payment
answer
is for ancillary services.
question
The case-mix management system that utilizes information from the Minimum Data Set (MDS) in long-term care settings is called
answer
Resource Utilization Groups (RUGs).
question
A fiscal year is a yearly accounting period. It is the 12-month period on which a budget is planned. The federal fiscal year is
answer
October 1st through September 30 of the next year
question
The following coding system(s) is/are utilized in the MS-DRG prospective payment methodology for assignment and proper reimbursement.
answer
ICD-9-CM codes
question
Commercial insurance plans usually reimburse health care providers under some type of ________ payment system, whereas the federal Medicare program uses some type of ________ payment system.
answer
retrospective, prospective
question
________ are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients.
answer
Never events
question
The present on admission (POA) indicator is required to be assigned to the ________ diagnosis(es) for ________ claims on ________ admissions.
answer
principal and secondary, Medicare, inpatient
question
To monitor timely claims processing in a hospital, a summary report of "patient receivables" is generated frequently. Aged receivables can negatively affect a facility's cash flow; therefore, to maintain the facility's fiscal integrity, the HIM manager must routinely analyze this report. Though this report has no standard title, it is often called the
answer
DNFB (discharged, no final bill)
question
A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The nonPAR Medicare fee schedule amount for this service is $190.00. If this physician is a participating physician who accepts assignment for this claim, the total amount the physician will receive is
answer
$200.00.
question
A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The nonPAR Medicare fee schedule amount for this service is $190.00. If this physician is a participating physician who accepts assignment for this claim, the total amount of the patient's financial liability (out-of-pocket expense) is
answer
$40.00.
question
If a participating provider's usual fee for a service is $700.00 and Medicare's allowed amount is $450.00, what amount is written off by the physician?
answer
$250.00
question
A HIPPS (Health Insurance Prospective Payment System) code is a five-character alphanumeric code. A HIPPS code is used by
answer
home health agencies (HHA) and inpatient rehabilitation facilities (IRF)
question
The limiting charge is a percentage limit on fees specified by legislation that the nonparticipating physician may bill Medicare beneficiaries above the nonPAR fee schedule amount. The limiting charge is
answer
15%
question
When payments can be made to the provider by EFT, this means that the reimbursement is
answer
sent to the provider by check.
question
The Centers for Medicare and Medicaid Services (CMS) will make an adjustment to the MS-DRG payment for certain conditions that the patient was not admitted with, but were acquired during the hospital stay. Therefore, hospitals are required to report an indicator for each diagnosis. This indicator is referred to as
answer
present on admission
question
To compute the reimbursement to a particular hospital for a particular MS-DRG, multiply the hospital's base payment rate by the
answer
relative weight for the MS-DRG.
question
This is a 10-digit, intelligence-free, numeric identifier designed to replace all previous provider legacy numbers. This number identifies the physician universally to all payers. This number is issued to all HIPAA-covered entities. It is mandatory on the CMS-1500 and UB-04 claim forms.
answer
National Provider Identifier (NPI)
question
CMS assigns one ________ to each APC and each ________ code.
answer
payment status indicator, HCPCS
question
This is the amount collected by the facility for the services it bills
answer
reimbursement
question
In calculating the fee for a physician's reimbursement, the three relative value units are each multiplied by the
answer
geographic practice cost indices.
question
When a provider, knowingly or unknowingly, uses practices that are inconsistent with accepted medical practice and that directly or indirectly result in unnecessary costs to the Medicare program, this is called
answer
abuse.
question
This accounting method attributes a dollar figure to every input required to provide a service.
answer
cost accounting
question
CMS adjusts the Medicare Severity DRGs and the reimbursement rates every
answer
fiscal year beginning October 1
question
Currently, which prospective payment system is used to determine the payment to the physician for outpatient surgery performed on a Medicare patient?
answer
RBRVS
question
This information is published by the Medicare Administrative Contractors (MACs) to describe when and under what circumstances Medicare will cover a service. The ICD-9-CM and CPT/HCPCS codes are listed in the memoranda.
answer
LCD (Local Coverage Determinations)
question
Under Medicare, a beneficiary has lifetime reserve days. All of the following statements are true, EXCEPT
answer
lifetime reserve days are paid under Medicare Part B.
question
Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare Part B services?
answer
The provider cannot bill the patients for the balance between the MPFS amount and the total charges
question
LCDs and NCDs are review policies that describe the circumstances of coverage for various types of medical treatment. They advise physicians which services Medicare considers reasonable and necessary and may indicate the need for an advance beneficiary notice. They are developed by the Centers for Medicare and Medicaid Services (CMS) and Medicare Administrative Contractors. LCD and NCD are acronyms that stand for
answer
local coverage determinations and national coverage determinations.
question
A Medicare patient was seen by Dr. Zachary, who is a nonparticipating physician. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The Medicare Fee Schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termed as "balance billing," which means that the patient is
answer
financially liable for charges in excess of the Medicare fee schedule, up to a limit
question
A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The nonPAR Medicare fee schedule amount for this service is $190.00. If this physician is a nonparticipating physician who does NOT accept assignment for this claim, the total receive is
answer
$218.50
question
The DNFB report includes all patients who have been discharged from the facility but for whom, for one reason or another, the billing process is not complete. DNFB is an acronym for ________.
answer
discharged not final billed
question
When health care providers are found guilty under any of the civil false claims statutes, the Office of Inspector General is responsible for negotiating these settlements and the provider is placed under a
answer
Corporate Integrity Agreement
question
The prospective payment system used to reimburse home health agencies for patients with Medicare utilizes data from
answer
OASIS (Outcome and Assessment Information Set)
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question
To compute the reimbursement to a particular hospital for a particular MS-DRG, multiply the hospital's base payment rate by the
answer
relative weight for the MS-DRG.
question
These are financial protections to ensure that certain types of facilities (e.g., children's hospitals) recoup all of their losses due to the differences in their APC payments and the pre-APC payments.
answer
hold harmless
question
Under APCs, payment status indicator "T" means
answer
ancillary services
question
Changes in case-mix index (CMI) may be attributed to all of the following factors EXCEPT
answer
changes in coding productivity
question
________ is knowingly making false statements or representation of material facts to obtain a benefit or payment for which no entitlement would otherwise exist.
answer
Fraud
question
How many major diagnostic categories are there in the MS-DRG system?
answer
25
question
Under ASCs, bilateral procedures are reimbursed at ________ of the payment rate for their group.
answer
150%
question
The nursing initial assessment upon admission documents the presence of a decubitus ulcer. There is no mention of the decubitus ulcer in the physician documentation until several days after admission. The present on admission (POA) indicator is
answer
U = Documentation is insufficient to determine if condition was present at the time of admission.
question
This prospective payment system is for ________ and utilizes a Patient Assessment Instrument (PAI) to classify patients into case-mix groups (CMGs).
answer
inpatient rehabilitation facilities
question
The following type of hospital is considered excluded when it applies for and receives a waiver from CMS. This means that the hospital does not participate in the inpatient prospective payment system (IPPS)
answer
cancer hospital
question
All of the following items are "packaged" under the Medicare outpatient prospective payment system, EXCEPT for
answer
medical visits
question
Regarding hospital emergency department and hospital outpatient evaluation and management CPT code assignment, which statement is true?
answer
Each facility is accountable for developing and implementing its own methodology.
question
The Health Insurance Portability and Accountability Act (HIPAA) requires the retention of health insurance claims and accounting records for a minimum of ________ years, unless state law specifies a longer period.
answer
six
question
All of the following statements are true of MS-DRGs, EXCEPT
answer
a patient claim may have multiple MS-DRGs.
question
This prospective payment system replaced the Medicare physician payment system of "customary, prevailing, and reasonable (CPR)" charges whereby physicians were reimbursed according to their historical record of the charge for the provision of each service.
answer
Medicare Physician Fee Schedule (MPFS)
question
Assume the patient has already met his or her deductible and that the physician is a nonparticipating Medicare provider but does accept assignment. The standard fee for the services provided is $120.00. Medicare's PAR fee is $60.00 and Medicare's nonPAR fee is $57.00. How much reimbursement will the physician receive from Medicare?
answer
$45.60
question
What prospective payment system reimburses the provider according to prospectively determined rates for a 60-day episode of care?
answer
home health resource groups
question
Once all data are posted to a patient's account, the claim can be reviewed for accuracy and completeness. Many facilities have internal auditing systems. The auditing systems run each claim through a set of edits specifically designed for the various third-party payers. The auditing system identifies data that have failed edits and flags the claim for correction. These "internal" auditing systems are called
answer
scrubbers
question
A patient is admitted for a diagnostic workup for cachexia. The final diagnosis is malignant neoplasm of lung with metastasis. The present on admission (POA) indicator is
answer
Y = Present at the time of inpatient admission.
question
In a global payment methodology, which is sometimes applied to radiological and similar types of procedures that involve professional and technical components, all of the following are part of the "technical" components EXCEPT
answer
physician services.
question
In the managed care industry, there are specific reimbursement concepts, such as "capitation." All of the following statements are true in regard to the concept of "capitation," EXCEPT
answer
each service is paid based on the actual charges
question
Under APCs, payment status indicator "C" means
answer
inpatient procedures/services
question
Under the inpatient prospective payment system (IPPS), there is a 3-day payment window (formerly referred to as the 72-hour rule). This rule requires that outpatient preadmission services that are provided by a hospital up to three calendar days prior to a patient's inpatient admission be covered by the IPPS MS-DRG payment for
answer
both diagnostic services and therapeutic (or nondiagnostic) services whereby the inpatient principal diagnosis code (ICD-9-CM) exactly matches the code used for preadmission services.
question
The following services are excluded under the Hospital Outpatient Prospective Payment System (OPPS) Ambulatory Payment Classification (APC) methodology.
answer
clinical lab services
question
Under the RBRVS, each HCPCS/CPT code contains three components, each having assigned relative value units. These three components are
answer
physician work, practice expense, and malpractice insurance expense
question
Health plans that use ________ reimbursement methods issue lump-sum payments to providers to compensate them for all the health care services delivered to a patient for a specific illness and/or over a specific period of time.
answer
episode-of-care (EOC)
question
When appropriate, under the outpatient PPS, a hospital can use this CPT code in place of, but not in addition to, a code for a medical visit or emergency department service.
answer
CPT Code 99291 (critical care)
question
CMS identified Hospital-Acquired Conditions (HACs). Some of these HACs include foreign objects retained after surgery, blood incompatibility, and catheter-associated urinary tract infection. The importance of the HAC payment provision is that the hospital
answer
will not receive additional payment for these conditions when they are not present on admission.
question
Accounts Receivable (A/R) refers to
answer
cases that have not yet been paid.
question
When the MS-DRG payment received by the hospital is lower than the actual charges for providing the inpatient services for a patient with Medicare, then the hospital
answer
absorbs the loss.
question
The term "hard coding" refers to
answer
HPCS/CPT codes that appear in the hospital's chargemaster and will be included automatically on the patient's bill.
question
Under the APC methodology, discounted payments occur when
answer
there are two or more (multiple) procedures that are assigned to status indicator "T", and modifier-73 is used to indicate a procedure is terminated after the patient is prepared but before anesthesia is started.
question
Under APCs, payment status indicator "V" means
answer
clinic or emergency department visit (medical visits).
question
This document is published by the Office of Inspector General (OIG) every year. It details the OIG's focus for Medicare fraud and abuse for that year. It gives health care providers an indication of general and specific areas that are targeted for review. It can be found on the Internet on CMS'Web site.
answer
the OIG's Workplan
question
The prospective payment system used to reimburse hospitals for Medicare hospital outpatients is called
answer
APCs.
question
A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The nonPAR Medicare fee schedule amount for this service is $190.00.
answer
$66.50.
question
Under APCs, payment status indicator "S" means
answer
significant procedure, multiple procedure reduction does not apply.
question
Under APCs, the payment status indicator "N" means that the payment
answer
is for ancillary services.
question
The case-mix management system that utilizes information from the Minimum Data Set (MDS) in long-term care settings is called
answer
Resource Utilization Groups (RUGs).
question
A fiscal year is a yearly accounting period. It is the 12-month period on which a budget is planned. The federal fiscal year is
answer
October 1st through September 30 of the next year
question
The following coding system(s) is/are utilized in the MS-DRG prospective payment methodology for assignment and proper reimbursement.
answer
ICD-9-CM codes
question
Commercial insurance plans usually reimburse health care providers under some type of ________ payment system, whereas the federal Medicare program uses some type of ________ payment system.
answer
retrospective, prospective
question
________ are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients.
answer
Never events
question
The present on admission (POA) indicator is required to be assigned to the ________ diagnosis(es) for ________ claims on ________ admissions.
answer
principal and secondary, Medicare, inpatient
question
To monitor timely claims processing in a hospital, a summary report of "patient receivables" is generated frequently. Aged receivables can negatively affect a facility's cash flow; therefore, to maintain the facility's fiscal integrity, the HIM manager must routinely analyze this report. Though this report has no standard title, it is often called the
answer
DNFB (discharged, no final bill)
question
A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The nonPAR Medicare fee schedule amount for this service is $190.00. If this physician is a participating physician who accepts assignment for this claim, the total amount the physician will receive is
answer
$200.00.
question
A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The nonPAR Medicare fee schedule amount for this service is $190.00. If this physician is a participating physician who accepts assignment for this claim, the total amount of the patient's financial liability (out-of-pocket expense) is
answer
$40.00.
question
If a participating provider's usual fee for a service is $700.00 and Medicare's allowed amount is $450.00, what amount is written off by the physician?
answer
$250.00
question
A HIPPS (Health Insurance Prospective Payment System) code is a five-character alphanumeric code. A HIPPS code is used by
answer
home health agencies (HHA) and inpatient rehabilitation facilities (IRF)
question
The limiting charge is a percentage limit on fees specified by legislation that the nonparticipating physician may bill Medicare beneficiaries above the nonPAR fee schedule amount. The limiting charge is
answer
15%
question
When payments can be made to the provider by EFT, this means that the reimbursement is
answer
sent to the provider by check.
question
The Centers for Medicare and Medicaid Services (CMS) will make an adjustment to the MS-DRG payment for certain conditions that the patient was not admitted with, but were acquired during the hospital stay. Therefore, hospitals are required to report an indicator for each diagnosis. This indicator is referred to as
answer
present on admission
question
To compute the reimbursement to a particular hospital for a particular MS-DRG, multiply the hospital's base payment rate by the
answer
relative weight for the MS-DRG.
question
This is a 10-digit, intelligence-free, numeric identifier designed to replace all previous provider legacy numbers. This number identifies the physician universally to all payers. This number is issued to all HIPAA-covered entities. It is mandatory on the CMS-1500 and UB-04 claim forms.
answer
National Provider Identifier (NPI)
question
CMS assigns one ________ to each APC and each ________ code.
answer
payment status indicator, HCPCS
question
This is the amount collected by the facility for the services it bills
answer
reimbursement
question
In calculating the fee for a physician's reimbursement, the three relative value units are each multiplied by the
answer
geographic practice cost indices.
question
When a provider, knowingly or unknowingly, uses practices that are inconsistent with accepted medical practice and that directly or indirectly result in unnecessary costs to the Medicare program, this is called
answer
abuse.
question
This accounting method attributes a dollar figure to every input required to provide a service.
answer
cost accounting
question
CMS adjusts the Medicare Severity DRGs and the reimbursement rates every
answer
fiscal year beginning October 1
question
Currently, which prospective payment system is used to determine the payment to the physician for outpatient surgery performed on a Medicare patient?
answer
RBRVS
question
This information is published by the Medicare Administrative Contractors (MACs) to describe when and under what circumstances Medicare will cover a service. The ICD-9-CM and CPT/HCPCS codes are listed in the memoranda.
answer
LCD (Local Coverage Determinations)
question
Under Medicare, a beneficiary has lifetime reserve days. All of the following statements are true, EXCEPT
answer
lifetime reserve days are paid under Medicare Part B.
question
Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare Part B services?
answer
The provider cannot bill the patients for the balance between the MPFS amount and the total charges
question
LCDs and NCDs are review policies that describe the circumstances of coverage for various types of medical treatment. They advise physicians which services Medicare considers reasonable and necessary and may indicate the need for an advance beneficiary notice. They are developed by the Centers for Medicare and Medicaid Services (CMS) and Medicare Administrative Contractors. LCD and NCD are acronyms that stand for
answer
local coverage determinations and national coverage determinations.
question
A Medicare patient was seen by Dr. Zachary, who is a nonparticipating physician. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The Medicare Fee Schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termed as "balance billing," which means that the patient is
answer
financially liable for charges in excess of the Medicare fee schedule, up to a limit
question
A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The nonPAR Medicare fee schedule amount for this service is $190.00. If this physician is a nonparticipating physician who does NOT accept assignment for this claim, the total receive is
answer
$218.50
question
The DNFB report includes all patients who have been discharged from the facility but for whom, for one reason or another, the billing process is not complete. DNFB is an acronym for ________.
answer
discharged not final billed
question
When health care providers are found guilty under any of the civil false claims statutes, the Office of Inspector General is responsible for negotiating these settlements and the provider is placed under a
answer
Corporate Integrity Agreement
question
The prospective payment system used to reimburse home health agencies for patients with Medicare utilizes data from
answer
OASIS (Outcome and Assessment Information Set)
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