Question 1

Under RBRVS, the nationally uniform relative value is based on

Accepted Answer

The Resource-Based Relative Value Scale (RBRVS) system calculates payments for physicians' services by considering the provider's work, practice expenses, and malpractice insurance costs, making option A correct.

Question 2

The standard conversion factor for any year is __________.

Accepted Answer

The standard conversion factor can vary depending on the context it is used in, such as converting between different units of measurement or accounting for differences in currency values over time. There is no single conversion factor that applies to every situation for any year.

Question 3

Using a job reference aid may lead to

Accepted Answer

Using a job reference aid may raise questions about compliance because it might not be updated or accurate, leading to potential errors in coding practices.

Question 4

The cost of a practice depends on all of the following except

Accepted Answer

All the options listed (office rental prices, malpractice insurance, and local taxes) are factors that can influence the cost of running a practice. Therefore, the statement that all of these are determinants is correct.

Question 5

What are the main methods payers use to pay providers?

Accepted Answer

The main methods payers use to pay providers include allowed charges, contracted fee schedule, and capitation. These methods cover a range of payment structures from per-service agreements to pre-paid amounts for each patient covered.

Question 6

In the CCI, which type of codes cannot both be billed for a patient on the same day of service?

Accepted Answer

Mutually exclusive codes represent procedures or services that, due to their nature, cannot reasonably be performed at the same time or during the same patient encounter. This is because the two procedures would not logically be done together based on the clinical scenario or patient anatomy.

Question 7

Although anyone who comes into contact with a medical record is responsible for the accuracy of his or her own entry, who in the medical practice is ultimately responsible for proper documentation and correct coding?

Accepted Answer

The physician is ultimately responsible for proper documentation and correct coding in a medical practice. This is because they are the primary provider of care and are legally accountable for the accuracy of the medical records and the procedures coded and billed.

Question 8

All of the following are common billing errors except

Accepted Answer

Billing with proper signatures on file is not a billing error; it is a requirement for legitimate billing practices. Upcoding, unbundling, and billing noncovered services are all common billing errors.

Question 9

The CMS/AMA Documentation Guidelines set up the rules for the selection of

Accepted Answer

The CMS/AMA Documentation Guidelines specifically set up the rules for the selection of Evaluation and Management (E/M) codes, which are used to bill for the majority of doctor-patient encounters.

Question 10

In an allowed charges payment method, if a provider's charge is higher than the allowed amount, the provider's reimbursement is based on

Accepted Answer

The provider's reimbursement is based on the allowed amount, not the higher charge they might have billed. This allowed amount is the maximum amount the insurer will pay for a covered service.

Question 11

What type of external audit is performed by payers before claims are processed?

Accepted Answer

Prepayment audits are conducted by payers before claims are processed to ensure accuracy and compliance with billing regulations.

Question 12

A conversion factor is multiplied by a _________ to arrive at a charge.

Accepted Answer

A conversion factor is multiplied by a relative value unit (RVU) to calculate a charge for medical services. The RVU reflects the relative level of time, skill, training, and intensity required of a medical provider to provide a service.

Question 13

Which of the following modifiers is important for compliant billing?

Accepted Answer

Modifiers like -59, -91, and -25 are all important for compliant billing as they provide additional information about the service provided, helping to ensure that the billing is accurate and conforms to payer requirements. Modifier -59 indicates a distinct procedural service, -91 signifies a repeat clinical diagnostic laboratory test, and -25 indicates that a significant, separately identifiable evaluation and management service was performed on the same day as another procedure or service.

Question 14

The _________ is the method used to set fees for Medicare.

Accepted Answer

The Resource-Based Relative Value Scale (RBRVS) is the method used to set fees for Medicare. It determines payments for physicians' services based on the resource costs needed to provide them, taking into account factors like the physician's work, practice expenses, and malpractice insurance costs.

Question 15

If a practice accepts credit and debit cards, it must follow which standard?

Accepted Answer

PCI DSS (Payment Card Industry Data Security Standard) is the correct standard that a practice must follow if it accepts credit and debit cards. This standard is designed to ensure that all companies that process, store, or transmit credit card information maintain a secure environment.

Question 16

The relative value unit is assigned to a service based on the

Accepted Answer

The relative value unit (RVU) is primarily based on the time and skill required to perform a service, reflecting the resources and expertise necessary for the procedure.

Question 17

RACs use a software program to analyze a practice's claims, looking for

Accepted Answer

RACs (Recovery Audit Contractors) use software programs to analyze healthcare practices' claims for a variety of issues, including excessive billing units, medically unnecessary treatments, and clear coding errors, making all the options correct.

Question 18

Which of the following means that a physician has chosen to waive the charges for services to other physicians?

Accepted Answer

Professional courtesy refers to the practice where a physician chooses to waive fees for services provided to other physicians. This is a traditional practice in the medical profession aimed at fostering goodwill among medical professionals.

Question 19

Which of the following three factors are built into the resource-based fee structure?

Accepted Answer

The resource-based fee structure typically includes the difficulty of the procedure, office overhead (which encompasses various costs associated with running a medical practice), and the risk associated with the procedure. These factors help determine the cost of medical services by considering the resources required for each service.

Question 20

What type of audit do payers routinely conduct to ensure that claims are compliant with the provisions of their contracts?

Accepted Answer

Postpayment audits are conducted after claims have been paid to ensure compliance with contract provisions.

Quiz 6: Visit Charges and Compliant Billing