AAPC Reimbursement Methods & Fee Schedules 2

Question 1

What is a Diagnosis-Related Group (DRG) payment system used for?

Accepted Answer

A prospective payment system for inpatient hospital stays based on diagnosis

Answer

DRGs are used in the Medicare Inpatient Prospective Payment System, where hospitals receive a fixed payment based on the patient's principal diagnosis and procedures.

Question 2

What is the Ambulatory Payment Classification (APC) system used for?

Accepted Answer

Reimbursing hospital outpatient department services under Medicare

Answer

APCs are the basis of Medicare's Outpatient Prospective Payment System (OPPS), grouping outpatient services into categories with predetermined payment rates.

Question 3

What does a 'global surgical package' include?

Accepted Answer

Pre-operative, intraoperative, and post-operative care within a defined period for a single payment

Answer

The global surgical package bundles pre-op visits, the surgery itself, and post-op care into a single reimbursement amount, with the global period varying by procedure.

Question 4

What is a contractual adjustment in medical billing?

Accepted Answer

The difference between a provider's billed charge and the contracted allowed amount that is written off

Answer

A contractual adjustment is the amount a participating provider writes off because their billed charge exceeds the payer's contracted allowed amount.

Question 5

What is the Resource-Based Relative Value Scale (RBRVS)?

Accepted Answer

A system that values physician services based on resources required, including work, practice expense, and malpractice

Answer

The RBRVS was developed to standardize Medicare physician payments based on the actual resources required to provide each service.

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

AAPC Reimbursement Methods & Fee Schedules 2