AAPC Reimbursement Methods & Fee Schedules

Question 1

What is a fee-for-service (FFS) reimbursement model?

Accepted Answer

Paying providers for each individual service or procedure performed

Answer

Paying a fixed amount per patient per month

Answer

Paying based on patient outcomes

Answer

Paying a bundled amount per episode of care

Question 2

What is capitation in managed care reimbursement?

Accepted Answer

A fixed per-member-per-month payment to a provider for all covered services regardless of utilization

Answer

A penalty for excessive billing

Answer

A type of stop-loss insurance

Answer

A reimbursement method based on diagnosis codes

Question 3

What is the Medicare Physician Fee Schedule (MPFS)?

Accepted Answer

A payment schedule that determines how much Medicare pays physicians for covered services based on RVUs

Answer

A list of excluded services

Answer

A list of approved medications

Answer

A credentialing requirement for physicians

Question 4

What does a relative value unit (RVU) represent in physician reimbursement?

Accepted Answer

A numeric value representing the work, practice expense, and malpractice components of a medical service

Answer

The patient's out-of-pocket cost

Answer

The number of services performed per day

Answer

A patient satisfaction score

Question 5

In the Medicare Physician Fee Schedule, what is the 'conversion factor'?

Accepted Answer

A dollar amount multiplied by total RVUs to calculate Medicare's payment for a service

Answer

A formula for converting ICD-10 codes to CPT codes

Answer

The ratio of denied to paid claims

Answer

A factor used to adjust for geographic location

Question 6

What is a bundled payment model?

Accepted Answer

A single payment to cover all services related to a specific episode of care or condition

Answer

Billing each service separately

Answer

A monthly capitation payment

Answer

A Medicare fee schedule adjustment