CCC CCC Reimbursement & Payer Policies 1

Question 1

Which Medicare program part primarily covers outpatient cardiology services such as ECGs and stress tests performed in a physician office?

Accepted Answer

Medicare Part B

Answer

Medicare Part A

Answer

Medicare Part C

Answer

Medicare Part D

Question 2

What does the term 'global period' refer to in cardiology reimbursement?

Accepted Answer

The number of days post-procedure during which follow-up visits are included in the procedure fee

Answer

The total annual payment for a provider

Answer

The worldwide coverage policy of a payer

Answer

The billing cycle for chronic cardiac conditions

Question 3

A cardiology practice submits a claim for a service that is already bundled into a previously billed procedure. This practice is known as:

Accepted Answer

Unbundling

Answer

Upcoding

Answer

Downcoding

Answer

Balance billing

Question 4

Which modifier is used to indicate that a procedure was performed by two surgeons, each with distinct roles, during a cardiac surgery?

Accepted Answer

Modifier -62

Answer

Modifier -51

Answer

Modifier -80

Answer

Modifier -59

Question 5

Prior authorization in cardiology billing is primarily required to:

Accepted Answer

Ensure medical necessity is approved by the payer before a non-emergency service is rendered

Answer

Increase the fee schedule amount

Answer

Allow same-day payment processing

Answer

Bypass claims adjudication

Question 6

The Medicare Physician Fee Schedule (MPFS) values procedures using which three components of the Resource-Based Relative Value Scale (RBRVS)?

Accepted Answer

Work RVU, practice expense RVU, and malpractice RVU

Answer

Diagnosis, procedure, and outcome

Answer

Surgeon skill, equipment cost, and overhead

Answer

CPT code, ICD-10 code, and NDC code