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 B covers outpatient physician and diagnostic services, including office-based cardiology procedures.

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 global period is the post-operative timeframe (typically 0, 10, or 90 days) during which related follow-up care is bundled into the original procedure payment.

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

Unbundling occurs when separate codes are billed for services that should be reported as a single bundled code, which is a compliance violation.

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 -62 is appended when two surgeons each perform a distinct part of a procedure, commonly used in complex cardiac surgeries.

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

Prior authorization confirms payer approval of medical necessity before scheduled procedures, reducing claim denials.

CCC Practice Test

CCC Practice Test

CCC CCC Reimbursement & Payer Policies 1