CCS Billing, Reimbursement, & Insurance Policies 2

Question 1

Which Medicare claim form is used to submit outpatient hospital facility claims?

Accepted Answer

UB-04 (CMS-1450)

Answer

The UB-04 (CMS-1450) is the standard claim form used by hospitals and other institutional providers to bill Medicare and most payers for outpatient and inpatient services.

Question 2

Under the Outpatient Prospective Payment System (OPPS), payment is based on which grouping unit?

Accepted Answer

Ambulatory Payment Classification (APC)

Answer

OPPS uses Ambulatory Payment Classifications (APCs) to bundle similar outpatient services into a single payment rate for Medicare hospital outpatient claims.

Question 3

A claim is denied due to a 'coordination of benefits' issue. What does this mean?

Accepted Answer

The patient has more than one insurance plan and payer order is disputed

Answer

Coordination of benefits (COB) determines which payer is primary and which is secondary when a patient has multiple insurance plans.

Question 4

What is the purpose of a Remittance Advice (RA)?

Accepted Answer

To explain how a claim was processed and what was paid or denied

Answer

A Remittance Advice (RA) is sent by the payer to the provider detailing claim adjudication: amounts paid, contractual adjustments, and reason codes for denials.

Question 5

Which federal law prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals of federal health care program business?

Accepted Answer

Anti-Kickback Statute (AKS)

Answer

The Anti-Kickback Statute (AKS) makes it a criminal offense to knowingly offer remuneration to induce referrals for services covered by federal health programs.

(CCS) Certified Coding Specialist Practice Test

(CCS) Certified Coding Specialist Practice Test

CCS Billing, Reimbursement, & Insurance Policies 2