CCS Billing, Reimbursement, & Insurance Policies 3

Question 1

What does the term 'chargemaster' refer to in hospital billing?

Accepted Answer

A comprehensive list of services, supplies, and procedures with their assigned charges and billing codes

Answer

The chargemaster (charge description master/CDM) is the hospital's comprehensive price list that assigns charge codes, revenue codes, HCPCS/CPT codes, and dollar amounts to every billable item.

Question 2

Under the Medicare Inpatient Prospective Payment System (IPPS), which factor does NOT directly influence DRG assignment?

Accepted Answer

Patient's insurance carrier

Answer

DRG assignment is based on clinical factors (principal diagnosis, CCs/MCCs, procedures, age, discharge status) - the patient's insurance carrier has no effect on DRG grouping.

Question 3

A coder submits a claim with a diagnosis code that is not supported by the clinical documentation. This is an example of which compliance risk?

Accepted Answer

Upcoding

Answer

Upcoding means reporting a more severe or complex diagnosis or procedure than is documented, inflating reimbursement - a False Claims Act violation.

Question 4

Which revenue code category is used on a UB-04 to report medical/surgical supplies?

Accepted Answer

27X

Answer

Revenue code 27X (Medical/Surgical Supplies) is used to report supplies provided to patients in the hospital setting on the UB-04.

Question 5

What is 'timely filing' in the context of insurance claims submission?

Accepted Answer

Submitting claims within the payer's required deadline from the date of service

Answer

Timely filing refers to the payer-specific deadline by which a claim must be submitted after the date of service; missing this deadline results in a non-payable denial.

(CCS) Certified Coding Specialist Practice Test

(CCS) Certified Coding Specialist Practice Test

CCS Billing, Reimbursement, & Insurance Policies 3