Reimbursement and Compliance Flashcards
6 cards from real Certified Coding Associate Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Reimbursement and Compliance flashcards as text
What does the acronym 'MS-DRG' stand for?
Answer: Medicare Severity Diagnosis Related Group
MS-DRG stands for Medicare Severity Diagnosis Related Group, used by Medicare for inpatient hospital reimbursement.
Which federal law primarily governs healthcare privacy and the security of patient health information?
Answer: HIPAA
HIPAA (Health Insurance Portability and Accountability Act) governs the privacy and security of protected health information.
What is a Remittance Advice (RA)?
Answer: A document sent by payers explaining payment or denial of claims
A Remittance Advice is sent by payers to explain how claims were processed, including payment amounts or denial reasons.
The Outpatient Prospective Payment System (OPPS) uses which payment unit?
Answer: APC
OPPS uses Ambulatory Payment Classifications (APCs) to reimburse hospitals for outpatient services.
Which of the following is an example of upcoding?
Answer: Billing for a higher-level service than what was actually provided
Upcoding is the fraudulent practice of billing for a higher-level or more expensive service than what was actually performed.
What is the purpose of a National Correct Coding Initiative (NCCI) edit?
Answer: To prevent improper payment of procedure codes that should not be billed together
NCCI edits are bundling edits that prevent Medicare from paying separately for services that should be billed together.