COBGC Reimbursement and Billing 1

Question 1

What is the fee schedule used for Medicare OB/GYN reimbursement?

Accepted Answer

The Medicare Physician Fee Schedule based on the Resource-Based Relative Value Scale (RBRVS)

Answer

Medicare uses the RBRVS system to assign relative values to services based on work, practice expense, and malpractice cost.

Question 2

What is a clean claim?

Accepted Answer

A claim submitted with all required information, correctly coded, and free of errors

Answer

Clean claims process faster because they contain all necessary information and have no errors requiring correction.

Question 3

What is the timely filing deadline?

Accepted Answer

The maximum time after the date of service within which a claim must be submitted to the payer

Answer

Each payer sets timely filing deadlines; missing them can result in claim denial regardless of whether services were properly rendered.

Question 4

What is a remittance advice?

Accepted Answer

A document from the payer explaining how a claim was processed, including payments and adjustments

Answer

The remittance advice (ERA/EOB) details what was billed, allowed, paid, adjusted, and what the patient owes.

Question 5

What is the difference between participating and non-participating providers?

Accepted Answer

Participating providers accept the payer's fee schedule; non-participating providers may charge higher rates

Answer

Participating providers agree to accept the payer's allowed amount as payment in full, while non-participating providers may balance bill patients.

(COBGC) Certified Obstetrics Gynecology Coder Practice Test