Healthcare Accounting Billing & Reimbursement Flashcards
7 cards from real HAC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Healthcare Accounting Billing & Reimbursement flashcards as text
Under the Medicare Inpatient Prospective Payment System (IPPS), what primarily determines the payment a hospital receives for a stay?
Answer: The Diagnosis-Related Group (DRG) assigned to the discharge
IPPS pays hospitals a fixed amount based on the DRG assigned at discharge, not actual costs or length of stay.
A claim is returned to the provider with a Remittance Advice Remark Code (RARC) of CO-97. What does this mean?
Answer: The service was denied because it is included in the allowance for another service
CO-97 indicates the payment was adjusted because the service or procedure is bundled into the allowance of another service.
Which federal law mandates the use of standardized electronic transactions and code sets in healthcare billing?
Answer: Health Insurance Portability and Accountability Act (HIPAA)
HIPAA's Administrative Simplification provisions require the use of standardized electronic transaction formats and code sets.
What is a 'crossover claim' in Medicare/Medicaid billing?
Answer: A claim where Medicare pays first and automatically forwards the balance to Medicaid
A crossover claim is one where Medicare is primary and automatically crosses over the remaining balance to Medicaid as the secondary payer.
In the context of the Revenue Cycle, what does 'cash posting' refer to?
Answer: Recording payments received from payers and patients into the accounting system
Cash posting is the process of recording all payments, adjustments, and denials from payers and patients into the practice management system.
A hospital's chargemaster lists a service at $5,000, but the Medicare fee schedule allows $1,200. The hospital is a participating provider. What amount is the patient's 20% coinsurance based on?
Answer: $1,200 (the Medicare-allowed amount)
For participating providers, Medicare cost-sharing (coinsurance) is calculated on the Medicare-allowed amount, not the billed charges.
What is the primary purpose of a National Provider Identifier (NPI)?
Answer: To serve as a unique identification number for covered healthcare providers in standard transactions
The NPI is a 10-digit unique identifier assigned to healthcare providers for use in HIPAA standard electronic transactions.
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