HAC Healthcare Accounting Billing & Reimbursement 2

Question 1

Under the Medicare Inpatient Prospective Payment System (IPPS), what primarily determines the payment a hospital receives for a stay?

Accepted Answer

The Diagnosis-Related Group (DRG) assigned to the discharge

Answer

The actual cost of services rendered

Answer

The number of days the patient is hospitalized

Answer

The number of procedures performed during the stay

Question 2

A claim is returned to the provider with a Remittance Advice Remark Code (RARC) of CO-97. What does this mean?

Accepted Answer

The service was denied because it is included in the allowance for another service

Answer

The claim was paid in full

Answer

The patient's eligibility could not be verified

Answer

The claim requires additional documentation

Question 3

Which federal law mandates the use of standardized electronic transactions and code sets in healthcare billing?

Accepted Answer

Health Insurance Portability and Accountability Act (HIPAA)

Answer

Affordable Care Act (ACA)

Answer

False Claims Act (FCA)

Answer

Stark Law

Question 4

What is a 'crossover claim' in Medicare/Medicaid billing?

Accepted Answer

A claim where Medicare pays first and automatically forwards the balance to Medicaid

Answer

A claim submitted to two different commercial payers

Answer

A claim that spans two different fiscal years

Answer

A claim filed for services provided across two different states

Question 5

In the context of the Revenue Cycle, what does 'cash posting' refer to?

Accepted Answer

Recording payments received from payers and patients into the accounting system

Answer

Sending statements to patients for outstanding balances

Answer

Submitting electronic claims to insurance companies

Answer

Verifying patient insurance eligibility before the visit

Question 6

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?

Accepted Answer

$1,200 (the Medicare-allowed amount)

Answer

$5,000 (the chargemaster rate)

Answer

$3,800 (the difference between chargemaster and allowed amount)

Answer

$0, because Medicare pays 100%

Question 7

What is the primary purpose of a National Provider Identifier (NPI)?

Accepted Answer

To serve as a unique identification number for covered healthcare providers in standard transactions

Answer

To identify a patient's insurance policy number

Answer

To classify the type of medical service rendered

Answer

To indicate the geographic region of a healthcare facility