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

IPPS pays hospitals a fixed amount based on the DRG assigned at discharge, not actual costs or length of 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

CO-97 indicates the payment was adjusted because the service or procedure is bundled into the allowance of another service.

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

HIPAA's Administrative Simplification provisions require the use of standardized electronic transaction formats and code sets.

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 crossover claim is one where Medicare is primary and automatically crosses over the remaining balance to Medicaid as the secondary payer.

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

Cash posting is the process of recording all payments, adjustments, and denials from payers and patients into the practice management system.

(HAC) Healthcare Accounting Certification Practice Test