RCC Medicare & Payer-Specific Radiology Billing 2

Question 1

What Medicare rule limits self-referral for designated health services including radiology?

Accepted Answer

Stark Law (Physician Self-Referral Law)

Answer

The Stark Law prohibits physicians from referring Medicare patients to entities with which they have a financial relationship for DHS including radiology.

Question 2

Prior authorization for advanced imaging studies is most commonly required by which payer type?

Accepted Answer

Commercial/private insurers and Medicare Advantage plans

Answer

Commercial insurers and Medicare Advantage plans typically require prior authorization for advanced imaging, while traditional Medicare FFS generally does not.

Question 3

Which Medicare coverage determination applies to a specific geographic area and addresses local coverage for radiology services?

Accepted Answer

Local Coverage Determination (LCD)

Answer

LCDs are issued by Medicare Administrative Contractors (MACs) and define coverage criteria at the regional level.

Question 4

Medicare's timely filing deadline for initial claims is generally how many months from the date of service?

Accepted Answer

12 months

Answer

Medicare requires claims to be filed within 12 months (one calendar year) from the date of service.

Question 5

A radiology claim denied as 'not medically necessary' should be appealed to which first level under Medicare?

Accepted Answer

Redetermination by the MAC

Answer

The first level of Medicare appeal is Redetermination, filed with the Medicare Administrative Contractor (MAC).

RCC - Radiology Certified Coder Practice Test

RCC - Radiology Certified Coder Practice Test

RCC Medicare & Payer-Specific Radiology Billing 2