Medicare & Payer-Specific Radiology Billing Flashcards
6 cards from real RCC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Medicare & Payer-Specific Radiology Billing flashcards as text
Revenue code 0320 on a UB-04 claim represents which radiology service category?
Answer: Diagnostic radiology — general
Revenue code 0320 (Radiology — Diagnostic) is used on institutional claims for general diagnostic radiology services.
A Medicare patient refuses to sign an Advance Beneficiary Notice (ABN) before a non-covered radiology service. What should the provider do?
Answer: Do not bill Medicare and bill the patient for the service
If a patient refuses an ABN, the provider may still furnish the service but cannot bill Medicare and may bill the patient.
Which condition applies when Medicare is the secondary payer for a radiology claim?
Answer: Coordination of Benefits (COB) rules determine Medicare's payment
When Medicare is secondary, Coordination of Benefits rules govern how Medicare pays after the primary insurer has paid.
Under OPPS, what is the status indicator 'S' for a radiology CPT code?
Answer: Significant procedure, not discounted when multiple
OPPS status indicator 'S' identifies significant procedures that are not subject to multiple procedure discounting.
Which Medicare program requires radiology providers to report quality measures for payment adjustments?
Answer: MIPS (Merit-based Incentive Payment System)
MIPS under MACRA requires eligible clinicians including radiologists to report quality measures affecting payment.
A Medicare claim is flagged by a Recovery Audit Contractor (RAC). What is the RAC's primary function?
Answer: Identify and recover improper Medicare payments
RACs are tasked with identifying and recovering improper payments made to healthcare providers under Medicare.