Reimbursement, RBRVS & Revenue Cycle Management Flashcards
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What is a Remittance Advice (RA) in the context of radiology billing?
Answer: A document from the payer explaining claim adjudication and payment details
A Remittance Advice (RA) itemizes how each claim was processed, showing paid amounts, adjustments, and denial reasons.
Which HCPCS code set is used for Medicare-specific drugs and supplies used in radiology procedures?
Answer: HCPCS Level II (A–V codes)
HCPCS Level II codes (alpha-numeric A–V) capture Medicare-specific items including contrast agents and radiopharmaceuticals.
Which process verifies a patient's insurance eligibility and benefits before a radiology service is performed?
Answer: Pre-authorization/pre-certification and eligibility verification
Eligibility and benefits verification, along with pre-authorization, confirms coverage before service delivery.
What is the purpose of a National Provider Identifier (NPI) in radiology billing?
Answer: Unique identifier for providers used in all HIPAA standard transactions
The NPI is a unique 10-digit identifier required on all HIPAA standard claim transactions.
Which denial reason code category indicates a claim was denied because the service was not covered under the patient's plan?
Answer: CO-96 (Non-covered charge)
Claim Adjustment Reason Code CO-96 indicates the service is not covered under the patient's current benefit plan.
In radiology revenue cycle, what does 'charge capture' refer to?
Answer: The process of recording all services rendered so they can be billed
Charge capture ensures every service performed is documented and entered into the billing system for claim submission.