Reimbursement, RBRVS & Revenue Cycle Management Flashcards
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What does RBRVS stand for in physician fee schedule calculations?
Answer: Resource-Based Relative Value Scale
RBRVS stands for Resource-Based Relative Value Scale, the foundation of the Medicare Physician Fee Schedule.
Which three components make up a Relative Value Unit (RVU)?
Answer: Physician work, practice expense, malpractice expense
RVUs consist of three components: physician work RVU, practice expense RVU, and malpractice (PLI) RVU.
What is the role of the Geographic Practice Cost Index (GPCI) in MPFS calculations?
Answer: Adjusts RVUs to reflect regional cost differences
GPCIs adjust each RVU component for geographic variation in physician work, practice costs, and malpractice premiums.
In revenue cycle management, what does 'clean claim' mean?
Answer: A claim submitted without errors that can be processed immediately
A clean claim contains all required information and no errors, allowing immediate adjudication by the payer.
Which metric measures the percentage of submitted claims that are paid on the first submission?
Answer: First-pass resolution rate
First-pass resolution rate measures the percentage of claims paid without rework on initial submission.
What is 'balance billing' in radiology billing practices?
Answer: Billing the patient for the difference between the provider's charge and insurer's payment
Balance billing occurs when a provider bills the patient for the remaining balance after the insurer's payment, beyond the contracted amount.