RCC Reimbursement, RBRVS & Revenue Cycle Management 2 — Questions and Answers
Question 1: What is the 'conversion factor' in the Medicare Physician Fee Schedule?
- A dollar amount multiplied by total RVUs to determine payment (Correct answer)
- The ratio of allowed to billed charges
- The geographic adjustment index
- The hospital cost-to-charge ratio
Correct answer: A dollar amount multiplied by total RVUs to determine payment
The conversion factor is a dollar multiplier applied to total adjusted RVUs to calculate Medicare payment amounts.
Question 2: Which KPI measures the average number of days it takes to collect payment after a service is provided?
- Days in Accounts Receivable (AR) (Correct answer)
- Net collection rate
- First-pass resolution rate
- Denial rate
Correct answer: Days in Accounts Receivable (AR)
Days in AR measures the average time from service date to payment receipt, indicating billing efficiency.
Question 3: What is 'upcoding' in the context of radiology billing compliance?
- Reporting a more complex or higher-paying code than the service actually performed (Correct answer)
- Reporting additional modifiers for accuracy
- Using updated ICD-10 codes after annual revision
- Correcting a previously submitted claim
Correct answer: Reporting a more complex or higher-paying code than the service actually performed
Upcoding is a fraudulent practice of reporting higher-paying codes than the documentation supports.
Question 4: Which federal law imposes liability for knowingly submitting false or fraudulent claims to Medicare?
- False Claims Act (FCA) (Correct answer)
- Stark Law
- Anti-Kickback Statute
- HIPAA
Correct answer: False Claims Act (FCA)
The False Claims Act imposes civil monetary penalties and treble damages for knowingly submitting false claims to federal health programs.
Question 5: What does the term 'write-off' mean in a radiology practice's revenue cycle?
- Amounts contractually adjusted off the billed charge per payer agreement (Correct answer)
- Payments received from insurers
- Charges submitted to secondary payers
- Patient deductible amounts
Correct answer: Amounts contractually adjusted off the billed charge per payer agreement
Write-offs are contractual adjustments reducing the billed charge to the payer-contracted rate.
Question 6: Which document authorizes a radiology group to bill Medicare on behalf of its physicians?
- Medicare Group Enrollment / Provider Transaction Access Number (PTAN) (Correct answer)
- NPI registration
- DEA registration
- Credentialing certificate
Correct answer: Medicare Group Enrollment / Provider Transaction Access Number (PTAN)
A PTAN (Provider Transaction Access Number) is issued by Medicare to enrolled providers authorizing billing.
RCC Reimbursement, RBRVS & Revenue Cycle Management 2
What is the 'conversion factor' in the Medicare Physician Fee Schedule?