Revenue Cycle and Reimbursement Flashcards
6 cards from real RHIA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Revenue Cycle and Reimbursement flashcards as text
What is a Medicare Recovery Audit Contractor (RAC) audit designed to identify?
Answer: Underpayments and overpayments in Medicare claims
RAC auditors identify both improper overpayments and underpayments in Medicare claims submitted by healthcare providers.
In ICD-10-CM, what is a combination code?
Answer: A single code that captures both a condition and an associated manifestation or cause
A combination code is a single ICD-10-CM code that classifies both a condition and its associated etiology, manifestation, or complication in one code.
What is the significance of the CC/MCC designation in the MS-DRG system?
Answer: Secondary diagnoses coded as complications or comorbidities affect DRG assignment and payment level
In the MS-DRG system, secondary diagnoses designated as complications (CC) or major complications/comorbidities (MCC) can move a case to a higher-weighted, better-reimbursed DRG.
Which federal law imposes civil monetary penalties for knowingly submitting false claims to government healthcare programs?
Answer: The False Claims Act (FCA)
The False Claims Act imposes civil monetary penalties on providers who knowingly submit false or fraudulent claims to Medicare, Medicaid, or other federal programs.
What is the primary difference between Medicare Part A and Medicare Part B coverage?
Answer: Part A covers inpatient hospital and facility services; Part B covers physician and outpatient services
Medicare Part A covers inpatient hospital stays, skilled nursing facilities, and hospice care, while Part B covers physician services, outpatient care, and durable medical equipment.
What is the purpose of grouper software in inpatient hospital coding?
Answer: Assign the appropriate DRG based on coded diagnoses and procedures
Grouper software analyzes coded diagnosis and procedure data to automatically assign the appropriate MS-DRG, which determines the Medicare payment amount.