RHIA Revenue Cycle and Reimbursement

Question 1

What is a diagnosis-related group (DRG) used for in inpatient reimbursement?

Accepted Answer

Grouping inpatient cases to set a fixed Medicare payment rate

Answer

DRGs group inpatient hospital cases with similar clinical characteristics and resource use to establish a fixed prospective payment rate under Medicare.

Question 2

Which code set is used to report physician and outpatient procedures for reimbursement?

Accepted Answer

CPT (Current Procedural Terminology)

Answer

CPT codes, maintained by the AMA, are used to report physician services and outpatient procedures for billing and reimbursement purposes.

Question 3

What is the chargemaster (charge description master) in a hospital's revenue cycle?

Accepted Answer

A comprehensive file of services, procedures, and their associated charges and codes

Answer

The chargemaster is a comprehensive file containing all hospital services, procedures, supplies, and associated billing codes and charges used to generate claims.

Question 4

Which prospective payment system is used to reimburse hospital outpatient services under Medicare?

Accepted Answer

Outpatient Prospective Payment System (OPPS)

Answer

The Outpatient Prospective Payment System (OPPS) uses Ambulatory Payment Classifications (APCs) to reimburse Medicare hospital outpatient services.

Question 5

What is the purpose of the National Correct Coding Initiative (NCCI)?

Accepted Answer

Prevent improper payment of procedures that should not be billed together

Answer

NCCI edits prevent Medicare from paying for procedure code combinations that should not be billed together due to bundling or mutually exclusive coding rules.

RHIA Exam Practice Test

RHIA Exam Practice Test

RHIA Revenue Cycle and Reimbursement