RHIT Revenue Cycle Management 5

Question 1

Which ambulatory payment classification (APC) system is used to reimburse Medicare outpatient hospital services?

Accepted Answer

Outpatient Prospective Payment System (OPPS)

Answer

Inpatient Prospective Payment System (IPPS)

Answer

Resource-Based Relative Value Scale (RBRVS)

Answer

Prospective Payment System (PPS) for SNFs

Question 2

A hospital's net collection rate is calculated as:

Accepted Answer

Payments collected divided by net patient revenue owed

Answer

Total charges divided by total payments

Answer

Gross charges minus contractual adjustments

Answer

Total denied claims divided by total claims submitted

Question 3

When a secondary payer processes a claim after the primary payer has paid, which document is required to show the primary payer's payment?

Accepted Answer

The primary payer's EOB/RA

Answer

The original superbill

Answer

A new patient authorization form

Answer

The facility's chargemaster entry

Question 4

Which modifier is appended to a CPT code to indicate a significant, separately identifiable evaluation and management service was provided on the same day as a procedure?

Accepted Answer

-25

Answer

-59

Answer

-51

Answer

-52

Question 5

A hospital's case mix index (CMI) increased from 1.45 to 1.62. What does this indicate?

Accepted Answer

The hospital is treating more complex or resource-intensive patients on average

Answer

The hospital treated fewer patients

Answer

The hospital's readmission rate increased

Answer

The denial rate has decreased

Question 6

Which law created the Medicare and Medicaid programs in the United States?

Accepted Answer

Social Security Act of 1965

Answer

HIPAA of 1996

Answer

Balanced Budget Act of 1997

Answer

Affordable Care Act of 2010

Question 7

In value-based purchasing (VBP), hospitals can receive incentive payments or penalties based on which of the following?

Accepted Answer

Quality and efficiency performance metrics

Answer

Total number of inpatient admissions

Answer

Number of physicians on staff

Answer

Volume of outpatient procedures