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

OPPS groups outpatient services into APCs and pays a predetermined rate per APC, used by Medicare for hospital outpatient reimbursement.

Question 2

A hospital's net collection rate is calculated as:

Accepted Answer

Payments collected divided by net patient revenue owed

Answer

Net collection rate measures the percentage of collectible revenue actually collected, calculated as collections divided by net charges (after contractual adjustments).

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 primary payer's EOB or Remittance Advice must accompany the secondary claim to show what the primary paid, allowing the secondary payer to calculate its liability.

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

Modifier -25 indicates that a significant, separately identifiable E/M service was performed by the same physician on the same day as a procedure or other service.

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

A higher CMI reflects a greater proportion of complex, resource-intensive cases, which generally correlates with higher Medicare reimbursement per case.

RHIT - Registered Health Information Technician Practice Test

RHIT - Registered Health Information Technician Practice Test

RHIT Revenue Cycle Management 5