RCC Reimbursement, RBRVS & Revenue Cycle Management 1 — Questions and Answers
Question 1: What does RBRVS stand for in physician fee schedule calculations?
- Resource-Based Relative Value Scale (Correct answer)
- Reimbursement-Based Radiology Value System
- Revenue-Based Resource Value Schedule
- Risk-Based Relative Volume Scale
Correct answer: Resource-Based Relative Value Scale
RBRVS stands for Resource-Based Relative Value Scale, the foundation of the Medicare Physician Fee Schedule.
Question 2: Which three components make up a Relative Value Unit (RVU)?
- Physician work, practice expense, malpractice expense (Correct answer)
- CPT code, modifier, diagnosis code
- Volume, intensity, complexity
- Labor, supplies, overhead
Correct answer: Physician work, practice expense, malpractice expense
RVUs consist of three components: physician work RVU, practice expense RVU, and malpractice (PLI) RVU.
Question 3: What is the role of the Geographic Practice Cost Index (GPCI) in MPFS calculations?
- Adjusts RVUs to reflect regional cost differences (Correct answer)
- Sets the national conversion factor
- Determines coding accuracy requirements
- Establishes APC payment rates
Correct answer: Adjusts RVUs to reflect regional cost differences
GPCIs adjust each RVU component for geographic variation in physician work, practice costs, and malpractice premiums.
Question 4: In revenue cycle management, what does 'clean claim' mean?
- A claim submitted without errors that can be processed immediately (Correct answer)
- A claim with zero patient balance
- A claim that has been audited
- A claim approved by a RAC
Correct answer: A claim submitted without errors that can be processed immediately
A clean claim contains all required information and no errors, allowing immediate adjudication by the payer.
Question 5: Which metric measures the percentage of submitted claims that are paid on the first submission?
- First-pass resolution rate (Correct answer)
- Net collection rate
- Denial rate
- Days in AR
Correct answer: First-pass resolution rate
First-pass resolution rate measures the percentage of claims paid without rework on initial submission.
Question 6: What is 'balance billing' in radiology billing practices?
- Billing the patient for the difference between the provider's charge and insurer's payment (Correct answer)
- Billing two insurers simultaneously
- Billing for a higher-level service than performed
- Billing a global service with separate components
Correct answer: Billing the patient for the difference between the provider's charge and insurer's payment
Balance billing occurs when a provider bills the patient for the remaining balance after the insurer's payment, beyond the contracted amount.
RCC Reimbursement, RBRVS & Revenue Cycle Management 1
What does RBRVS stand for in physician fee schedule calculations?