Reimbursement, RBRVS & Revenue Cycle Management Flashcards
6 cards from real RCC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Reimbursement, RBRVS & Revenue Cycle Management flashcards as text
What is the 'conversion factor' in the Medicare Physician Fee Schedule?
Answer: A dollar amount multiplied by total RVUs to determine payment
The conversion factor is a dollar multiplier applied to total adjusted RVUs to calculate Medicare payment amounts.
Which KPI measures the average number of days it takes to collect payment after a service is provided?
Answer: Days in Accounts Receivable (AR)
Days in AR measures the average time from service date to payment receipt, indicating billing efficiency.
What is 'upcoding' in the context of radiology billing compliance?
Answer: Reporting a more complex or higher-paying code than the service actually performed
Upcoding is a fraudulent practice of reporting higher-paying codes than the documentation supports.
Which federal law imposes liability for knowingly submitting false or fraudulent claims to Medicare?
Answer: False Claims Act (FCA)
The False Claims Act imposes civil monetary penalties and treble damages for knowingly submitting false claims to federal health programs.
What does the term 'write-off' mean in a radiology practice's revenue cycle?
Answer: Amounts contractually adjusted off the billed charge per payer agreement
Write-offs are contractual adjustments reducing the billed charge to the payer-contracted rate.
Which document authorizes a radiology group to bill Medicare on behalf of its physicians?
Answer: Medicare Group Enrollment / Provider Transaction Access Number (PTAN)
A PTAN (Provider Transaction Access Number) is issued by Medicare to enrolled providers authorizing billing.