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

Determining outpatient visit complexity

Answer

Calculating physician productivity

Answer

Assigning outpatient procedure codes

Question 2

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

Accepted Answer

CPT (Current Procedural Terminology)

Answer

ICD-10-CM

Answer

ICD-10-PCS

Answer

SNOMED CT

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

A list of all credentialed physicians

Answer

The master patient index

Answer

A billing software system

Question 4

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

Accepted Answer

Outpatient Prospective Payment System (OPPS)

Answer

MS-DRG system

Answer

Resource-Based Relative Value Scale (RBRVS)

Answer

Home Health PPS

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

Establish ICD-10 coding guidelines

Answer

Assign DRG weights for inpatient stays

Answer

Set hospital charge rates

Question 6

In the revenue cycle, what does 'clean claim' mean?

Accepted Answer

A claim that passes all edits and requires no additional information for processing

Answer

A claim submitted on paper rather than electronically

Answer

A claim with zero patient liability

Answer

A claim approved by the compliance officer