Healthcare Finance: Gross Patient Revenue and Deductions
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Questions and Answers

What is the primary purpose of coding systems in clinical laboratories?

  • To facilitate communication between healthcare providers
  • To facilitate proper payment or reimbursement (correct)
  • To streamline laboratory testing procedures
  • To ensure accurate diagnosis of medical conditions

What is the consequence of assigning a code that inflates reimbursement?

  • Delayed payment processing
  • Reduced reimbursement rates
  • Increased administrative paperwork
  • Legal action and fraud charges (correct)

Which of the following is a proprietary product of the American Medical Association (AMA)?

  • Medicaid
  • CPT codes (correct)
  • Medicare Part B
  • ICD-10 codes

What is the primary benefit of using procedure codes in medical services?

<p>Accurate description of medical services (D)</p> Signup and view all the answers

What is the consequence of incorrect diagnosis coding?

<p>Loss of revenue due to non-compliance with medical necessity requirements (A)</p> Signup and view all the answers

Which of the following is NOT a benefit of using coding systems in clinical laboratories?

<p>Streamlining laboratory testing procedures (C)</p> Signup and view all the answers

What type of payment system was used for inpatient reimbursement prior to 1982?

<p>Retrospective cost-based system (C)</p> Signup and view all the answers

What is the primary difference between Gross Patient Revenue and Net Patient Revenue?

<p>Gross Patient Revenue represents the total charges at a facility's full-established rates, while Net Patient Revenue is the total charges minus deductions. (C)</p> Signup and view all the answers

What is the significance of the Medicare Part B fee schedule?

<p>It serves as a baseline for private insurance payers to establish their own payment rates (C)</p> Signup and view all the answers

Which Medicare part is an alternative to traditional Medicare Part B?

<p>Medicare Part C (A)</p> Signup and view all the answers

What type of payment is typically reserved for elective testing, infertility testing, and some esoteric testing in the United States?

<p>Self-pay or out-of-pocket payment (B)</p> Signup and view all the answers

What is the primary difference between Medicare and Medicaid?

<p>Medicare is a federal program, while Medicaid is a state program (A)</p> Signup and view all the answers

What is the purpose of contractual adjustments in healthcare billing?

<p>To reflect the difference between billings at full-established rates and amounts received from third-party payers (C)</p> Signup and view all the answers

What is the main characteristic of managed care in the healthcare system?

<p>It was introduced with the Health Maintenance Organization Act (1973) (D)</p> Signup and view all the answers

What is the name of the act that changed the Medicare reimbursement system in 1982?

<p>Tax Equity and Fiscal Responsibility Act (TEFRA) (D)</p> Signup and view all the answers

When did the Medicare Part D program become effective?

<p>2003 (C)</p> Signup and view all the answers

What is the primary purpose of a fee schedule in a laboratory setting?

<p>To set pricing for services based on the market rate (A)</p> Signup and view all the answers

What is the result of a contractual adjustment of $2.00 on a test with a list price of $20.00?

<p>The test is reimbursed at $18.00 (D)</p> Signup and view all the answers

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