Healthcare Finance: Gross Patient Revenue and Deductions

Play an AI-generated podcast conversation about this lesson

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?

Accurate description of medical services Signup and view all the answers

What is the consequence of incorrect diagnosis coding?

Loss of revenue due to non-compliance with medical necessity requirements Signup and view all the answers

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

Streamlining laboratory testing procedures Signup and view all the answers

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

Retrospective cost-based system Signup and view all the answers

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

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

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

It serves as a baseline for private insurance payers to establish their own payment rates Signup and view all the answers

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

Medicare Part C 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?

Self-pay or out-of-pocket payment Signup and view all the answers

What is the primary difference between Medicare and Medicaid?

Medicare is a federal program, while Medicaid is a state program Signup and view all the answers

What is the purpose of contractual adjustments in healthcare billing?

To reflect the difference between billings at full-established rates and amounts received from third-party payers Signup and view all the answers

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

It was introduced with the Health Maintenance Organization Act (1973) Signup and view all the answers

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

Tax Equity and Fiscal Responsibility Act (TEFRA) Signup and view all the answers

When did the Medicare Part D program become effective?

2003 Signup and view all the answers

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

To set pricing for services based on the market rate 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?

The test is reimbursed at $18.00 Signup and view all the answers