18 Questions
What is the primary purpose of coding systems in clinical laboratories?
To facilitate proper payment or reimbursement
What is the consequence of assigning a code that inflates reimbursement?
Legal action and fraud charges
Which of the following is a proprietary product of the American Medical Association (AMA)?
CPT codes
What is the primary benefit of using procedure codes in medical services?
Accurate description of medical services
What is the consequence of incorrect diagnosis coding?
Loss of revenue due to non-compliance with medical necessity requirements
Which of the following is NOT a benefit of using coding systems in clinical laboratories?
Streamlining laboratory testing procedures
What type of payment system was used for inpatient reimbursement prior to 1982?
Retrospective cost-based system
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.
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
Which Medicare part is an alternative to traditional Medicare Part B?
Medicare Part C
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
What is the primary difference between Medicare and Medicaid?
Medicare is a federal program, while Medicaid is a state program
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
What is the main characteristic of managed care in the healthcare system?
It was introduced with the Health Maintenance Organization Act (1973)
What is the name of the act that changed the Medicare reimbursement system in 1982?
Tax Equity and Fiscal Responsibility Act (TEFRA)
When did the Medicare Part D program become effective?
2003
What is the primary purpose of a fee schedule in a laboratory setting?
To set pricing for services based on the market rate
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
Test your understanding of healthcare finance concepts, including gross patient revenue, net patient revenue, and deductions. Learn how contractual adjustments, bad debts, and charity care affect revenue. Prepare to ace your healthcare finance exam!
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