Questions and Answers
Which form is utilized by hospitals for paper claims?
UB-04
What is an electronic version of the remittance advice that is sent to the provider?
Electronic Remittance Advice (ERA)
What is the predetermined fixed amount paid by the individual at each healthcare encounter?
Co-payment
Which payment system used by Medicare is based on the Medicare Severity-Diagnosis Related Group (MS-DRG) classification system?
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How does the outpatient prospective payment system (OPPS) reimburse hospitals for the care they provide to Medicare beneficiaries?
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What is the resource-based reimbursement value system (RBRVS) based on?
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Which payment model is used in the healthcare industry where providers are paid a set amount for each patient they see?
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Which payment model is used in the healthcare industry where providers are paid for each service rendered, such as an office visit or a lab test?
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What is the purpose of the Medicare Physician Fee Schedule (MPFS)?
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What is the purpose of the Geographic Practice Cost Indices (GPCIs) in Medicare payment calculations?
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Which of the following terms refers to medical conditions and unrelated co-existing conditions that complicate patient care during a hospital stay?
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What do complications and co-morbidities (CC) refer to?
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What are hospital-acquired conditions (HAC)?
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What does Non-PAR limiting charge apply to?
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