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CMAA Module 6 Questions &Exam (elaborations) answers 100% satisfaction guarantee
CMAA Module 6 Questions &Exam (elaborations) answers 100% satisfaction guarantee
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STUVIA 2024/2025CMAA Module 6
- ✔✔An aging report can be generated to determine balances owed by the patient. This report
identifies outstanding patient balances that are considered overdue. Collecting patient balances is an
important part of the revenue cycle and should be monitored and managed regularly.
- ✔✔ICD-10-CM Codes
Most Recent Blood Pressure Reading
Code
Systolic less than 130 mm Hg
3074F-ZZ
Systolic 130 to 139 mm Hg
3075F-ZZ
Diastolic less than 80 mm Hg
3078F-ZZ
Diastolic 80 to 89 mm Hg
3079F-ZZ
- ✔✔The standard code sets used on claim forms are CPT, ICD-10-CM, ICD-10-PCS (for inpatient
%
claims), and HCPCS codes used to describe the diagnoses, services, supplies, and procedures on
the claim form.q
837I for electronic claims and UB-04 (CMS-1540) for paper claims. - ✔✔Inpatient claim formats are
837P for electronic claims
CMS-1500 for paper claims. - ✔✔The outpatient/professional service claim formats are
A
Part A
When a patient qualifies for Medicare, Part A covers inpatient hospital services. Part B covers
outpatient services. Part C is called the Medicare Advantage plan and covers Part A, B, and other
services. Part D is for prescription medication. - ✔✔A 68-year-old patient is admitted to the hospital
for kidney stones and does not have a managed care plan. Which of the following parts of Medicare
provides coverage for inpatient hospital services to the beneficiary?
A
Part A
B
Part B
C
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Part C
D
Part D
A clearinghouse is an organization that accepts the claims data from a health care organization,
formats the claim, and submits it to the third-party payer. A clearinghouse can also scrub the claim for
data and charge entry errors before sending it through to the payer. The error will be sent back to the
health care organization for correction and resubmission. - ✔✔Briefly describe the functions of a
clearinghouse.
a collection of all charges and payments entered for a particular date or time period. Each batch will
have a unique identifier for reference in the future. This unique identifier will help identify an
outstanding claim when referencing the aging reports. There may be multiple batches open by
multiple operators at any given time. - ✔✔Batch
A comprehensive patient questionnaire to assess overall well-being by measuring physical and
mental health, including lifestyle factors, fall risk, and cognitive function. - ✔✔Health Risk
Assessment
A daily batch is a collection of all transactions performed throughout the day. This includes posting
%
charges for the encounter and payments from the patient and payer along with any adjustments
made per the payer/provider contract. - ✔✔Describe the components of a daily batch within the
PMS.
A managed care method of monthly payments to the provider based on the number of enrolled
patients, regardless of how many encounters a patient may have during the month. - ✔✔Capitation
A patient expressing concern about not being able to provide payment at the time of service is a
special circumstance that requires management approval. There will also be times a patient is
emotional, such as the loss of a spouse, and may require a private location to openly discuss their
situation. - ✔✔Briefly describe the type of situation that would require privacy, empathy, and
professionalism in a special circumstance.
A referral may be needed for patient care when a patient is in need of more specialized care and
treatment. For example, when a primary care provider refers a patient to the cardiologist for
management of heart disease. - ✔✔Describe when a referral would be needed for patient care.
A reimbursement model intended to improve the traditional fee-for-service method by changing the
focus to value-based care rather than volume-based care. - ✔✔pay-for-performance (P4P)
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