Cca exam prep stuvia Study guides, Class notes & Summaries

PPS - ANSWER-Prospective Payment System What is prospective payment system? - ANSWER-Payment for all care delivered during an episode of care based on pre-determined fixed amount (DRGs). Influenced by care setting. What are the 4 types of Prospective Payment Systems? - ANSWER-Capitation, global payment method, case-rate methodology, and bundled payment. Capitation - ANSWER-System of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount ...

Code assignment - ANSWER2nd step in reimbursement process Documentation - medical/ financial record - ANSWER1st step in reimbursement process Claim preparation - ANSWER3rd step in reimbursement process Claim to payer(s) - ANSWER4th step in reimbursement process Claim review - ANSWER5th step in reimbursement process Claim resolution - ANSWER6th step in reimbursement process 1. Coding for physicians 2. Coding for facilities - ANSWERWhat are the 2 types of outpatient coding situ...

c - Answer What does the fourth character of an ICD-10-CM diagnosis code capture? a. anatomic site b. severity c. etiology d. supplemental information a - Answer Which of the following is a standard terminology used to code medical procedures and services? a. CPT b. HCPCS c. ICD-10-PCS d. SNOMED CT a - Answer A patient is admitted with spotting. She had been treated two weeks previously for a miscarriage with sepsis. The sepsis had resolved, and she is afebrile at this time. S...

Allowable fee - Answer Average or maximum amount the third-party payer will reimburse providers for the service Block grant - Answer It is a fixed amount of money given or allocated for a specific purpose. Ex. Medicare's payment system for home health services are consolidated into the single payment Capitated payment method - Answer It is a method of payment for health services in which the third-party payer reimburses providers a fixed, per capita amount for a period. "Per capita" mea...

The case-mix management system that utilizes information from the Minimum Data Set (MDS) in long term care settings is called - ANSWERResource Utilization Groups (RUGs) The prospective payment system used to reimburse home health agencies for patients with Medicare utilizes data from the - ANSWEROASIS (Outcome and Assessment Information Set Under APCs, the payment status indicator "N" means that the payment - ANSWERis packaged into the payment for other services All of the following i...

Code assignment - ANSWER2nd step in reimbursement process Documentation - medical/ financial record - ANSWER1st step in reimbursement process Claim preparation - ANSWER3rd step in reimbursement process Claim to payer(s) - ANSWER4th step in reimbursement process Claim review - ANSWER5th step in reimbursement process Claim resolution - ANSWER6th step in reimbursement process 1. Coding for physicians 2. Coding for facilities - ANSWERWhat are the 2 types of outpatient coding situ...

Allowable fee - ANSWERAverage or maximum amount the third-party payer will reimburse providers for the service Block grant - ANSWERIt is a fixed amount of money given or allocated for a specific purpose. Ex. Medicare's payment system for home health services are consolidated into the single payment Capitated payment method - ANSWERIt is a method of payment for health services in which the third-party payer reimburses providers a fixed, per capita amount for a period. "Per capita" means ...

Identify the diagnosis codes for carcinoma in situ of vocal cord - ANSWERD02.0 Identify the diagnosis codes for melanoma of skin of right shoulder - ANSWERC43.61 Which of the following organizations is responsible for updating the procedure classification of ICD-10-PCS? a) Centers for Disease Control (CDC) b) Centers for Medicare and Medicaid Services CMS c) National Center for Health Statistics NCHS d) World Health Organization WHO - ANSWERb) CMS (Centers for Medicare and Medicaid Ser...

The case-mix management system that utilizes information from the Minimum Data Set (MDS) in long term care settings is called - ANSWERResource Utilization Groups (RUGs) The prospective payment system used to reimburse home health agencies for patients with Medicare utilizes data from the - ANSWEROASIS (Outcome and Assessment Information Set Under APCs, the payment status indicator "N" means that the payment - ANSWERis packaged into the payment for other services All of the following i...

Which of the following organisations is responsible for updating the procedure classification of icd-10- pcs? - ANSWERCentres for medicaid and medicare services - CMS Which character in an icd-10-CM diagnosis code provides information regarding encounter of care? - ANSWERSeventh What is the 4th character of an icd-10-cm diagnosis code capture? - ANSWEREtiology ICD-10-CM codes must be a minimum length of how many characters? - ANSWER3 notes appearing under a 3 character code apply to ...