AHIMA AHIMA Certifications RHIA Questions & Answers

• Question 1421:

  If a participating provider's usual fee for a service is $700.00 and Medicare's allowed amount is $450.00, what amount is written off by the physician?

  A. none of it is written off.

  B. $250.00

  C. $450.00

  D. $391.00

  Correct Answer: B

• Question 1422:

  Health plans that use _________ reimbursement methods issue lump-sum payments to providers to compensate them for all the health care services delivered to a patient fro a specific illness and/or over a specific period of time.

  A. episode-of-care (EOC)

  B. capitation

  C. fee-for-service

  D. bundled

  Correct Answer: A

• Question 1423:

  In calculating the fee for a physician's reimbursement, the three relative value units are each multiplied by

  A. geographic practice cost indices.

  B. national conversion factor.

  C. usual and customary fees for the service

  D. the cost of living index for the particular region

  Correct Answer: A

• Question 1424:

  If the physician's standard fee for a service is $210.00 and the Medicare PAR fee is $115.00, what is the limiting charge for a nonparticipating (nonPAR) provider?

  A. $241.50

  B. $109.25

  C. $132.25

  D. $125.63

  Correct Answer: D

• Question 1425:

  CMS adjusts the Medicare Severity DRGs and the reimbursement rates every

  A. calendar year beginning January 1.

  B. quarter.

  C. month.

  D. fiscal year beginning October 1.

  Correct Answer: D

• Question 1426:

  Under Medicare Part B, Medicare participating providers

  A. will be able to collect his or her total charges.

  B. agrees to charge no more than 15% (limiting charge) over the allowed charge from the nonPAR fee schedule.

  C. accepts, as payment in full, the allowed charge from the nonPAR fee schedule.

  D. agrees to charge no more than 10% (limiting charge) over the allowed charge from the nonPAR fee schedule.

  Correct Answer: C

• Question 1427:

  All of the following statements are true of MS-DRGs, EXCEPT

  A. A patient claim may have multiple MS-DRGs.

  B. The MS-DRG payment received by the hospital may be lower than the actual cost of providing the services.

  C. Special circumstances can result in an outlier payment to the hospital.

  D. There are several types of hospitals that are excluded from the Medicare inpatient PPS.

  Correct Answer: A

• Question 1428:

  This program, formerly called CHAMPUS (Civilian Health and Medical Program-Uniformed Services), is a health care program for active members of the military and other qualified family members.

  A. TRICARE

  B. CHAMPVA

  C. Indian Health Service

  D. workers' compensation

  Correct Answer: A

• Question 1429:

  The occurrence of an OCE (outpatient code editor) edit can result in one of __________ different dispositions, which help to ensure that the fiscal intermediaries in all parts of the country are following similar claims processing procedures. An example of one of these dispositions is "claim rejection."

  A. 100

  B. 50

  C. 3

  D. 6

  Correct Answer: D

• Question 1430:

  Assume the patient has already met his or her deductible and that the physician is a nonparticipating Medicare provider, but does accept assignment. The standard fee for the services provided is $120.00. Medicare's PAR fee is $60.00 and Medicare's nonPAR fee is $57.00. How much reimbursement will the physician receives from Medicare?

  A. $120.00

  B. $60.00

  C. $57.00

  D. $45.60

  Correct Answer: D