Healthcare Billing and Reimbursement Principles Quiz

CMS (Centers for Medicare & Medicaid Services) is responsible for overseeing the coding system used in healthcare billing.

CPT stands for Current Procedural Technology, a coding system used to describe medical, surgical, and diagnostic services.

The primary purpose of healthcare reimbursement is to compensate healthcare providers for the services they render to patients.

Medicare is a government program in the United States that provides healthcare coverage for individuals aged 65 and older.

Medical coders play a crucial role in healthcare billing by interpreting medical charts and assigning appropriate codes for diagnoses and procedures.

CMS (Centers for Medicare & Medicaid Services) is responsible for administering Medicaid, a government program providing healthcare coverage for low-income individuals and families.

Franchise Payments are not a common type of healthcare reimbursement; typical methods include fee-for-service, capitation, and value-based reimbursement.

ICD codes (International Classification of Diseases) are used in healthcare billing to identify and categorize medical diagnoses and procedures.

The revenue cycle in healthcare billing aims to optimize financial processes, including patient registration, charge capture, and claims processing.

A clean claim is error-free and ready for processing, but its reimbursement rate is not a characteristic; it depends on the payer's policies.

The UB-04 form in healthcare billing is used to bill facility services, such as hospital stays and other institutional healthcare services.

In value-based reimbursement, healthcare providers are financially incentivized based on achieving positive patient outcomes and quality of care.

EOB (Explanation of Benefits) in healthcare billing is a statement sent by an insurance company explaining the benefits and costs of a medical service.

Remittance advice in healthcare billing serves to communicate information about claim denials, payments, or adjustments between healthcare providers and payers.

ICD codes (diagnoses) are more specific, whereas CPT codes (procedures) provide details about medical services rendered in healthcare billing.

RAC (Recovery Audit Contractor) in healthcare billing refers to contractors tasked with identifying and recovering improper payments made in the Medicare and Medicaid programs.

The HIPAA 837 form in healthcare billing is used to submit electronic claims to insurance companies, ensuring compliance with HIPAA standards.

The National Correct Coding Initiative (NCCI) in healthcare billing aims to establish coding guidelines to prevent improper payments and ensure accurate coding.