#1
Which organization is responsible for creating the Healthcare Common Procedure Coding System (HCPCS)?
Centers for Medicare & Medicaid Services (CMS)
ExplanationCMS creates HCPCS.
#2
What is the primary purpose of the Diagnosis-Related Group (DRG) system?
To classify patients based on their primary diagnosis and treatment procedures
ExplanationDRG classifies patients by diagnosis and treatment.
#3
Which entity is responsible for overseeing the implementation of the Health Insurance Portability and Accountability Act (HIPAA) in the United States?
Office for Civil Rights (OCR)
ExplanationOCR oversees HIPAA implementation.
#4
What does the term 'Explanation of Benefits (EOB)' refer to in healthcare billing?
A statement sent to the patient explaining services provided and payments made
ExplanationEOB explains services and payments.
#5
What is a deductible in health insurance?
The fixed amount of money you pay out of pocket for covered healthcare services before your insurance plan starts to pay
ExplanationDeductible is the initial out-of-pocket payment.
#6
Which government agency administers the Medicaid program in the United States?
Centers for Medicare & Medicaid Services (CMS)
ExplanationCMS administers Medicaid.
#7
Which of the following is a characteristic of fee-for-service payment model in healthcare?
Providers are paid based on the number of services they deliver
ExplanationFee-for-service pays based on services provided.
#8
What is the purpose of the International Classification of Diseases (ICD) coding system in healthcare?
To classify diseases and health problems
ExplanationICD codes classify diseases.
#9
What is the purpose of the Centers for Medicare & Medicaid Services (CMS) 1500 claim form?
To submit claims for reimbursement to Medicare and Medicaid
ExplanationCMS 1500 submits claims to Medicare/Medicaid.
#10
What role does the Current Procedural Terminology (CPT) coding system serve in healthcare billing?
To report services and procedures provided to patients
ExplanationCPT codes report services/procedures.
#11
What is a 'clean claim' in healthcare billing?
A claim that contains all required data elements and is processed without errors
ExplanationClean claim has all required data without errors.
#12
What is the primary purpose of the National Provider Identifier (NPI) system?
To identify healthcare providers in standard transactions
ExplanationNPI identifies healthcare providers.
#13
Under the prospective payment system (PPS), how are payments to healthcare providers determined?
Based on predetermined rates for specific services or conditions
ExplanationPPS pays based on preset rates.
#14
In value-based healthcare payment models, what is the primary focus of reimbursement?
The quality and outcomes of patient care
ExplanationReimbursement focuses on quality/outcomes.
#15
What is the primary role of the Office of Inspector General (OIG) in healthcare?
To investigate fraud and abuse in healthcare programs
ExplanationOIG investigates healthcare fraud/abuse.
#16
In healthcare reimbursement, what does the term 'bundled payment' refer to?
A single payment made to cover all services related to a specific condition or procedure
ExplanationBundled payment covers all services for a condition/procedure.
#17
In healthcare billing, what is the purpose of a 'precertification' process?
To authorize medical procedures before they are performed
ExplanationPrecertification authorizes medical procedures.