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29 Cards in this Set

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Which is a relative value unit (RVU) in the Medicare Physician fee schedule payment system?
practice expense
Medicare Part B radiology services payment vary according to
place of services
The physician fee schedule for CPT code 99214 is $75. Calculate the nonPAR limiting charge for this service.
$81.94
The physician fee schedule for CPT code 99214 is $75. Calculate the nonPAR allowed charge for this service.
$71.25
Which is classified as a nonphysician practitioner?
physician assistant
Which publication communicates new or changed policies and procedures that are being incorporated into a specific CMS manual?
program transmittal
Medicare is primary to
Medicaid
MS DRG
Medical Severity Diagnosis-Related Groups
HHRG
Home Health Resource Groups=
Home Health
APC
Ambulatory Payment Classification= Outpatient
DRG
Diagnosis-Related Group= Inpatient
RBRVS
Resource-Based Relative Value Scale= Physician
RUG
Resource Utilization Group= Skilled Nursing
Ambulance Fee Schedule
Fee charge for transportation (remote will cost more in the country rather than the city)
Sally Jones underwent outpatient surgery to have one mole removed from her upper back. The charge was $65. the fixed copayment amount for this type of procedure, adjusted for wages in the geographic area, is $15.
65 x 20%=
65 x .20=13
so the copay is $13
Cherie Brown underwent an outpatient chest x-ray that cost $75. The fixed copayment for this type of procedure, adjusted for wages in the geographic area, is $25.
75 x 20%=
75 x .20=15
so the copay is $15
James Hill underwent outpatient oral glucose tolerance test. the charge for this procedure was $122. The fixed copayment for this type of procedure, adjusted for wages in the geographic area, is $20.
122 x 20%=
122 X .20=24.40
so the copay is $20
Scott Wills underwent toenail removal as an outpatient. The charge was $81. The fixed copayment for this type of procedure, adjusted for wages in the geographic area, is $25.
81 x 20%=
81 x .20=16.20
so the copay is $16.20
George Harris had a suspicious lesion removed from his left temple as an outpatient. The charge was $78. The fixed copayment amount for this type of procedure, adjusted for wages in the geographic area, is $15.
78 x 20%=
78 x .20=15.60
so the copay is $15
Which DRG is assigned when the provider documents "transient ischemia" as the patient's principal diagnosis?
DRG 524
For a patient who has cranial and peripheral nerve disorder and a documented comorbidity, which DRG is assigned?
DRG 18
Which DRG is assigned for a patient whose principal diagnosis is multiple sclerosis?
DRG 13
A patient was diagnosed with trigeminal neuralgia. This is the only diagnosis reported in the record. Which DRG is assigned?
DRG 19
For a patient with cerebrovascular disease that is classified as non-specific, which DRG is assigned when the patient has a secondary diagnosis of insulin-dependent diabetes mellitus?
DRG 16
For an age 25 patient who undergoes craniotomy for implantation of a chemotherapeutic agent, which DRG is assigned?
DRG 543
Which DRG is assigned to a 5-year-old patient who underwent a procedure for a ventricular shunt?
DRG 3
A 56-year-old patient underwent a craniotomy and suffered a cerebrovascular accident after the procedure. Which DRG is assigned?
DRG 1
Which DRG is assigned for an otherwise healthy patient who underwent sciatic nerve biopsy?
DRG 8
A patient underwent lumbar laminectomy because of injury from a fall. The patient recently completed a course of chemotherapy for non-Hodgkin's lymphoma. Which DRG is assigned?
DRG 531