Under an FFS payment methodology, reimbursement would be determined by _______ reported on the claim.

If a query is submitted to the provider, and the coder receives no response within 5 days to a week, the coder should:

According to CPT, in which of the following cases would an established E/M code be used?

APCs are groups of services that the OPPS will reimburse. Which one of the following services is not included in APCs?

Under ASC PPS, when multiple procedures are performed during the same surgical session, a payment reduction is applied. The procedure in the highest level group is reimbursed at _____, and all remaining procedures are reimbursed at ______.

Use the following table to answer the question.   MS-DRG Description Number of Patients CMS Relative Weight 470 Major joint replacement or reattachment of lower extremity w/o MCC 2,750 1.9871 392 Esophagitis, gastroent & misc. digestive disorders w/o MCC 2,200 0.7121 194 Simple pneumonia & pleurisy w CC 1,150 1.0235 247 Perc cardiovasc proc 2 drug-eluting stent w/o MCC 900 2.1255 293 Heart failure & shock w/o CC/MCC 850 0.8765 313 Chest pain 650 0.5489 292 Heart failure & shock w CC 550 1.0134 690 Kidney & urinary tract infections w/o MCC 400 0.8000 192 Chronic obstructive pulmonary disease w/o CC/MCC 300 0.8145 871 Septicemia w/o MV 96+ hours w MCC 250 1.7484 Based on the this patient volume, during this time period, the MS-DRG that brings in the highest “total” reimbursement to the hospital is 

Use the following table to answer the question.       HCPCS Code       Charge Service Code Item Service Description General Ledger Key Medicare Medicaid Charges Revenue Code Activity Date 49683105 CT scan; head; w/out contrast and with contrast 3 70470 70470 500.00 0351 1/1/2024 49683106 CT scan; soft tissue neck; with contrast 3 70491 70491 675.00 0351 1/1/2024 This information is printed on the UB-04 claim form to represent the cost center (e.g., lab, radiology, cardiology, and respiratory) for the department in which the item is provided. It is used for Medicare billing.

According to the American Medical Association, medical decision making is measured by all of the following except the 

The patient was recently diagnosed with stage 3 renal disease and has arrived at the facility to receive the fitting and adjustment of a catheter for renal dialysis. The correct diagnosis code to report this condition is:  Z49.01 Encounter for fitting and adjustment of extracorporeal dialysis catheter Z49.02 Encounter for fitting and adjustment of peritoneal dialysis catheter Z49.31 Encounter for adequacy testing for hemodialysis Z49.32 Encounter for adequacy testing for peritoneal dialysis  

This prospective payment system replaced the Medicare physician payment system of “customary, prevailing, and reasonable (CPR)” charges whereby physicians were reimbursed according to their historical record of the charge for the provision of each service.