QUESTION: 409

Commercial insurance plans usually reimburse health care providers under some type of __________ payment system, whereas the federal Medicare program uses some type of ___________ payment system.

prospective, retrospective
retrospective, concurrent
retrospective, prospective
prospective, concurrent

Answer(s): C

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QUESTION: 410

The difference between a rejected claim and a denied claim is that

a rejected claim is sent back to the provider; errors may be corrected and the claim resubmitted.
a denied claim is sent back to the provider; errors may be corrected and the claim resubmitted.
a rejected claim may be appealed, but a denied claim may not be appealed.
if a procedure or service is unauthorized, the claim will be rejected, not denied.

Answer(s): A

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These services are those performed by a nonphysician practitioner (such as a Physician Assistant) that are an integral yet incidental component of a physician's treatment for illness or injury. A physician must have personally performed an initial visit and must remain actively involved in the continuing care to the patient. Medicare requires direct supervision for these services to be billed.

"technical component" billing.
"assignment" billing.
"incident to" billing.
"assistant" billing.

Answer(s): C

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QUESTION: 412

The Quality Improvement Organizations (QIO) are given hospital-specific data from the Hospital Payment Monitoring Program (HPMP). Hospital data is provided to the QIOs for fourteen target areas on a quarterly basis. This report is called the

Program for Evaluation Payment Patterns Electronic Report (PEPPER).
Payment Error Prevention program (PEP).
Office of Inspector General (OIG) Workplan.
National Correct Coding Initiative (NCCI).

Answer(s): A

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QUESTION: 409

QUESTION: 410

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QUESTION: 412