Chapter 23 — Quiz

26 questions. Answers and explanations are in the instructor guide.

1. Account 10-4471's \$128.40 allowed amount is:

  • A. Computed from RVUs
  • B. A contracted rate
  • C. A percentage of the charge
  • D. Set by CMS

2. An RVU is:

  • A. A dollar amount
  • B. A ratio expressing resources relative to other services
  • C. A percentage of the charge
  • D. A time measurement

3. Which RVU component measures overhead?

  • A. Work
  • B. Practice expense
  • C. Malpractice
  • D. Conversion

4. Which RVU component has two published values?

  • A. Work
  • B. Practice expense
  • C. Malpractice
  • D. All three

5. RVU values are established by:

  • A. Direct measurement of physician effort
  • B. A specialty society survey, a committee recommendation, and CMS acceptance or modification
  • C. Negotiation with payers
  • D. Statute

6. A GPCI of 1.000 means the locality is:

  • A. The most expensive
  • B. At the national average
  • C. Exempt from adjustment
  • D. Rural

7. GPCIs adjust for:

  • A. The value of the service
  • B. Relative cost
  • C. Patient acuity
  • D. Physician specialty

8. How many conversion factors apply to the physician fee schedule?

  • A. One per specialty
  • B. One per locality
  • C. One, national
  • D. One per code family

9. Budget neutrality means:

  • A. Total spending must fall each year
  • B. RVU changes must not increase total spending beyond a statutory threshold
  • C. Each code must pay the same as last year
  • D. Payers must break even

10. Compute: work 1.92 × 1.000, PE 0.89 × 1.008, MP 0.13 × 1.005, conversion factor \$32.7442.

  • A. \$94.00
  • B. \$96.52
  • C. \$100.11
  • D. \$128.40

11. A code's work RVU rises and its payment falls. The most likely explanation is:

  • A. A coding error
  • B. The conversion factor came down more
  • C. The GPCI changed
  • D. A site-of-service change

12. The physician fee schedule proposed rule is published:

  • A. In January
  • B. In the summer, with a comment period
  • C. Only when Congress acts
  • D. Quarterly

13. The site-of-service differential lives in:

  • A. The work RVU
  • B. The practice expense RVU
  • C. The malpractice RVU
  • D. The conversion factor

14. A service performed in a facility pays the physician less because:

  • A. Facilities negotiate lower rates
  • B. The facility supplied the overhead and bills separately
  • C. Facility work is less complex
  • D. The GPCI is lower

15. Place of service code 22 is:

  • A. Office
  • B. Inpatient hospital
  • C. On-campus outpatient hospital
  • D. Ambulatory surgical center

16. A practice acquired by a hospital and converted to a provider-based department continues to submit place of service 11. This produces:

  • A. A denial
  • B. A wrong payment on an otherwise perfect claim
  • C. A rejection
  • D. No effect

17. Account 10-4471's blended commercial rate is 128.55% of Medicare. How many of its four lines are at 128.55%?

  • A. All four
  • B. Two
  • C. One
  • D. None

18. Two practices sign the identical contract but have different service mixes. They realize:

  • A. The same percentage of Medicare
  • B. Different percentages
  • C. The same dollar amount
  • D. Whatever they negotiated

19. A charge of \$90 is submitted for a service with an allowed amount of \$96.52. Payment is:

  • A. \$96.52
  • B. \$90.00
  • C. \$93.26
  • D. The claim denies

20. A very high charge:

  • A. Increases payment from contracted payers
  • B. Does not increase contracted payment, but inflates the gross collection rate's denominator and sets what a self-pay patient is asked for
  • C. Is required for negotiation
  • D. Reduces the contractual adjustment

21. Why can nobody at Northgate derive the \$185.00 charge?

  • A. It is proprietary
  • B. It is a historical artifact adjusted by across-the-board increases, with no current method behind it
  • C. It is set by the payer
  • D. It equals 200% of Medicare

22. In a defensible charge-setting method, the step that fixes distortion is:

  • A. Reviewing annually
  • B. Applying the same multiple to every code, rather than raising everything by a percentage
  • C. Writing it down
  • D. Finding the highest contracted rate

23. Charge uniformity permits which of the following?

  • A. A higher charge for payers who pay a percentage of billed charges
  • B. Self-pay discounts under a written, consistently applied policy
  • C. Routinely waiving patient coinsurance
  • D. Charges tuned per payer

24. Lost charges are difficult to detect because:

  • A. They are usually small
  • B. They leave no record anywhere in the billing system
  • C. They deny with an unclear reason
  • D. Payers do not report them

25. A practice doubles its charges with no other change. Its gross collection rate:

  • A. Doubles
  • B. Roughly halves
  • C. Is unchanged
  • D. Becomes negative

26. A four-year silent underpayment, written off as contractual adjustment, causes the net collection rate to:

  • A. Fall
  • B. Rise
  • C. Stay flat
  • D. Become uncomputable