CPB

CPB practice questions, page 9 of 9, with answer review and explanations.

Question 41

Adjusted Claim is payment correction resulting in additional payment(s) to the provider.

  1. TRUE
  2. FALSE

Question 42

What is All Patient Refined DiagnosisRelated Group (ARPDRG)?

  1. Adopted by Medicare in 2008 to reimburse hospitals for inpatient care provided to Medicare beneficiaries; expanded original DRG system (based on intensity of resources) to add two subclasses to each DRG that adjusts Medicare inpatient hospital reimbursement rates for severity of illness (SOI) (extent of physiological decompensation or organ system loss of function) and risk of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.
  2. DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross BlueShield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.

Question 43

What does BSR stand for?

  1. Beneficiary Standards Representative
  2. Beneficiary Services Representative
  3. Blue Shield Representative
  4. Black Shield Representative

Question 44

ERISA

  1. First Look Analysis for Hospital Outlier Monitoring
  2. False Claims Act
  3. Fair Debt Collection Practices Act
  4. Employee Retirements Income Security Act of 1974

Question 45

Capitation

  1. Provider accepts preestablished payments for providing healthcare services to enrollees over a period of time (usually one quarter)
  2. Provider accepts preestablished payments for providing healthcare services to enrollees over a period of time (usually one month)
  3. Provider accepts preestablished payments for providing healthcare services to enrollees over a period of time (usually 6 months)
  4. Provider accepts preestablished payments for providing healthcare services to enrollees over a period of time (usually one year)