Revenue Cycle Management Specialist (RCMS) Practice Exam

These questions are part of the practice quiz. Start practicing

• Which data item contains the Attending Provider and their identifiers?
• Total RVU multiplied by the conversion factor yields which of the following?
• The remarks field is used to provide information not listed elsewhere but necessary for proper payment. True or False?
• The MA12 (MUE Table) is based on what?
• Which groups are covered by PTP edits according to the material?
• When was the RBRVS created?
• PPS was created in which year?
• FL 18-28 contains which type of codes?
• Which field contains Remarks, or special annotations that provide information not listed elsewhere but necessary for proper payment?
• Is the use of a different diagnosis code required when using Modifier 25?
• The 278 transaction relates to which of the following?
• What does an MUE denial indicate regarding ABN applicability and billing?
• Within MUE, which column holds the comprehensive codes?
• In MUE Methodologies, what does M6 refer to?
• When was OPPS implemented?
• How is the Administrative Law Judge hearing typically conducted?
• What does the XU modifier indicate?
• Which RVU component accounts for professional liability insurance?
• Which field represents Admission/Start of Care Date?
• In MUE Methodologies, what does M1 refer to?
• Which statement is true about Modifier 58?
• What can be used to indicate a code pair exception in medical billing?
• Can you use both Modifier 59 and X modifiers together?
• Which TOB code corresponds to Clinic CORF?
• In what year was the Outpatient Code Editor (OCE) developed?
• What does OCE stand for?
• Which set of organizations is listed as working on claim standards?
• Are all APCs paid under OPPS?
• Which stakeholders are represented by the National Uniform Claim Committee?
• What does MUE apply to?
• In Medicare secondary payer claims with multiple primary payers and multiple allowed amounts, what is required of providers?
• Which entity is responsible for Medicare’s bundled procedure policies?
• When are NCD/LCD updated?
• What does RBRVS stand for?
• In MUE Methodologies, what does M4 refer to?
• Global Surgery Indicator 090 includes day before, day of, and how many days after the procedure?
• What does the XE modifier indicate?
• MS-DRG is assigned to how many major diagnostic categories?
• How many line items can Integrated OCE (I/OCE) accept per claim?
• Who uses the Outpatient Code Editor (OCE) when processing outpatient claims?
• What is the GROUPER?
• What do new technology APCs reimburse facilities for?
• Which modifier is described as a subset of Modifier 59?
• What does a CCMI value of 1 indicate?
• What does Modifier 59 identify?
• What is the purpose of an Outlier payment?
• Which TOB code is associated with Clinic OPT?
• Which of the following costs are included in the cost-based methodology?
• Where is the OPPS rate published?
• The 834 transaction covers which process?
• FL 12 corresponds to which data element?
• Which modifier indicates a separate practitioner?
• Which of the following best describes the scope of I/OCE updates?
• For services covered under OPPS, what does Integrated OCE (I/OCE) assign?
• What does APC stand for in healthcare payment?
• The 999 transaction serves as an acknowledgement for:
• What does TOB code 073X represent?
• OPPS uses APCs to determine payment instead of cost-to-charge ratio.
• Which modifier indicates a significant E/M service by the same physician on the same day as the procedure?
• Which data field captures value codes and their corresponding monetary amounts on a claim?
• In MUE Methodologies, what does M5 refer to?
• Together, the 3rd and 4th components of MUE primarily govern what processes?
• When is Modifier 59 appropriate to use?
• In CCMI terms, which value indicates that the NCCI edit does not apply to the code pair?
• Which modifier indicates a separate structure?
• The 276/277 transaction set is used for which purpose?
• What does NCD stand for in Medicare coverage policy?
• Which statement about the 837 standard format is true?
• Transitional pass-through payments reimburse facilities for new drugs, biologicals, and devices during a review period of up to how many years?
• Which statement best describes the relationship between MUE and PTP edits?
• Which field represents Point of origin for admission or visit?
• FL 15 corresponds to which data element?
• How often is Integrated OCE (I/OCE) updated?
• Global Surgery Indicator 010 includes the day of the procedure plus how many days after?
• Which determinations are national in scope?
• What is the time frame for Judicial Review after an Appeals Council decision?
• What is the Outpatient Code Editor (OCE) primarily used for?
• What payment methodology does OPPS use?
• Which field records the patient’s reason for the visit?
• Which stage involves the possibility of federal judicial review?
• What is the purpose of the conversion factor?
• Which modifier is described as a distinct procedural modifier?
• Why might some APCs not be paid or discounted?
• What percentage of the total RVU is attributed to professional liability insurance in the RBRVS?
• Is a planned procedure that fails and is converted to an open procedure separately reportable?
• Under Medicare rules, when can claims be submitted on paper?
• What is the purpose of the information returned by Integrated OCE (I/OCE)?
• What is the time frame to request a hearing with an Administrative Law Judge after a reconsideration decision?
• Who updates the conversion factor annually?
• What is the result of I/OCE processing for OPPS services?
• What is the basis for payment under OPPS?
• Which group is represented as stakeholders in the National Uniform Claim Committee?
• What is the time frame to request an Appeals Council review after an ALJ's decision?
• At what level is LCD mandated?
• The 3rd component of MUE includes what type of rules?
• Outlier payments are designed to offset what?
• What does a CCMI value of 9 indicate?
• What is the purpose of the RARCS field?
• Which form is used to submit reconsideration in the MCR process?
• What is the correct RVU formula?
• What type of edits do hospitals apply to TOB?
• The 277 transaction is used for which purpose?
• Which description correctly matches M4 through M6 in MUE Methodologies?
• Integrated OCE (I/OCE) performs which function?
• If the total RVU is 1.5 and the conversion factor is $40, what is the reimbursement amount before modifiers?
• The 820 transaction is associated with which concept?
• If specific anatomic modifiers are available, what should be used instead of Modifier 59?
• Which TOB code corresponds to Hospital Outpatient (ASC)?
• In the RVU formula, which term is multiplied by PE GPCI?
• Which statement about the conversion factor in RVU-based payments is correct?
• Under OPPS, APC payments may be discounted based on what?
• What are the primary claim types included in the 837 standard format?
• What is the time frame for the ALJ to issue a decision after hearing?
• Which elements are used in the RVU method for calculating physician fees?
• The 835 transaction is primarily used for which of the following?
• Which data element identifies accommodation charges and ancillary items tied to a specific revenue code?
• What does the conversion factor in RVU-based payment reflect?
• In MUE Methodologies, what does M3 refer to?
• Which is the final level of review in the MCR appeals process?
• OPPS is primarily used for which patient setting?
• What does GAF stand for?
• In the RVU formula, which GPCI multiplies the WORK RVU term?
• What is the purpose of the RBRVS?
• What form is used to request an Appeals Council review?
• Medicare rejects include claims for invalid future date within onset, acute manifestation, initial treatment, accident or LMP. Which option correctly describes this?
• What does the XS modifier indicate?
• Does OPPS apply to MA plans?
• When are Outlier payments made?
• What is the second component of MUE?
• In MUE, which component addresses provider appeals of denials based on edits?
• What does NCCI stand for?
• How is the hospital paid under OPPS?
• What do the codes DN Referring and ZZ Other operating physician represent on a claim?
• The RVU Method is used for what purpose?
• PTP stands for Procedure to Procedure.
• What is the time frame for redetermination in the Medicare claims appeals process?
• What percentage of the total RVU is attributed to physician work in the RBRVS?
• The 4th component of MUE addresses which of the following?
• What is a conversion factor in medical billing?
• Which data element distinguishes the physician who provides ongoing care from the referring physician?
• The XE modifier indicates which of the following?
• If the conversion factor increases, what happens to reimbursement for a CPT code?
• Which TOB code corresponds to Clinic CORF?
• Roster billing is used for inoculations. Which statement is true?
• What does TOB code 018X represent?
• Code pairs in medical billing are pairs that should not be billed together because one service includes another.
• FL 17 is used to capture what?
• Which organization developed the Outpatient Code Editor (OCE)?
• Which hospitals are targeted by Integrated OCE (I/OCE)?
• What does TOB code 072X represent?
• What is the primary purpose of NCCI edits?
• How is Medicare reimbursement calculated?
• Where are comprehensive codes found in MUE?
• Modifier 76 describes which of the following?
• MS-DRGs are assigned based on which criterion?
• What is the purpose of the National Uniform Claim Committee?
• The 270/271 transaction is used for which purpose?
• What is the purpose of the current physician fee schedule in relation to RVUs?
• NCCI edits apply to claims submitted by which providers?
• What types of facilities utilize the Outpatient Code Editor (OCE)?
• What types of claims does MUE include?
• What does Modifier 58 indicate?
• Which CCMI value indicates the modifier is allowed?
• Which organizations work on claim standards?
• What must documentation support when using Modifier 59?
• What is the first methodology of the Physician Fee Schedule?
• Which of the following are the three components of the total RVU in RBRVS?
• Within MUE, which column holds the component codes?
• Edits are updated quarterly. How often are edits updated?
• Which field lists the HCPCS codes, rates, and HIPPS rate codes used for billing?
• Which facility category's claims are processed by I/OCE to assign an ASC payment group?
• Which statement correctly describes M1 and M2 in MUE Methodologies?
• If a claim is submitted as outpatient, what does it indicate?
• Which statement about the 837 standard claim formats is true?
• LCD guidelines applicability relates to which type of jurisdiction?
• Provider Type Qualifiers are used to indicate what about the provider?
• Which determinations are local in scope?
• What does a CCMI value of 0 indicate?
• What does TOB code 013X represent?
• LCDs are local coverage determinations created by which entity?
• Roster billing is a method used for what type of Medicare-covered services?
• What percentage of the total RVU is attributed to practice expense in the RBRVS?
• The 278 transaction is used for which purpose?
• Which TOB code corresponds to Critical Access Hospital?
• For OPPS, hospitals are subject to which system?
• What is the code for physician orders in patient services?
• Transitional pass-through payments are designed to reimburse new drugs, biologicals, and devices during a review period of up to how many years?
• Which form is used to request an Appeals Council review?
• Which statement correctly matches the TOB codes to their described facility types?
• The ALJ hearing is typically conducted by which method, and what alternative can be requested?
• What will CMS reimburse for when using Modifier 58?
• What is the time frame for the Administrative Law Judge to issue a decision?
• Can Modifier 59 be used together with X modifiers in the same procedure?
• What field on Medicare claims contains occurrence codes and dates such as admission, discharge, and service dates?
• In Medicare claims, what does MUE usage govern?
• In the context of RVU, what is the primary use?
• Which transaction handles enrollment and disenrollment in a health plan?
• What is the final level of review in the MCR appeals process?
• What is the first component of MUE?
• What is the X-ESPU modifier?
• LCD stands for which term?
• Which entity allows states to deactivate edits that conflict with state laws and policies?
• What does GPCI stand for?
• Under Medicare, paper submissions are allowed only under what condition?
• Which field would you check to review the admission date on a claim?
• RVU stands for which term?
• What does RVU stand for?
• What does Modifier 25 indicate?
• Which CCMI value indicates that a modifier is not allowed?
• Is a diagnostic procedure that results in a decision to perform surgery separately reportable?
• Which statement correctly describes a function of Integrated OCE (I/OCE)?
• What does Integrated OCE (I/OCE) assign for services on claims from certain non-OPPS hospitals?
• When is an LCD developed?
• Which statement is true about the relationship between the first two components of MUE?
• What limited services are associated with the Outpatient Code Editor (OCE)?
• In Medicare, which organization defines bundled procedures?
• Are endoscopic procedures covered under Modifier 58?
• Which form is developed and maintained by the National Uniform Claim Committee?
• What form is used to submit a reconsideration in the MCR appeals process?
• What does the XP modifier indicate?
• Where are component codes found in MUE?
• What types of costs are included in the cost-based methodology?
• MUE stands for Medically Unlikely Edits.
• For new technology APCs, what is their reimbursement purpose?
• LCDs primarily define which type of codes?
• In MUE Methodologies, what does M2 refer to?
• Which TOB code corresponds to Critical Access Hospital?
• Modifier 25 is primarily used to indicate:
• Which data element denotes the codes for the referring physician and other operating physician?
• Which modifier most clearly denotes a distinct procedure that is not an E/M service?
• What are the two components of MUE described in the material?
• Integrated OCE (I/OCE) applies to which type of hospitals?
• Which is the deadline to file Judicial Review following the Appeals Council decision?
• What is Modifier 59?
• Which field represents Discharge Status (top MCR rejection)?
• Medicare rejects include claims for which scenario?
• Under the Administrative Simplification Compliance Act (ASCA), claims must be sent electronically unless unusual circumstances are met. Which statement best describes this requirement?