AAPC CPB - Chapter 11 Review | Questions and Verified Solutions Latest Update 2024
Medicare's payment amount for services are determined by which of the following formulas?
- Sustainable growth rate (SGR) X Geographic Practice Cost Index (GPCI) = Medicare payment
- Total RVU X Conversion factor = Medicare payment
- Total Practice Expense (PE) X Conversion factor = Medicare payment
- Total Malpractice insurance (MP) X Conversion factor (CF) = Medicare payment - Answer - b. Total RVU
X Conversion factor = Medicare payment
The total RVU is composed of which of the following components:
- Conversion factor (CF), practice expense (PE), and malpractice insurance (MP)
- Physician work, practice expense (PE), and malpractice insurance (MP)
- Sustainable growth rate (SGR), conversion factor (CF), and malpractice insurance (MP)
- Sustainable growth rate (SGR), practice expense (PE), and physician work. - Answer - b. Physician work,
practice expense (PE), and malpractice insurance (MP)
Response Feedback:
Total RVU is based on three components of physician services: physician work, practice expense (PE) and malpractice insurance (MP).
Medicare Supplement Insurance policies or Medigap is sold by:
- Medicare
- Medicaid 1 / 2
- Private insurance companies
- Healthcare providers - Answer - c. Private insurance companies
Medicare statutorily excluded services are:
- Non-covered items and services
- Not reimbursed by Medicare
- Reimbursed on a case-by-case basis.
- Both A & B - Answer - d. Both A & B
Response Feedback:
Non-covered items and services are statutorily excluded and are not reimbursed by Medicare. Examples of statutorily excluded services are routine foot care, cosmetic surgery, and acupuncture.Albert has purchased a Medigap policy to supplement his Medicare benefits. To which entity will Albert pay his monthly premium for this policy?
- Medicare
- MAC
- Medicaid
- Medigap insurance company - Answer - d. Medigap insurance company
Response Feedback:
Premiums for Medigap policies are paid directly to the Medigap insurance company, not to CMS, MAC's or Medicaid.
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