Revenue Cycle 360

Medicare PPS

100

What is the base rate for FQHC PPS?

$173.50

200

Name three billable providers for Medicare.

Medical Doctor, Optometrist, Podiatrist, PA, CNM, NP, CP, LCSW, Certified Diabetic Educator

300

How do you determine the charge for your Medicare G codes?

The charge should reflect a typically bundle of services for you Medicare population.

Sliding Fee

100

How many levels of discounts are required between 101 and 200% of FPG

Three

200

What chapter in the compliance manual is dedicated to the topic of the sliding fee?

Chapter 9

300

Can you apply the sliding fee discount to patients who have third party insurance?

It depends

Coding & Documentation

100

True or False – The HPI may be taken by the clinical staff, however, the provider must re-ask and redocument for coding purposes.

False

200

True or False – The proposed rule for 2021 indicates that documentation will not be required for coding purposes.

False

300

True of False - The proposed rule for 2021 includes changing the definition of the time element associated with the E/M codes from typical face-to-face time to total time spent on the day of the encounter.

True

Compliance

100

An organizational risk assessment should be performed by which of the following

1. The compliance officer
2. The compliance committee
3. The director of quality
4. The Board

The answer is 2.

200

How should the annual compliance work plan be developed from the risk assessment results

1. Risk areas should be prioritized by the compliance committee considering materiality and potential likelihood of occurrence
2. All noted risk areas should be addressed
3. The compliance officer should decide the priorities
4. The Board should decide the final risk areas to be addressed

• The answer is 1

300

How long do we have to refund Medicare for claims we realize were erroneously billed and paid once we have quantified the overpayments?

1. 90 days
2. 120 days
3. 30 days
4. 60 days

The answer is 4

Accounts Receivables

100

FQHC Revenue cycle management (i.e,, RCM; a.k.a. billing) is focused exclusively on sending professional (837-P) claim files and receiving payment from 3rd party payers.

False: FQHC RCM/billing involves HRSA compliance around SFDS, Medicare PPS G code pricing, grant dollars management, claim submission, payment posting, and much more.

200

The revenue cycle management (i.e,, RCM; a.k.a. billing) department should have no interaction with clinic operations.

False: RCM/billing team should regularly engage with front desk, providers, and clinical leadership about maximizing financial performance.

300

Blended Encounter Rate (BER) is the average per visit/encounter payment across ______ payers.

 A. Medicare, B. Medicare, Medicaid, & Blue Cross, C. Medicare and commercial payers, D. All Payers.

D