CCS Practice Medical Billing

_______________________ offers voluntary, supplemental medical insurance to help pay for physician's services, outpatient hospital services, medical services, and medical and surgical supplies not covered by the hospitalization plan. Medicare Part B Medicare Part C Medicare Part D Medicare Part A

Medicare Part B

These are assigned to every HCPCS/CPT code under the Medicare hospital outpatient prospective payment system to identify how the service or procedure described by the code would be paid. geographic practice cost indices major diagnostic categories payment status indicator minimum data set

payment status indicator

This is the amount collected by the facility for the services it bills. charges reimbursement contractual allowance costs

reimbursement

When the third-party payer returns a claim due to missing, inaccurate, or invalid information, this is called a denied claim. clean claim. rejected claim. unprocessed claim.

rejected claim.

Commercial insurance plans usually reimburse health care providers under some type of __________ payment system, whereas the federal Medicare program uses some type of _________ payment system. retrospective, prospective retrospective, concurrent prospective, concurrent prospective, retrospective

retrospective, prospective

A four-digit code that describes a classification of a product or service provided to a patient is a HCPCS Level II code. CPT code. ICD-10-CM code. revenue code.

revenue code.

The process by which health care facilities and providers ensure their financial viability by increasing revenue, improving cash flow, and enhancing the patient's experience is called patient orientation. revenue cycle management. auditing. accounts receivable.

revenue cycle management.

Under APCs, payment status indicator "T" means significant procedure, not discounted when multiple. clinic or emergency department visit (medical visits). significant procedure, multiple procedure reduction applies. ancillary services.

significant procedure, multiple procedure reduction applies.

Under the APC methodology, discounted payments occur when there are two or more (multiple) procedures that are assigned to status indicator "T." pass-through drugs are assigned to status indicator "K." there are two or more (multiple) procedures that are assigned to status indicator "S." modifier -78 is used to indicatean unplanned return to the operating room by the same physician

there are two or more (multiple) procedures that are assigned to status indicator "T."

When a provider bills separately for procedures that are a part of the major procedure, this is called fraud. discounting. unbundling. packaging.

unbundling.

A bundled payment that covers all services from immediately prior to a surgical procedure through the appropriate post-procedure care period is known as __________. a prospective payment system capitation fee-for-service a global payment

a global payment

Of the following, which is a hospital-acquired condition (HAC)? air embolism breach birth stage I pressure ulcer traumatic wound infection

air embolism

Under APCs, payment status indicator "X" means significant procedure, multiple procedure reduction applies. ancillary services. clinic or emergency department visit (medical visits). significant procedure, not discounted when multiple.

ancillary services.

The following type of hospital is considered excluded when it applies for, and receives, a waiver from CMS. This means that the hospital does not participate in the inpatient prospective payment system (IPPS). psychiatric hospital rehabilitation hospital long-term care hospital cancer hospital

cancer hospital

A Medicare patient was seen by Dr. Zachary, who is a nonparticipating physician. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The Medicare Fee Schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termed as "balance billing," which means that the patient is not financially liable for any amount. financially liable for the Medicare Fee Schedule amount. financially liable for only the deductible. financially liable for charges in excess of the Medicare Fee Schedule, up to a limit.

financially liable for charges in excess of the Medicare Fee Schedule, up to a limit.

CMS adjusts the Medicare Severity DRGs and the reimbursement rates every month. fiscal year beginning October 1. calendar year beginning January 1. quarter.

fiscal year beginning October 1.

The computer-to-computer transfer of data between providers and third-party payers in a data format agreed upon by both parties is called health data exchange (HDE). health information exchange (HIE). HIPAA (Health Insurance Portability and Accountability Act). electronic data interchange (EDI).

electronic data interchange (EDI).

The category "Commercial payers" includes private health insurance companies and Medicare/Medicaid. TriCare. employer-based group health insurers. Blue Cross Blue Shield.

employer-based group health insurers.

Health plans that use ____________ reimbursement methods issue lump-sum payments to providers to compensate them for all the health care services delivered to a patient over a specific period of time for a particular reason. capitation episode of care (EOC) bundled fee-for-service

episode of care (EOC)

The prospective payment system (PPS) requiring the use of DRGs for inpatient care was implemented in 1983. This PPS is used to manage the costs for assisted living facilities. medical homes. inpatient hospital stays. home health care.

inpatient hospital stays.

Under APCs, payment status indicator "C" means significant procedure, multiple procedure reduction applies. significant procedure, not discounted when multiple. ancillary services. inpatient procedures/services.

inpatient procedures/services.

This prospective payment system is for ____________________ and utilizes a Patient Assessment Instrument (PAI) to classify patients into case-mix groups (CMGs). inpatient rehabilitation facilities home health agencies long-term acute care hospitals skilled nursing facilities

inpatient rehabilitation facilities

There are times when documentation is incomplete or insufficient to support the diagnoses found in the chart. The most common way of communicating with the physician for answers is by e-mailing physicians. leaving notes in the chart. calling the physician's office. using established physician query protocols.

using established physician query protocols.

All of the following items are "packaged" under the Medicare ASC payments, EXCEPT for splints and casts. medical supplies. brachytherapy. implanted prosthetic devices.

brachytherapy.

CMS identified Hospital-Acquired Conditions (HACs). Some of these HACs include foreign objects retained after surgery, blood incompatibility, and catheter-associated urinary tract infection. The importance of the HAC payment provision is that the hospital will not receive additional payment for these conditions when they are not present on admission. will not receive additional payment for these conditions when they are present on admission. will receive additional payment for these conditions when they are not present on admission. will receive additional payment for these conditions whether they are present on admission or not.

will not receive additional payment for these conditions when they are not present on admission.

When appropriate, under the outpatient PPS, a hospital can use this CPT code in place of, but not in addition to, a code for a medical visit or emergency department service. CPT Code 50300 (donor nephrectomy) CPT Code 35001 (direct repair of aneurysm) CPT Code 99291 (critical care) CPT Code 99358 (prolonged evaluation and management service)

CPT Code 99291 (critical care)

Which of the following categories of information would NOT prompt the coder to send a query to the provider? Contradictory details Missing detail Financial details Ambiguous details

Financial details

____ is knowingly making false statements or representation of material facts to obtain a benefit or payment for which a lesser amount or no amount at all was actually earned. Fraud Abuse Whistle-blowing Assault

Fraud

Some services are performed by a nonphysician practitioner (such as a physician assistant). These services are an integral yet incidental component of a physician's treatment. A physician must have personally performed an initial visit and must remain actively involved in the continuing care. Medicare requires direct supervision for these services to be billed. This is called "Assistant" billing. "Technical component" billing. "Assignment" billing. "Incident to" billing.

"Incident to" billing.

The operative report stated that a complete hysterectomy was performed. However, within the body of the report, it states a laparoscopic instrument was used. The coder should query the physician with: "What approach was used to perform the hysterectomy?" "How long was the patient on the operating table?" "An open hysterectomy reimburses at a higher rate. Please amend the chart." "Was an open hysterectomy performed?"

"What approach was used to perform the hysterectomy?"

If the Medicare non-PAR approved payment amount is $128.00 for a proctoscopy, what is the total Medicare approved payment amount for a doctor who does not accept assignment, applying the limiting charge for this procedure? $147.20 $143.00 $140.80 $192.00

$147.20

If a participating provider's usual fee for a service is $700.00 and Medicare's allowed amount is $450.00, what amount is written off by the physician? $250.00 $340.00 $391.00 none of it is written off

$250.00

Use the following case scenario to answer the question. A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The non-PAR Medicare fee schedule amount for this service is $190.00. If this physician is a participating physician who accepts assignment for this claim, the total amount of the patient's financial liability (out-of-pocket expense) is $40.00. $30.00. $200.00. $160.00.

$40.00.

Use the following case scenario to answer the question. A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The non-PAR Medicare fee schedule amount for this service is $190.00. If this physician is a nonparticipating physician who does NOT accept assignment for this claim, the total amount of the patient's financial liability (out-of-pocket expense) is $190.00. $152.00. $38.00. $66.50.

$66.50.

The limiting charge is a percentage limit on fees specified by legislation that the nonparticipating physician may bill Medicare beneficiaries above the non-PAR fee schedule amount. The limiting charge is 15%. 20%. 50%. 10%

15%.

Use the following case scenario to answer the question. A patient with Medicare is seen in the physician's office. The total charge for this office visit is $250.00. The patient has previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00. The patient is financially liable for the coinsurance amount, which is 20%. 100%. 80%. 15%.

20%.

The prospective payment system used to reimburse hospitals for Medicare hospital outpatients is called APCs. APGs. RBRVS. MS-DRGs.

APCs.

Based on CMS's DRG system, other systems have been developed for payment purposes. The one that classifies the non-Medicare population, such as HIV patients, neonates, and pediatric patients, is known as RDRGs. IR-DRGs. AP-DRGs. APR-DRGs.

APR-DRGs.

Currently, which prospective payment system is used to determine the payment to the "physician" for physician services covered under Medicare Part B, such as outpatient surgery performed on a Medicare patient? MS-DRGs RBRVS ASC PPS APCs

ASC PPS

Which of the following statements is FALSE regarding the use of modifiers with the CPT codes? Some procedures may require more than one modifier. Modifiers are appended to the end of the CPT code. Not all procedures need a modifier. All modifiers will alter (increase or decrease) the reimbursement of the procedure.

All modifiers will alter (increase or decrease) the reimbursement of the procedure.

This patient is a 55-year-old male, known to me for several years. He is here, today, for his annual physical examination. Vitals are of concern, as he is showing an elevated blood pressure (152/92 mm Hg) and his weight is 50 pounds over where it should be. Patient complained that he has been feeling sluggish and fatigued more often than not. Patient stated that he has been taking his BP medication and believes that he sleeps well. However, the patient shares that his wife has been complaining recently about his loud snoring and told him that he appears to be breathing irregularly when asleep. I am recommending that he go through diagnostic testing for suspected obstructive sleep apnea (OSA). Why should you query this physician and what would you ask? Ambiguous information: Was the wife's assessment accurate? Missing detail: Does the patient have OSA or not? Contradictory information: Does the patient have elevated BP or hypertension? Missing detail: Does the patient have OSA or not?

Contradictory information: Does the patient have elevated BP or hypertension?

______ classifies inpatient hospital cases into groups that are expected to consume similar hospital resources. MAC CMS IPPS DRG

DRG

HIPAA administrative simplification provisions require all of the following code sets to be used EXCEPT CPT. ICD-10-CM. DSM. CDT.

DSM.

This data is used because it provides a uniform system of identifying procedures, services, or supplies. Multiple columns can be available for various financial classes. revenue code HCPCS/CPT code charge/service code general ledger key

HCPCS/CPT code

The term "hard coding" refers to ICD-10-CM/ICD-10-PCS codes that are coded by the coders. HCPCS/CPT codes that appear in the hospital's chargemaster and will be included automatically on the patient's bill. ICD-10-CM/ICD-10-PCS codes that appear in the hospital's chargemaster and that are automatically included on the patient's bill. HCPCS/CPT codes that are coded by the coders.

HCPCS/CPT codes that appear in the hospital's chargemaster and will be included automatically on the patient's bill.

The following coding system(s) is/are utilized in the Inpatient Psychiatric Facilities (IPFs) prospective payment methodology for assignment and proper reimbursement. revenue codes both HCPCS/CPT codes and ICD-10-CM/ICD-10-PCS codes HCPCS/CPT codes ICD-10-CM/ICD-10-PCS codes

ICD-10-CM/ICD-10-PCS codes

The following coding system(s) is/are utilized in the MS-DRG prospective payment methodology for assignment and proper reimbursement. NPI codes ICD-10-CM/ICD-10-PCS codes HCPCS/CPT codes both HCPCS/CPT codes and ICD-10-CM/ICD-10-PCS codes

ICD-10-CM/ICD-10-PCS codes

A 41-year-old woman presented to Dr. Morrison, her rheumatologist, with active bilateral synovitis in her hands, wrists, and ankles, and nodules on her left elbow. X-ray revealed small erosions in both feet. She was subsequently diagnosed with moderate rheumatoid arthritis (RA) and started on methotrexate (MTX) at 10 mg/week, which was then increased to 15 mg/week. To avoid an unspecified code, what question should be queried to the physician: How long has the RA been present? In which joint or joints is the RA present? Would you describe the patient's condition as rheumatoid polyneuropathy? If you add she had a rash, we can report Still's disease.

In which joint or joints is the RA present?

This information is published by the Medicare Administrative Contractors (MACs) to describe when and under what circumstances Medicare will cover a service. The ICD-10-CM, ICD-10-PCS, and CPT/HCPCS codes are listed in the memoranda. OSHA (Occupational Safety and Health Administration) SI/IS (Severity of Illness/Intensity of Service Criteria) LCD (Local Coverage Determinations) PEPP (Payment Error Prevention Program)

LCD (Local Coverage Determinations)

This prospective payment system replaced the Medicare physician payment system of "customary, prevailing, and reasonable (CPR)" charges whereby physicians were reimbursed according to their historical record of the charge for the provision of each service. Medicare Physician Fee Schedule (MPFS) Global payment Medicare Severity-Diagnosis Related Groups (MS-DRGs) Capitation

Medicare Physician Fee Schedule (MPFS)

The ________________________ refers to a statement sent to the patient to show how much the provider billed, how much Medicare reimbursed the provider, and what the patient must pay the provider. Medicare Summary Notice coordination of benefits remittance advice Advance Beneficiary Notice

Medicare Summary Notice

A patient is admitted to the hospital for a coronary artery bypass surgery. Postoperatively, he develops a pulmonary embolism. The present on admission (POA) indicator is W = provider is unable to clinically determine if condition was present at the time of admission. N = not present at the time of inpatient admission. U = documentation is insufficient to determine if condition was present at the time of admission. Y = present at the time of inpatient admission.

N = not present at the time of inpatient admission.

This program, formerly called CHAMPUS (Civilian Health and Medical Program-Uniformed Services), is a health care program for active members of the military and other qualified family members. Indian Health Service TRICARE CHAMPVA workers' compensation

TRICARE

This is a 10-digit, intelligence-free, numeric identifier designed to replace all previous provider legacy numbers. This number identifies the physician universally to all payers. This number is issued to all HIPAA-covered entities. It is mandatory on the CMS-1500 and UB-04 claim forms. National Provider Identifier (NPI) National Practitioner Data Bank (NPD) Universal Physician Number (UPN) Master Patient Index (MPI)

National Provider Identifier (NPI)

____ are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients. Potential compensable events Never events or sentinel events Misadventures Adverse preventable events

Never events or sentinel events

The prospective payment system used to reimburse home health agencies for patients with Medicare utilizes data from the MDS (Minimum Data Set). OASIS (Outcome and Assessment Information Set). UHDDS (Uniform Hospital Discharge Data Set). UACDS (Uniform Ambulatory Core Data Set).

OASIS (Outcome and Assessment Information Set).

This initiative was instituted by the government to eliminate fraud and abuse and recover overpayments, and involves the use of ______________. Charts are audited to identify Medicare overpayments and underpayments. These entities are paid based on a percentage of money they identify and collect on behalf of the government. Clinical Data Abstraction Centers (CDAC) Medicare Code Editors (MCE) Recovery Audit Contractors (RAC) Quality Improvement Organizations (QIO)

Recovery Audit Contractors (RAC)

The medical coder's query stated, "Dr. Jones, I noticed that the patient has had elevated blood pressure during his last three visits. Shouldn't he be diagnosed with hypertension and prescribed medication?" What do you observe about this query? The query should state the specific medication. The coder correctly suggests the physician prescribe a medication in the query. The query is leading Dr. Jones to a conclusion. The query should suggest specific diagnoses since the patient had elevated blood pressure for the last 3 visits.

The query is leading Dr. Jones to a conclusion.

The nursing initial assessment upon admission documents the presence of a decubitus ulcer. There is no mention of the decubitus ulcer in the physician documentation until several days after admission. The present on admission (POA) indicator is U = documentation is insufficient to determine if condition was present at the time of admission. W = provider is unable to clinically determine if condition was present at the time of admission. Y = present at the time of inpatient admission. N = not present at the time of inpatient admission.

U = documentation is insufficient to determine if condition was present at the time of admission.

The coder issued a query to the physician, asking, "Did you mean to state the patient's retinopathy was caused by her type 2 diabetes mellitus?" The proper way to ask this is: What caused her diabetes mellitus? What caused her retinopathy? When was she diagnosed with diabetes mellitus? Does the patient have renal disease?

What caused her retinopathy?

The query asked, "Do you agree that the edema in the patient's legs were caused by his previous diagnosis of malnutrition?" A legal version of this question would be: Please add to the documentation the connection between the edema and the patient's nutrition. Did the malnutrition cause the patient's edema? Lower extremity bilateral edema is usually caused by malnutrition. Do you agree? What is the cause of the patient's edema?

What is the cause of the patient's edema?

A patient is admitted for a diagnostic workup for cachexia. The final diagnosis is malignant neoplasm of lung with metastasis. The present on admission (POA) indicator is Y = present at the time of inpatient admission. N = not present at the time of inpatient admission. U = documentation is insufficient to determine if condition was present at the time of admission. W = provider is unable to clinically determine if condition was present at the time of admission.

Y = present at the time of inpatient admission.

A patient undergoes outpatient surgery. During the recovery period, the patient develops atrial fibrillation and is subsequently admitted to the hospital as an inpatient. The present on admission (POA) indicator is W = provider is unable to clinically determine if condition was present at the time of admission. U = documentation is insufficient to determine if condition was present at the time of admission. N = not present at the time of inpatient admission. Y = present at the time of inpatient admission.

Y = present at the time of inpatient admission.

A 47-year-old female came for an initial appointment with a neurologist, Dr. Libby. She was diagnosed with relapsing-remitting multiple sclerosis (RRMS) two years ago. She states that she was initially diagnosed after experiencing acute blurred vision and pain in her left eye, urinary incontinence, and numbness in her arms and legs on several occasions. Her primary care physician ordered a magnetic resonance imaging (MRI) which revealed several demyelinating lesions in the right frontal cerebral white matter as well as her cervical spinal cord. She expressed that, over the last year, she has had acute attacks which were treated with corticosteroids by her primary care physician. At this time, I am prescribing interferon (IFN)β-1a (30 mcg weekly by IM injection) as a long-term disease-modifying therapy. Based on this, I suspect progressive multifocal leukoencephalopathy (PML), and want to perform a lumbar tap to analyze her cerebrospinal fluid using a quantitative polymerase chain reaction (PCR) assay. A query sent to Dr. Libby asked if the PML was a new diagnosis, a differential diagnosis, or a replacement diagnosis. Was this a legal query? No, because no one can question a physician about his or her diagnosis. No, because the query should always be open-ended. Yes, because the question enables coding at a higher level. Yes, because there is no influence presented.

Yes, because there is no influence presented.

A 33-year-old male went to his primary care physician (PCP) with heartburn-like symptoms including reflux, disturbed sleep, and elevated blood pressure. Upon questioning, the PCP asked about alcohol consumption. At first, he denied any, then admitted to drinking half to 1 bottle of scotch per night roughly 4 times a week. He stated that he usually drinks 3 bottles a week and commented that consumption occurs late at night and does not interfere with his work responsibilities. Do you need to query the physician? Yes, there needs to be a treatment plan. Yes, there needs to be a diagnostic statement. Yes, there needs to be information about a follow-up appointment. No. All the needed information is here.

Yes, there needs to be a diagnostic statement.

When the MS-DRG payment received by the hospital is lower than the actual charges for providing the inpatient services for a patient with Medicare, then the hospital absorbs the loss. can bill Medicare for the difference. makes a profit. can bill the patient for the difference.

absorbs the loss.

When a provider, knowingly or unknowingly, uses practices that are inconsistent with accepted medical practice and that directly or indirectly result in unnecessary costs to the Medicare program, this is called unbundling. fraud. hypercoding. abuse.

abuse.

Changes in case-mix index (CMI) may be attributed to all of the following factors EXCEPT changes in coding productivity. changes in support staff composition. changes in medical staff composition. changes in services offered.

changes in coding productivity.

In a hospital, a document that contains a computer-generated list of procedures, services, and supplies, along with their revenue codes and charges for each item, is known as a(n) encounter form. chargemaster. revenue master. superbill.

chargemaster.

Accounts receivable (A/R) refers to claims for which money has not yet come in. the amount the hospital was paid. claims for which money has been received. denials that have been returned to the hospital.

claims for which money has not yet come in.

The Correct Coding Initiative (CCI) edits contain a listing of codes under two columns titled "comprehensive codes" and "component codes." According to the CCI edits, when a provider bills Medicare for a procedure that appears in both columns for the same beneficiary on the same date of service, code only the component code. do not code either one. code only the comprehensive code. code both the comprehensive code and the component code.

code only the comprehensive code.

If a query is submitted to the provider, and the coder receives no response within 5 days to a week, the coder should: contact the HIM Director to refer to the Medical Director. code whatever you can and move on. phone the physician every day until a response is provided. tell the CEO of the hospital.

contact the HIM Director to refer to the Medical Director.

Regardless of how much is charged, this is the maximum amount the third-party will pay. contractual allowance costs reimbursement customary

contractual allowance

The Review of Systems states, "No inflammation of the bronchioles". The patient was treated with a Croup Tent. The Assessment/Diagnosis line of this chart states, "Bronchiolitis". This is a problem due to ______ documentation. ambiguity inaccuracy missing information contradictory

contradictory

The question or questions in a query must be written to be: open-ended. close-ended. multiple-choice. either open-ended or multiple choice.

either open-ended or multiple choice.

Under the inpatient prospective payment system (IPPS), there is a 3-day payment window (formerly referred to as the 72-hour rule). This rule requires that outpatient preadmission services that are provided by a hospital up to three calendar days prior to a patient's inpatient admission be covered by the IPPS MS-DRG payment for diagnostic services. therapeutic (or nondiagnostic) services whereby the inpatient principal diagnosis code (ICD-10-CM) does not match the code used for preadmission services. diagnostic and therapeutic services whereby the inpatient principal diagnosis code (ICD-10-CM) exactly matches the code used for preadmission services. therapeutic (or nondiagnostic) services whereby the inpatient principal diagnosis code (ICD-10-CM) exactly matches the code used for preadmission services.

diagnostic and therapeutic services whereby the inpatient principal diagnosis code (ICD-10-CM) exactly matches the code used for preadmission services.

When payments can be made to the provider by EFT, this means that the reimbursement is sent to the provider by check. combined with all other payments from the third-party payer. directly deposited into the provider's bank account. sent to the patient, who then pays the provider.

directly deposited into the provider's bank account.

The DNFB report includes all patients who have been discharged from the facility but for whom, for one reason or another, the billing process is not complete. DNFB is an acronym for _____________. diagnosis not finally balanced discharged no final bill days not fiscally balanced dollars not fully billed

discharged no final bill

The following services are excluded under the Hospital Outpatient Prospective Payment System (OPPS) Ambulatory Payment Classification (APC) methodology. surgical procedures clinic/emergency visits radiology/radiation therapy durable medical equipment

durable medical equipment

This information is used to assign each item to a particular section of the general ledger in a particular facility's accounting section. Reports can be generated from this information to include statistics related to volume in terms of numbers, dollars, and payer types. charge/service code HCPCS code revenue code general ledger key

general ledger key

In calculating the fee for a physician's reimbursement, the three relative value units are each multiplied by the cost of living index for the particular region. national conversion factor. usual and customary fees for the service. geographic practice cost indices.

geographic practice cost indices.

These are financial protections to ensure that certain types of facilities (e.g., children's hospitals) recoup all of their losses due to the differences in their APC payments and the pre-APC payments. hold harmless pass through limiting charge indemnity insurance

hold harmless

What prospective payment system reimburses the provider according to determined rates for a 60-day episode of care? home health resource groups long-term care Medicare severity diagnosis-related groups inpatient rehabilitation facility the skilled nursing facility prospective payment system

home health resource groups

State Medicaid programs are required to offer medical assistance for individuals with qualified financial need. patients with end-stage renal disease. patients with a permanent disability. all individuals age 65 and over.

individuals with qualified financial need.

When a patient is discharged from the inpatient rehabilitation facility and returns within three calendar days (prior to midnight on the third day) this is called a(n) qualified discharge. transfer. interrupted stay. per diem.

interrupted stay.

This information provides a narrative name of the services provided. This information should be presented in a clear and concise manner. When possible, the narratives from the HCPCS/CPT book should be utilized. revenue code HCPCS general ledger key item/service description

item/service description

Under Medicare, a beneficiary has lifetime reserve days. All of the following statements are true, EXCEPT lifetime reserve days are not renewable, meaning once a patient uses all of their lifetime reserve days, the patient is responsible for the total charges. the patient has a total of 60 lifetime reserve days. lifetime reserve days are usually reserved for use during the patient's final (terminal) hospital stay. lifetime reserve days are paid under Medicare Part B.

lifetime reserve days are paid under Medicare Part B.

LCDs and NCDs are review policies that describe the circumstances of coverage for various types of medical treatment. They advise physicians which services Medicare considers reasonable and necessary and may indicate the need for an advance beneficiary notice. They are developed by the Centers for Medicare and Medicaid Services (CMS) and Medicare Administrative Contractors. LCD and NCD are acronyms that stand for local contractor's decisions and national contractor's decisions. local covered determinations and noncovered determinations. local coverage determinations and national coverage determinations. list of covered decisions and noncovered decisions.

local coverage determinations and national coverage determinations.

The term used to indicate that the service or procedure is reasonable and necessary for the diagnosis or treatment of illness or injury consistent with generally accepted standards of care is benchmarking. medical necessity. evidence-based medicine. appropriateness.

medical necessity.

A Medicare Summary Notice (MSN) is sent to ________ as their EOB. physicians patients (beneficiaries) skilled nursing facilities hospitals

patients (beneficiaries)

Coinsurance payments are paid by the _______ and determined by a specified percentage. facility physician third-party payer patient (insured)

patient (insured)

Under the RBRVS, each HCPCS/CPT code contains three components, each having assigned relative value units. These three components are geographic index, wage index, and cost of living index. fee-for-service, per diem payment, and capitation. physician work, practice expense, and malpractice insurance expense. conversion factor, CMS weight, and hospital-specific rate.

physician work, practice expense, and malpractice insurance expense.

Under an FFS payment methodology, reimbursement would be determined by ___ reported on the claim. OASIS procedure codes diagnosis codes POA Indicator

procedure codes

The documentation under History of Present Illness [HPI] states, "The patient denies any sore throat or coughing." In the last paragraph, under Plan, it states "The patient was given a prescription for Tessalon." Tessalon is a cough suppressant. The coder should: query the physician about the contradiction. query the physician to amend the notes to include report of a cough. code a chronic cough. code an adverse reaction to Tessalon.

query the physician about the contradiction.

The documentation stated that a biopsy was performed. The coder should: query the physician to ask what approach was used. code a fine needle biopsy. code an excision or biopsy. code an incision.

query the physician to ask what approach was used.

The physician documented that he had not seen this patient in his office in "quite a while", but there are no previous records available. Before determining the evaluation and management (E/M) code, the coder must: report 99499 Unlisted evaluation and management service. report the visit as a Consultation. query the physician to document the date of the patient's previous visit. query the physician to document the patient was a New Patient.

query the physician to document the date of the patient's previous visit.

The physician excised a lesion from the patient's left arm with a simple closure. To report this accurately, the coder should: query the physician to document how the defect was closed. query the physician to note the patient's age. query the physician to document the excised diameter of the lesion. report the code for a simple repair.

query the physician to document the excised diameter of the lesion.

A HIPPS (Health Insurance Prospective Payment System) code is a five-character alphanumeric code. A HIPPS code is used by home health agencies (HHA) and ____. physical therapy (PT) centers and inpatient rehabilitation facilities (IRFs) ambulatory surgery centers (ASCs) and physical therapy (PT) centers ambulatory surgery centers (ASCs) and skilled nursing facilities (SNFs) skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs)

skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs)