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MDA 121 Study Guide

6 reasons that would deny or hold up ins. Carrier Wrong date missing date, dx not supporting procedure, coding errors, patient ineligible, wrong carrier billed, coding or dates not compatible with documentation
What does choledocholithiasis mean Stones in the bile duct
-rrhexis Rupture
How long a ICD10 codes 3-7
Upcoding Increase a CPT code to receive higher reimbursements
How many levels are there in the E&M sections 5
Where can I find and E&M code The CPT code book
Healthcare professionals who may provide care sit on what's committee Utilization Review committee. URC
When a person is referred to a specialist, what do you need to obtain first Authorization
Does Medicare B cover preventative services? Yes. Medically necessary ones too
Factory to use when determining the correct E&M codes Place, type of service and patient status
What happens when a patient signs the assignment of benefits block on the insurance claim form The payment goes to the provider
When looking for a ICD code, you find the. Sin term in the alphabetic index then what? Cross reference code in tabular list.
According to what is medically necessary, what do you need to do in order to get services covered? Diagnose and treat
Coding in the ICD book, what do you look up first? The condition, then location
Why are E&M codes in the front Most commonly used
How many excludes notes in ICD-10CM 2
Which coding system uses a five letter alph-numeric format that begin with letters A-V and addresses services not covered in the CPT codes, such as pharmaceuticals, supplies and ambulance services? HCPCS
Tell me about ICD-9 Divided in 3 volumes, has fewer codes than 10, first digit can be alpha or numeric
X as a placeholder is for what? Future expansion
Which reimbursement form can be mostly filled out using the EHR? CMS 1500
What does a patient need to do before doctors office sends out claim form to the ins. Co.? ROI. Because sometimes the offices needs to send out chart notes
Where is case management covered? E&M section of the CPT code book
Perks of a PAR provider? Direct reimbursement, free advertising, 800 numbers...
The words problem focused, expanded problem focused, detailed, and comprehensive talk about? History and physical examination
Created by: Kbowers