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MDA 121 Study Guide
| Question | Answer |
|---|---|
| 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
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