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INCO 213 and 220

Final Exam questions

QuestionAnswer
Category II Codes Optional CPT codes that track performance measures for a medical goal such as reducing tobacco use.
What are level I HCPCS codes? CPT Codes. American Medical Association Current Procedural Terminology
What is a nonessential modifier? Terms in parentheses that follow main terms. Supplementary words that may or may not be present in the diagnostic or procedural statement without affecting the code number to which it is assigned
When you have words such as probable, suggested, and rule out- does it matter what setting those are used in? Yes, it should be inpatient only
Can our chapter 20 external causes of morbidity be used as primary or principal diagnosis? FALSE
How do you report vaccines and immunizations? What codes are used? They are coded using CPT codes in the Medicine section. J codes are used.
What are category III codes? Temporary set of codes for emerging technologies, services, and procedures.
Where are your CPT guidelines located? Dispersed throughout the book
What are our three functions of ICD regarding insurance purposes? justifies procedures, medical necessity, measures health care quality of physician
Know the three volumes of ICD 10. tabular list (1), alphabetic index (2), and PCS (3)
Who created ICD 10? WHO
What does the excludes 1 note mean? Not coded here
Which insurance plans accept HCPCS II codes? Insurance carriers do not pay them
What does the acronym HCPCS II stand for? Healthcare Common Procedure Coding System Level 2
What does HPI stand for? What is it? History of Present Illness
What are anesthesia qualifying circumstances? Factors such as extreme age, extraordinary condition of the patient, and unusual risk factors which may affect the anesthesia services
What are anesthesia physical status modifiers? Indicates the physical status of the patient
How many alphanumeric characters are in an ICD code? 10 (Max)
Who developed ICD 10? World Health Organization (WHO)
What was the compliant date for ICD 10? 10-1-15
What are preventive services? Shots/screening tests that help prevent things
When is a deductible paid? Paid before a health plan’s payment begins
3. Patient’s medical records must document what elements? Documentation of patients’ conditions, treatments, and tests.
4. What is an encounter? Visit between a patient and a medical professional
5. What is HIPAA? Health insurance portability and accountability act. Health Insurance Portability and Accountability Act
6. What is the definition of a new patient? Patient who has not seen a provider within the past three years
7. What information is important to collect from a new patient? Name, phone, address, DOB, M/F, complaint, information about previous treatment, if insured, the name of the health plan and whether a copay or coinsurance payment at the time of service, is required, if referred, the name of the referring physician.
8. What is tertiary insurance? Third insurance plan
9. How many alphanumeric digits are in an ICD 10 code? 10
10. Regarding ICD 10, what is our alphabetic index? List of ICD terms in alphabetic order
11. What is our tabular index? Expanded instructions in back of ICD for main terms and selecting the correct one
12. What is a placeholder “x” digit mean? Fills in empty characters to allow for future expansion if needed.
13. What are level 1 HCPCS codes? CPT
14. Are HCPCS level 2 codes alphanumeric, numeric? 5 digits long, first is alpha then last 4 are numeric
16. Know key elements in E/M coding. History, medical decision making, exam
18. Is routinely waiving deductibles/copayments legal? No, it is illegal
19. What are CCI code edits? Correct Coding Initiative
20. Global Surgery Days. 0-10 or 90 days. Each CPT code is assigned a global period of 0, 10, or 90. Major procedures are 90 days. Minor are 0-10.
21. Maximum charge. Allowed charge, maximum allowable fee, or allowed amount
22. The current paper claim approved by the NUCC is the CMS 1500 (02-12).
23. What is a referring physician? Physician who has seen the patient and needs to be identified as referring provider
24. How many diagnosis codes can be reported on the HIPAA 837? Up to 12
25. What are claim scrubbers? Software that checks claims to permit error correction
26. What are stop loss provisions? Protection against the risk of large losses or severely adverse claims experience
27. What is the best method for determining patient eligibility? EMEVS or by using the card to check if it is still running
28. What percentage is the coinsurance for Medicare part B? 20%
29. What is LCD? Local Coverage Determination
30. What is an MSN? Explanation of Medicare benefits
31. What is a spend down program? Beneficiaries are required to pay part of their monthly expenses
32. How often should Medicaid eligibility be checked? Every appointment, each time it is made
34. What is Medicaid known as? Payer of last resort
35. What should be checked on the military ID card to confirm validity? Expiration date
36. What is the Tricare term for coinsurance? cost share
37. What is OSHA? Protects workers from health and safety risks on the job. Stands for Occupational Safety and Health Administration
38. At what level of government are worker’s comp programs administered? state
39. What is the physician of record? Physician who first treats the injured or ill employee
40. What is the first report of injury? Document that must be filed with state when a provider initially examines a workers comp patient
41. What is a determination in regards to a claim? Decision whether to pay, deny, or pay at reduced level
42. What is adjudication? The process followed by health plans to examine claims and determine benefits
43. What is concurrent care? Medical assistance given to a patient who receives independent care from two or more physicians on the same date
44. What is an RA? Remittance Advice. Document describing a payment resulting from a claim adjudication.
45. What is COB? Coordination of benefits. Explains how an insurance policy will pay if more than one policy applies
46. What is an insurance aging report? Report grouping unpaid claims transmitted to payers by the length of time they remain due
47. What is a medical necessity denial? Refusal by a plan to pay for a procedure that does not meet its medical necessity criteria
48. What is a patient statement? A report that show the services provided to a patient, total payments made, total charges, adjustments, and balance due.
49. What is a day sheet? In a medical office, a report that summarizes the business day’s charges and payments, drawn from all the patient ledgers for the day
50. What is embezzlement? Theft of funds by an employer or contractor
51. What are collections? Step 10
52. What are collection agencies? Outside firm hired to collect overdue payments from patients
53. What is FACTA? Fair and Accurate Credit Transaction Act. Law designed to modify the fair credit reporting act to protect the accuracy and privacy of credit reports.
54. What is FCRA? Fair credit reporting act. Law requiring consumer reporting agencies to have reasonable and fair procedures to protect both consumers and business users of the reports.
55. What is FDCPA? Fair Debt Collection Practices Act of 1977. Laws regulating collection processes.
56. What is skip tracing? Process of locating a patient who has not paid on an outstanding balance.
57. What is bad debt? An account deemed uncollectible.
58. What is bankruptcy? Legal declaration that a person is unable to pay his or her debts.
59. How many years do records need to be kept to meet HIPAA compliance? At least 6 years from date of creation or when it was last in effect, whichever is later.
60. What setting is ambulatory care provided in? Outpatient
61. What is the definition of an emergency in medical terms? A situation in which a delay in the treatment of the patient would lead to a significant increase in the threat to life or a body part.
62. What is HHA? . Home Health Agency. Organization that provides home care services to patients.
63. What is a SNF? Skilled nursing facility. Healthcare facility in which licensed nurses provide nursing and/or rehabilitation services under a physician’s direction.
64. What is hospice care? Palliative care for people with terminal illnesses.
65. What is the definition of an inpatient status? A person admitted to a medical facility for services that require a stay over two midnights.
66. Who is the attending physician? Clinician primarily responsible for the care of the patient from the beginning of a hospitalization.
67. What is a charge master? Hospital’s list of the codes and charges for its services.
68. What is HIM? Health Information Management. Hospital department that organizes and maintains patient medical records; also a profession devoted to managing, analyzing, and utilizing data vital for patient care, making the data accessible to healthcare providers.
69. What are comorbidities? Admitted patient’s coexisting condition that affects the length of the hospital stay or the course of treatment.
70. What is a complication? Condition an admitted patient develops after surgery or treatment that affects the length of hospital stay or the course of further treatment.
Know difference of inpatient/outpatient diagnosis: which can be questionable/suspected/probable? 71. Inpatient can and outpatient cannot.
On that date, the inpatient facility coders started using ICD-10-PCS system. 10-1-15
What does POA stand for in diagnosis coding? Present on admission. Indicator required by Medicare that identifies whether a coded condition was present at the time of hospital admission.
What is DRG? Diagnosis-related groups. A system of analyzing conditions and treatments for similar groups of patients used to establish Medicare fees for hospital inpatient services.
Used to report Medicare part A. The HIPAA 837I or the UB O4 are
What is the admitting diagnosis? ADX. The patient’s condition determined by a physician at admission to an inpatient facility.
What is our principal diagnosis? In inpatient coding, the condition that after study is established as chiefly responsible for a patient’s admission to a hospital.
Created by: hyruleprincess93