If an established patient is given an immunization at an office visit, and the only service provided was an immunization, what type of codes would you use to report the service?
A medicine section immunization code, and a admiistration code.
What word is used to describe the pushing of liquid into the body over a long period of time?
What must always be documented in the patients record and is the major billing factor for a Psychiatric subsection?
Outpatient dialysis services are billed on the basis of?
What is the name of the process that routes the blood including waste products outside the body through filters?
What is the name of the of the dialysis that involves using a body cavity as a filter?
What is the name of the procedure that is performed to check the intraocular pressure of the eye?
Tonometry or Tomography
The Cardivascular subsection contains many diagnosis and therapeutic procedures and services that are primarily divided as to whether the procedures or services are invasive or______
What is being measured while sleep testing is being conducted?
What does the abbreviation EMG stand for?
On what basis are the dermatology codes usually used by the dermatologist who sees patients in the office.
HCPCS are not used in what setting?
What would you use to code drugs
What edition of the Federal Registry would hospital facilitites be especially interested in?
What edition of the Federal Registry would outpatient facilities be especially interested in?
November or December
Who is the largest third party biller?
What goverment organization is responsible for administering the Medicare program?
Centers for Medicare and Medicaid Services (CMS)
What are the 3 items Medicare beneficiaries are responsible to pay before Medicare will begin to pay for services?
deductibles, premiums, & coininsurance
Where and when were DRGs first developed?
What was the state that first used the DRGs on a large scale?
What is the total number of MDCs?
The creation of the QIO (formerly the PRO) was made possible under a provision of what act 1982?
What is the name of the document that is produced by CMS that defines the type and number of health records that must be reviewed for a patient record?
Scope of work
A complication is defined as a condition that increases the patient's length of stay in the hospital by atleast 1 day in atleast what percent of cases?
Medicare funds are collected by whom?
Social Security Administration
What are the 3 goals of a Physician Payment Reform?
Decrease Medicare expenditures, Re-Distribute physicians payments more equitibly, Ensure quality health care at a reasonable rate.
What are 3 components of the Relative value unit?
Work, Overhead, Malpractice.
What are 3 types of persons eligible for Medicare?
Elderly, Disabled by Social Security Administration and Renal Failure patients (ESRD)
Pertaining to the peritoneum (membrane surrounding the abdomen),the process of using an artificial kidney to filter waste materials from the body
dialysis of the blood to remove toxic substances or metabolic wastes from the bloodstream
Medicare Administrative Contractors
Department of Health and Human Services
Center for Medicare and Medicaid Services, delegates daily operations to MACs
Quality Improvement Organization
Participating QIO providers recieve _____% more than non providers.
Medicare Severity Diagnosis Related Groups, implemented in 1983.
prospective payment system
How many "Major Diagnostic Catergories" (MDC) are there?
Resource-Based Relative Value Scale, fee schedule based on relative value of resources that physcians spend to provide services to medicare patients , implemented in 1992
Relative value units
OUTPATIENT PROSPECTIVE PAYMENT SYSTEM ,Prospective payments system implemented by CMS that provides reimubursement for hospital outpatient settings, APC, Implemented in 2000
AMBULATORY PAYMENT CLASSIFICATION
Office of the Inspector General
Bribe or rebate for referring patient for any service covered by Medicare, any personal gains
Fines for Kickbacks
$25,000.00 or 5 yrs in jail or Both