MIBMS Test Review

52 terms by KellieB

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Step by Step Ch 13 & 16 Next Step Ch 2 Case Studues

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?

Infusion

What must always be documented in the patients record and is the major billing factor for a Psychiatric subsection?

Time.

Outpatient dialysis services are billed on the basis of?

Monthly.

What is the name of the process that routes the blood including waste products outside the body through filters?

Hemodialysis.

What is the name of the of the dialysis that involves using a body cavity as a filter?

Peritoneal.

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______

noninvasive.

What is being measured while sleep testing is being conducted?

Parameters.

What does the abbreviation EMG stand for?

Electromyographic.

On what basis are the dermatology codes usually used by the dermatologist who sees patients in the office.

Consultation.

HCPCS are not used in what setting?

Inpatient

What would you use to code drugs

J codes

IT

Intrathecal

IV

Intravenous

IM

Intramuscular

SC

Subcutaneous

IHN

Inhalant Solution

VAR

Various Routes

OTH

Other Routes

What edition of the Federal Registry would hospital facilitites be especially interested in?

October

What edition of the Federal Registry would outpatient facilities be especially interested in?

November or December

Who is the largest third party biller?

American Goverment

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?

Yale, 1960's

What was the state that first used the DRGs on a large scale?

New Jersey

What is the total number of MDCs?

Twenty Five

The creation of the QIO (formerly the PRO) was made possible under a provision of what act 1982?

TEFRA

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?

75%

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)

Peritoneal Dialysis

Pertaining to the peritoneum (membrane surrounding the abdomen),the process of using an artificial kidney to filter waste materials from the body

Hemodialysis

dialysis of the blood to remove toxic substances or metabolic wastes from the bloodstream

MACs

Medicare Administrative Contractors

DHHS

Department of Health and Human Services

CMS

Center for Medicare and Medicaid Services, delegates daily operations to MACs

QIO

Quality Improvement Organization

Participating QIO providers recieve _____% more than non providers.

5

MS-DRG

Medicare Severity Diagnosis Related Groups, implemented in 1983.

PPS

prospective payment system

How many "Major Diagnostic Catergories" (MDC) are there?

25

RBRVS

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

RVU

Relative value units

OPPS

OUTPATIENT PROSPECTIVE PAYMENT SYSTEM ,Prospective payments system implemented by CMS that provides reimubursement for hospital outpatient settings, APC, Implemented in 2000

APC

AMBULATORY PAYMENT CLASSIFICATION

OIG

Office of the Inspector General

Kickbacks

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

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