Level I HCPCS codes
the 5 digit CPt codes used to report services performed by health care providers are referred to as:
HCPCS was developed in order to achieve all of the following goals:
allowing providers & suppliers to communicate their services in a consistient manner, ensuring the validity of profiles & fee schedules through standardized coding, & coordinating goverment programs by uniform application of the Center for medicare & medicaid Services policies.
If a medical office assistant wanted to find the code for prosthetic procedures, they would find it in the:
Level II HCPCS code book.
Level II HCPCS codes would include all of the following:
dental procedures, ambulance services, & medical & surgical supplies.
The National Panal that maintains Level II HCPCS codes includes represenatives from:
the Blue Cross/Blue Sheild Association, The Centers for Medicare & Medicaid Services & the Health Insurance Association of America.
If a medical office assistant wanted to find the code for a new procedure, they would find it in the:
Level III codebook.
To identify that a procedure was preformed on the left hand thumb, the medical office assistant would select the modifier:
The HCPCS modifier GA indicates:
an advanced beneficiary notice has been signed by the patient, a waiver of liability statement is on file, & the procedure billed may not be covered by Medicare.
The written notification that must be signed by a medicare patient as a warning that a services may not be medically necessary is called a:
advanced beneficiary notice
Inaccurate coding & incorrect billing can result in:
prison sentences, delays in receiving payments, & loss of the providers license to practice medicine.
When each reported service is connected to a diagnosis that supports the procedure as necessary, the claim is referred to as:
Services can be denied for all of the following reasons:
there is a cap on the number of services allowed, the procedure is considered expermental, & the service was not preformed at an appropriate location.
THe act that prohibits submitting a fraudulent claim or making a false statement in connection with a claim is called:
Federal Civil False Claims Act
Individuals suspected of medical fraud & abuse can be investicated & prosecuted by all of the following:
Office of Inspector General (OIG), Federal Bureau of Investigation (FBI), & U.S. Department of Justice.
The Healthcare Fraud & Abuse Control Program was created by the:
Health Insurance Portability & Accountability Act (HIPPA)
In physical therapy cases, if a coder bills for supervised attendance:
one-on-one direct contact is not required by the provider.
The Stark Law was enacted to govern the practice of:
physician refferals to medical facilities in which they have a financial interest.
Using a procedure code that provides a higher reimbursement rate than the code that actually reflects the services provided is referred to as:
Billing the parts of a bundled procedure as separate procedures for higher reimbursement is referred to as:
The types of edits for National Correct Coding Initiative (NCCI) errors include all of the following:
mutually exclusive edits, comprehensive versus componets edits, & modifiers indicators.
2 codes that could not have both been reasonably performed during a single patient encounter are referred to as:
mutually exclusive codes
The best way to be sure that an intended action will not be subject to investigation as fraud is to:
obtain an advisory opinion from the Office of Inspector General & Centers for Medicare & Medicaid Services.
Compliance Program Guidance for Individual & Small Group Physician Practices can be found in the:
The Compliance Program Guidance suggest that a physician's office implement a plan that includes all of the following:
developing open lines of communication, conducting appropriatetraining& education of staff, & conducting internal monitoring & suditing claims.
Benefits of voluntary compliance plan include:
reducing the chances that an audit will be conducted by the Office of Inspector General, minimizing billing mistakes, & avoiding conflicts with the anti-kickback statue.
If a provider requests an advisory opinion & fails to follow the advise if The Inspector General, the provider:
could be prosecuted.
If the coder determines that the code checked off by the physican on the encounter form does not match the medical record, the coder should:
inform the physician of the issue & dtermine the correct code.
A medical coder can receive information about coding & governmental regulations from:
national speciality medical societies, local carriers, & the American Medical Society.
The types of claims sudits include all of the following:
accreditation audit, internal audit, & external audit.
A postpayment audit would be conducted to verify all of the following:
patient progress notes, lab results, & date of services.
An internal audit would determine:
if training is needed for office staff, whether procedures were coded correctly, the coders' skill & knowledge.
Phsician office should audit their charts
asses the completness of medical records, determine the accuracy of the physicians documentaition, & discover lost revenue.
The following are advantages of a prospective internal audit:
it insures compliance, it decreases the wrk load of the medical office assistant, & it decreases the risk of errors.
If dicumentation in the patient chart supports a higher level of service than coded, the error would be called:
If documnetation in the patient chart supports a lower level of service than coded. the error would be coded.
When auditing a medical chart, the medical office assistant should verify that all documentation is initaled or signed by:
the provider only
Key componets for selecting evaluation& management codes include all of the following:
extent of the exam documented, extent of the history documented, & complexity of the medical decision.
If medicare determines that an evaluation & management services excedes the patients documented need, Medicare could:
Medical necessity of evaluation & management services is based on all of the following factors:
physical scope encompassed by the problems, acuity & severity of the problems addressed, & complexity of documented comorbidities.
An expanded problem-focused history requires all of the following elements:
history of present illness, review of systems, & chief complaint
If a patient states that the present illness atarted 3 days ago, the element he would be describing is the:
If a patient states that the pain he is experiencing is burning, the element he would be describing is the:
associated signs & symptoms
If a patient states that the pain he is experiencing is in his right arm, the element that he is describing is the:
Documentation o an extended history of present illness include at least:
4 history of present illness(HPI)
If a patient complains of a dull ache in the left ear over the past 24 hours, he would be describing :
3 History of present illness(HPI)
If a physician examines the system directly related to the problem plus 2-9 additional systems, the review of systems would be considered:
If a PFSH includes a review of the patient's past, family, & social history, it would be an example of the patient's:
If a chart note documents that the patient is status post-thyroid resection 10 years ago, this would be an example of the patient's:
If a chart note documents that the patient has smoked 2 packs of cigarettes everyday for the past 10 years, it woul be an example of the patients:
In documentsing a medical exam, all of the following are recognized body area:
back, abdomen, & neck
In documenting a medical exam, all of the following are recognized organ systems:
ear, nose, mouth, & throat, eyes, & skin
In documntation of a medical exam, the terms musculoskeletal, respiratory, & gastrointestinal would refer to:
If a physician documents that an exam included the measurement of patient's blood pressure, the system reviewed would be the:
An exam that documents a limited exam of the affected body area or organ system & any other symptomatic or related body areas would be considered a:
a problem-focused exam
Elements of medical decsion making include all of the following:
number of diagnoses or management options, risk of significant complications, morbidity, or mortality, amount & complexity of data to be reviewed.
If physician who ordered a test personally reviews the image to supplement information from the physician who prepared the test report, the work would add to the level of the:
amount &/or complexity of data to be reviewed
If a patient presents with one self-lmited or minor problem, the level of risk involved with the medical decsion making would be considered:
If a patient presents with an acute or chronic illness that poses a threat to life or body function & requires emergency major surgery, the level of risk involved with the medical decsion making would be considered:
The risk of significant complication, morbidity, &/or mortality is based on the risk of:
the diagnostic procedures, the presenting problem, & the possible management options.
In order to consider time as the key factor in determining the level of evaluation & management services, the counseling &/or coordination of care must make up:
50% of the encounter
A medical office assistant is unsure which evaluation & management code to use, they should:
not code the procedure
A medical office assistant can find clinical examples for documenting medical necessity is the:
CPT Appendix C
An example of an evaluation & management code that requires 3 key compenets documented & comprehensive history & comprehensive exam is:
a new patient office visit