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5 Written questions

5 Matching questions

  1. Services not Rendered
  2. NOS - Not Otherwise Specified
  3. NPI (National Provider Identifier)
  4. Unbounding
  5. Stark Law
  1. a The simplest scheme of HC fraud is the billing for services that were never rendered to patients
  2. b This is a unique identification number for covered health care providers which they use to bill Medicare for their services
  3. c a physician is prohibited from making any referral to a provider of designated health services if the physician has a "financial relationship" with the provider. a healthcare provider is prohibited from submitting for services rendered to patients referred in violation of the statute
  4. d using tow codes when a combined code exists
  5. e Means Unspecified (don't know yet)
    Used when the coder does not have enough information to select a more definitive diagnosis (ie. Cultures are pending)

5 Multiple choice questions

  1. Billing for services not provided or not at the level billed for

    False Claims Act- allows individuals to file claims against companies that they think have defrauded the government. More than $17 billion dollars have been recovered by the government since 1987
  2. used to enclose synonyms, alternative wordings or explanatory phrases
  3. Procedures in which the follow-up is generally non-existent or varies with the patient's underlying condition
    When billing for a starred procedure, the charge does not include any pre or post-operative care
  4. It's how we get paid.

    Optimal Reimbursement
    Avoid denials/delay in payment

    Avoid audit by coding properly
    Documentation must support code
    "If it isn't documented, you didn't do it"
  5. are placed after an incomplete term which requires one or more of the modifying terms that follow it in order to make the code assignable to a given category.

5 True/False questions

  1. Reflex TestingAutomatically running a test based on a previous test result w/o the MD/PA requesting the second test


  2. Incident To• A Medicare billing provision that enables services provided by NNPs (non-physician providers) in an office or clinic setting to be reimbursed at 100% of the physician fee schedule by billing using the physician's NPI (otherwise reimbursed 85%)


  3. HCPCSPronounced "hick picks"
    Health Care Financing Administration's Common Procedural Coding System

    HCFA (Health Care Financing Administration) Now CMS (Centers for Medicare and Medicaid Services) was/is the governing agency of Medicare and Medicaid

    Three levels:
    CPT (Common Procedural Terminology)
    National Codes or alpha-numeric codes
    Local codes (phased out in 2003)


    List the major procedure first, with the additional lesser procedure(s) secondary with mod 51
    For example, if a 100 sq. cm. knee wound is debrided, then reconstructed with a medial gastrocnemius muscle flap and split thickness skin graft, the procedure is reported:
    15738 Muscle flap
    15100-51 STSG
    15000-51 Wound preparation
    The major procedure is the muscle flap and the "-51" modifier is not appended to its CPT code. The secondary procedure CPT codes take the "-51" modifier.


  5. Modifiers2-digit numeric code
    Used to indicate that a procedure has been altered by some specific circumstance, but not changed in its definition