When should an ABN be signed?
When a service is not expected to be covered by Medicare.
What are NCD's interpreted at the MAC level considered?
What is medical billing?
Translating medical documentation into codes.
What part of Medicare should be billed for the pain medication by the pharmacy?
The amount on an ABN should be within how much of the cost to the patient?
$100 or 25% of cost.
An entity that processes nonstandard health information they receive from another entity into a standard is considered what?
What is PHI?
Personal Health Information.
Intentional billing of services not provided is considered?
What OIG document should a provider reveiw for potential problem areas that will receive special scrutiny in the upcoming year?
OIG Work Plan. Each year in October.
What is ABN?
Advance Beneficiary Notification
What is AMA?
American Medical Association.
What is CPC?
Current Procedural Terminology. What was done into codes.
What is ICD-9-CM?
International Classification of Disease, 9th Clinical Modification. Why was done in codes.
What is HIPAA?
Health Insurance Portability and Accountability Act of 1996. Law passed by Congress to improve the portability and continuity of healthcare coverage.
What is OIG?
Office of Inspector General. Makes sure everyone is in compliance
What is CMS?
Centers for Medicare & Medicaid Services. Basic guidelines for private prctice and rules.
Without, lack of, absent, deficient
Vessle (blood or lymph)
Tumor, swelling, hernia, sac
Common bile duct
Through, between, across, apart
Painful, difficult, disordered
Outer, or on the outside
Within inner, on the inside
Ileum (part of small intestine)
Bad, poor, disordered
Spinal cord, bone marrow
To repair a defect, suture
Incision, to cut into
to sew up in position, fixation
Shape, mold, repair, operative revision, plastic repair
Condition of, presence in urine
Where is the great saphenous vein located?
What is the function of the pancreas?
Supplies digestive enzymes.
Sebaceous glands are part of which anatomical system?
What causes refraction function in eye?
Myocardium is thickest arount which chamber of the heart?
Tunica vaginalis is part of which system?
Compete this series: Incus, stapes, ?
Hemiplegia is a disorder caused by a defect in which anatomical system?
What is the result of a ureteral blockage?
Urine will not be able to flow from the kidney to the bladder.
Renal calculus is?
What is Part A?
Medicares's Hospital Insurance; covers hospital/facility care.
What is Part B?
Medicare's Supplemental Medical Insurance; covers physician services and durable medical equipment that are not paid for under Part A.
What is Part C?
Medicare's Advantage is a set of health care options from which beneficiaries choose health care providers.
What is Part D?
Medicare's prescription drug program.
What is WHO?
World Health Organization. A group that deals with health care issues on a global basis.
Volume 1 of ICD-9-CM contains what?
Tabular List: Diagonosis codes organized in order by code.
Volume 2 of ICD-9-CM contains what?
Index to Diseases: Diagnosis codes organized in an alphabetic index.
Volume 3 of ICD-9-VM contains what?
Alphabetic Index and Tabular Index of Procedures: Procedures performed in the inpatient setting.
A condition with a rapid onset with a short course.
A condition that develops slowly and lasts a long period of time.
A fractured bone that does not pierce the skin.
Codes reported to indentify how an injury occurred and the location when it occurred. Never sequenced first.
First Degree Burn
Superficial burns through only the epidermis.
An inactive, residual effect or condition produced after the acute portion of an injury or illness has passed.
A fracture bone that pierces the skin.
Second Degree Burn
A partial-thickness burn involving the epidermis and the dermis.
A systemic disease that is associated with microorganisms or toxins in the blood. These toxins are caused by bacteria, viruses, fungi, or other organisms.
Systemic Inflammatory Response Syndrome (SIRS)
Sytemic response to infection, burns, trauma, or cancer.
Sepis with associated acute organ dysfunction.
Whole body inflammatory state. It generally refers to SIRS that is due to an infection.
Third Degree Burn
A full-thickness burns that involve the epidermis, dermis, and varying levels of the subcutaneous and underlying structures.
Codes used to describe circumstances or condition that could influence patient care.
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