Create an account
What is the False Claims Act (FCA)
A Federal law that prohibits submitting a false claim or making a false statement or representation in connection with a claim.
What is the National Correct Coding Initiative (NCCI)?
Initiative developed by CMS to promote national correct coding methods and control improper coding that leads to wrong payments of Part B health claims.
What are the two types of edits that the NCCI implements?
1. Column 1/ Column 2; identified unbundled codes.
2. Mutually Exclusive Edits: Codes that are unlikely to be performed on the same patient in the same day.
When can a provider share PHI without specific permission from the patient?
1. For treatment (discussing the case with another professional)
2.Payment (When providers submit claims on the patient's behalf).
3. Operations: Staff training and Quality Improvement.
What is Employer Liability?
Physicians are legally responsible for their actions and their employee's actions. a.k.a Respondant Superior. (Let the master answer.)
What is Employee Liability Insurance?
Protection against loss of money caused by failure through error or unintentional omission of the individual or service submitting the claim.
What is in a Medical Record?
-Social and Medical History
-Physical Exam Findings
-Correspondence to the patient
When billing an insurance company, what information must be included?
-Date of Service (DOS)
-Place of Service (POS)
-Type of Service (TOS)
How long should Medical Records be retained?
Governed by State and Local laws; should be retained indefinitely. For deceased patients, they should be kept at least 5 years.
What are the 3 layers of skin?
1. Epidermis (Top layer)
2. Dermis (Middle layer)
3. Subcutaneous Layer
Small, rounded bones that resemble sesame seeds that are found near joints. (ie knee cap)
What are bursae?
Sacs of fluid located in-between the bones of the joint and tendons that hold the muscles into place.
What is a Colles Fracture?
A break at the distal end of the bone, usually when someone tries to break their fall.
How many volumes is the ICD-9 manual divided into?
1. Volume 1; Tabular List
2. Volume 2; Diseases, Alphabetic Index
3. Volume 3; Procedures, tabular list and index
When are V codes used?
-When a person who is not sick/injured seeks health services for a specific thing (immunizations, organ donors)
-When a person with a chronic condition presents for specific treatment of that condition (diabtetes)
-When a circumstance influences the patients health status, but is not a current illness (family history)
-Birth status of a newborn
What are the 3 classifications of Hypertension?
1. Malignant (Accelerated and severe)
2. Benign (Mild or controlled)
3. Unspecified (Not specified in the Medical Record)
What is primary malignancy?
The original cancer site. Malignant tumores are considered primary unless documented as secondary or metastatic.
What does a triangle in the CPT book next to a code mean?
A change in the code description since the last edition.
What does a bullet in the CPT code book next to a code mean?
A new procedure or service since the previous edition.
What are the key components of E/M?
-History of Present illness
-Review of Symptoms
-Past, Family and Social History
2. Physical Exam
3.Medical Decision Making Complexity
What does a Surgical Package (aka Global Surgery) include?
-Surgical Procedure Performed
-Local infiltration/metatarsal/digit block/anesthesia
-Pre-Op E/M services on day before surgery
-Immediate Post-Op care
-Normal, uncomplicated Post-Op care
How is Usual, Customary and Reasonable pricing calculated?
1. The provider's usual charge for the service
2. The average charge of all the other providers in the same geographical area
3. The actual charge submitted on the claim
The lowest amount is used as basis for the payment.
How is Medicare's RBRVS calculated?
1. The amount of time, intensity of effort and medical skill required for the service
2.Overhead; the practice costs related to performing the service
3. Cost of Medical Malpractice insurance
What is CHAMPVA
Provides medical benefits to spouses and children of veterans with total, permanent, service related disabilities- or have died.
What is Fiscal Intermediary?
An insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Please allow access to your computer’s microphone to use Voice Recording.
Having trouble? Click here for help.
We can’t access your microphone!
Click the icon above to update your browser permissions and try again
Reload the page to try again!Reload
Press Cmd-0 to reset your zoom
Press Ctrl-0 to reset your zoom
It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.
Please upgrade Flash or install Chrome
to use Voice Recording.
For more help, see our troubleshooting page.
Your microphone is muted
For help fixing this issue, see this FAQ.
Star this term
You can study starred terms together