60 terms

chatper 5&6

the health insurance specialist employed in a physicians office assigns the ICD-9-CM codes to procedures documented by the health care provider
the ICD 9 is orgainized into three volumes
an advanced beneficiary notice is signed by the patient to acknowledge that the health care provider is a subscriber to the medicare program
inpatient is a person admitted to a hospital for treatment with the expectation that the patient will remain in the hospital for a period of 34 hours or more
the first listed diagnosis and the primary diagnosis are the same thing
cosed that describe signs and symptoms as opposed to definative diagnosises are never acceptable for reporting purposes when the physician has not documented an stablished or confirmed diagnosis
resadmission testing is routinely completed prior to an inpatient admisson or outpatient surgery to facilitate the patients treatment and reduce the length of stay
v codes are located in the index and are assined fo patient encounters when circumstances other than a disease or injurt is present
e codes are located in the tabular index and are assigned for patient encounters when a circumstance other then diseases or injury is rpesent
nonessential modifiers are qualifying words that do not have to be included in the diagnostic statement for the code number listed at the end of the parenthetical statements to apply
coding convetions are rules that apply to the assignment of ICD9 codes and are always found in the guidelines
a principal procedure is a procedure performed for definitice treatement reather than diagnostic purpses or one performed to treat a complication, or one that is most closeley related to the principal diagnosis
a lesion is a neoplasm defined as and discontinutiy of tissues that is not malignant
an adverse effect or adverser reaction is the apperance of a pathologic condition caused by ingestion or exposure to a chemical substance properly administerd or taken
a late effect is a residual effect or sequelae of a previous acute illness, injury, or surgery
to accurately process health insurance claims, especially for government programs like medicare and medcaid, the health insurance specialist insurance should become familiar with the federal registers
HIPPA mandates that health insurance claims be retained for a minimum of two years adter a patients death
record retention is the storage of documentation for an established period of time, ususally mandated be federal and or state law
the most common form of medicare abuse is billing for services not furnished
a voluntary compliance program can help physicians avoiding generating erroneous and fraudulent claims by ensuring that submitted claims are true and accurate
suppliers of durable medical equipment that have accepted assignment will always be reimbursed for rental items by the beneficiary
the national correct coding initiaticve was developed to reduce medicare program expenditures by detecting inappropriate codes submitted on claims and denying payment
the nation provider identifier (NPI) is assingned to heath care providers as a 10 digit numerical identifier, with our a check digit in the last position
protected health information is the information that is identifiable to an individual such as name address telephone number date of birth and social security number.
a date signed special release form is gernally considered calid as long as the patient sees the physicians
an insurance company that is prohibited from reviewing patient records will probably refuse to reimburse the provider for the submitted claim
the HIPPA security rule adopts standards and safeguards to protect health information that is collected, maintained, used or transmitted ellectronically.
the privacy rule established standards for the PHI should be controlled by indicating authorized uses and disclosure and patients rights with respect to their health information
the patient safty and quality improvment act does not allow providers to report health care errors on a voluntary and confidential basis
the recovery audit contractor program is mandated by the medicare prescription drug improvement and moderization act of 2003
the health insruance specialist employed in a physicains office assigns ICD0 codes to
diagnosis, signs and symptoms documented by the provider
what volume of ICD 9 contains the index to disease
volume 2
the medicare catastrophic coverage act of 1988 mandates the reporting of ICD 9 diagnosis coeds on what type of claims
all medicare claims
according to the medicare the determination that a service or procedure rendered is reasonable and neccessary for the diagnosis or treatment of an illness or injury is called
medical neccessity
an outpaitent is a person treated in which of the following settings
all of the above
codes that describe signs and symptoms as opposed to definitive diagnosises are acceptable to report when
the physician has not documented an established or confirmed diagnosis
_____ codes are located in the tabular list of disease and are assigned for patient encounters when a circumstance other than a disease or injury is present
V codes
a removal of a cast applied by another physician, personal history of breast cancer and exposure to tuberculosis are all examples of what types of codes
Both A and B
what type of codes describe external causes of injury, poisoning and other adverse affecting a persons health
E codes
these codes are reported for enviromental events, industrial accidents or injuries inflicted by criminal activity
the classification of industrial accidents accroding to agency is found in which apendix of the ICD 9 book
D Appendix D
the list of the three digit categories is found in which appendix of the ICD 9
Appendix A
_____ indentifiers codes to be assigned when information needed to assign a more specific code can note be located in the ICD 9 coding manual
a ____ is a proceudre performed for definitive treatment rather thatn a diadnostic purpose
principal procedure
it is always neccessary that theses codes be coded directly from the pathology report
codes for neoplasms
to accuraty process health insurance claims especially for government programs like medicare and medcaid a health insurance specialist should become familiar with
code of federal register
the health care industy is heavily regulated by ___ and ____ legislation
federal and state
regulated fruad associated with military contractors selling supplies and equipment to the union army
false claims act
act that authorise the federal gov. to monitor the putiry of food and the safty of medications now a respocibility of the food and drug administration
food and drug act
protect patients and federal health care programs from fruad and abuse by curtailing the corrupting infulence of money on health care decisions
federal anti-kickback law
participating mainting , at thier own expense and at the same rate health care plan coverage that would have been lost due to a triggering event
consolidated omnibus reconsciliation act
responsible for establishing the first medicare prospectince payment system implemented in 1983
tax equity and fiscal responcibility act
medicare program that was developed by CMS to reduce the inappropraite expenditures
clinical data abstracting centers were established by
in 1996 congress passed the ____ because of concerns about fraud and abuse
health insurance portablitity accountablitiy act
____ is the storange of documentation for and extablished period of time usually mandated by the federal and or state law
record retention
the ___ mandates the retention of a patients records and health information for a minumum of 6 years unless state law says longer
the most common form of medicare fraud is
all of the above
which of the following is not an example of abuse
falsifiying certiciates of medical neccessity plans of treatment
an example of overpayment is
all of above