Section 1
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Explain how the RBRVS calculates how a provider gets reimbursed. Make sure to include the terms "relative value" and "conversion factor" in your explanation.
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Section 1
(50 cards)
Explain how the RBRVS calculates how a provider gets reimbursed. Make sure to include the terms "relative value" and "conversion factor" in your explanation.
relative value by geographical region x conversion factor = $
Matt has chronic back pain from an old motor vehicle accident. He came to the office to see his provider because he is experiencing acute back pain after having a bowel movement. Acute back pain would be the first-listed condition coded and then chronic back pain would be coded.
True
The most common forms of Medicare Fraud include
BIling for services not furnished, misrepresenting a diagnosis, unbundling, up coding
The largest third-party payer in the United States is
Medicare Program
The two coding systems that will be taught in this class are _______ and_________
ICD -10-CM and CPT
ICD-10-CM provides codes to deal with encounters for ___________________other than a disease or injury. These codes begin with the letter _______.
cirumstances; Z
The World Health Organization (WHO) is responsible for maintaining ICD-10-CM
The patient was last seen in the office two years ago, so this patient is considered a (n):
established patient
MEANS: must follow this information
See
CPT codes that end with the numbers "99" are considered
unlisted procedure codes
CPT codes that begin with the numbers "99" are considered
Evaluation and Management
You completed and documented the vitals of a patient who came in the office short of breath. You saw that the provider went into the examination room and exited within two minutes. Your provider gave you a fee ticket (super bill) that documented 99205 E/M visit with a diagnosis of congestive heart failure (CHF). After reviewing this patient's medical record you notice the provider documented that they spent 60 minutes in counseling and/or coordination of care. What would you do in this situation?
Do not submit the fee ticket, and query the provider
The best modifier to use when a provider does an E/M visit on a postoperative patient for a condition not related to the operation would be
-24
Codes assigned in chapter 16 of the ICD-10-CM code book pertain to ________________patients
certain conditions origination in the perinatal period
Subjective information, like a patient stating "my arm hurts bad", is considered objective:
false
A subsequent nursing home visit E/M level 99307 states the history and examination are problem-focused, and the medical decision making as____________________. If the provider spent more than 50% of their time counseling and/or coordinating care of the patient, the provider has to document at least ____________minutes.
straight forward; 10 mins
According to the E/M coding guidelines when the nature of presenting problem is this type, it does not require the presence of a physician, but service is provided under the physician's supervision.
minimal
Volume 1, Arranged with the first character always a letter and then numerically
tabular
Volume 2, Arranged alphabetically
Index
Solid Rock was seen in the office today and the provider performed a low-level E/M visit. However, the provider placed a comprehensive high level E/M visit for reimbursement. You educate your provider that this is called _________and is considered fraud.
upcoding
According to chapter 19 specific coding guidelines fractures are coded using the appropriate 7th character extension for _______________care for encounters after the patient has completed active treatment of the fracture and is receiving _____________care for the fracture during the healing or recovery phase.
subsequent; routine
what is the largest 3rd party payer?
Medicare Program
If the medical assistant is responsible for filing Medicare claims then it is important that they validate that the services being billed were provided by consulting the medical record or physician.
True
If you, the medical assistant, is asked by your provider to assign codes for the practice, whose responsibility is it to assign codes accurately and completely to maximize reimbursement?
the medial assistant
Stacy went to see her provider because her nose would not stop bleeding after she picked it with her new fake nails. The provider noticed a small laceration in her nostril and applied pressure with a gauze which eventually stopped the bleeding. Which would be the first-listed diagnosis?
laceration
According to chapter 1 specific coding guidelines only confirmed cases of HIV can be coded.
True
The ICD-10-CM alphabetic index and tabular are used in outpatient settings to substantiate
Patient came in with a cough and provider asked the patient if they are experiencing any chest pain as well. The patient denied any chest pain. This information would be found under
review of systems ( ROS)
The ICD-10 is designed for the classification of patient mortality and
For outpatient encounters it is appropriate to assign codes that the provider has documented as "probable", "rule-out", "versus", or otherwise uncertain.
False
List the six reasons codes are used today
The elements of the key history component are, chief complaint (CC), history of present illness (HPI), _______________________________________________, and past, family, social history (PFSH).
review of systems (ROS)
A new patient consultation in an office setting with a detailed history, detailed examination, and low complexity medical decision making would be assigned E/M CPT code _______________.
99243
the organization developed and maintains the ICD - 10- CM
NCHS
A three character code is to be used only if it is not further subdivided
true
MEANS: non- essential modifer
( parenthesis)
MEANS; a more specific code does not exist
(NEC)- not elsewere classified
Additions, deletions, and revised CPT codes can be found in appendix______of the CPT Official code book
B
Transforming verbal or narrative descriptions of diseases, injuries, conditions, and procedures into alphanumeric designations is a complex activity and should not be undertaken without proper training.
ICD-10-CM stands for
international classification of diseases 10th revision clinical modifications
The insurance claim form (paper type) used in physician office clinics for reimbursement is called
CMS 1500 claim form
MEANS: not included here, if the condition is present that code can be included
Exclude 2
Patient information located in the medical record is referred to as
documentation
Codes that describe symptoms and signs, as opposed to diagnoses, are ________________for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.
acceptable
For a new patient, what key components must meet or exceed the stated requirements to qualify for a particular evaluation and management (E/M) level
History Component Physical Component Medical Decision Making Component
the organization developed and maintains the ICD-10
WHO
The symbol that indicates a product is pending FDA approval is the
lighting bolt
The best modifier to use when during an E/M visit the provider decides that surgery needs to be performed would be
-57
Medicare Part _______ pays for physician office visits
B
One of the reasons coding systems are used in a physician office or medical clinic is because codes directly relate to how a provider will be reimbursed.
TRUE
Section 2
(48 cards)