COMPREHENSIVE ASSESSMENT
◉ In the anesthesia section of the CPT manual, what are considered
qualifying circumstances? Answer: Add-on codes
◉ As of April 1, 2014 what is the maximum number of diagnoses
that can be reported on the CMS-1500 claim form before a further
claim is required? Answer: 12
◉ What is considered proper supportive documentation for
reporting CPT and ICD codes for surgical procedures? Answer:
Operative report
◉ What action should be taken first when reviewing a delinquent
claim? Answer: Verify the age of the account
◉ A claim can be denied or rejected for which of the following
reasons? Answer: Block 24D contains the diagnosis code
◉ A coroner's autopsy is comprised of what examinations? Answer:
Gross Examination
,◉ Medigap coverage is offered to Medicare beneficiaries by whom?
Answer: Private third-party payers
◉ What part of Medicare covers prescriptions? Answer: Part C
◉ What plane divides the body into left and right? Answer: Sagittal
◉ Where can unlisted codes be found in the CPT manual? Answer:
Guidelines prior to each section
◉ Ambulatory surgery centers, home health care, and hospice
organizations use which form to submit claims? Answer: UB-04
Claim Form
◉ What color format is acceptable on the CMS-1500 claim form?
Answer: Red
◉ Who is responsible to pay the deductible? Answer: Patient
◉ A patient's health plan is referred to as the "payer of last resort."
What is the name of that health plan? Answer: Medicaid
◉ Informed Consent Answer: Providers explain medical or
diagnostic procedures, surgical interventions, and the benefits and
, risks involved, giving patients an opportunity to ask questions
before medical intervention is provided.
◉ Implied Consent Answer: A patient presents for treatment, such
as extending an arm to allow a venipuncture to be performed.
◉ Clearinghouse Answer: Agency that converts claims into
standardized electronic format, looks for errors, and formats them
according to HIPAA and insurance standards.
◉ Individually Identifiable Answer: Documents that identify the
person or provide enough information so that the person can be
identified.
◉ De-identified Information Answer: Information that does not
identify an individual because unique and personal characteristics
have been removed.
◉ Consent Answer: A patient's permission evidenced by signature.
◉ Authorizations Answer: Permission granted by the patient or the
patient's representative to release information for reasons other
than treatment, payment, or health care operations.