CODING 3 FINAL EXAM STUDY GUIDE
WITH COMPLETE SOLUTIONS
the battery in a pacemaker is called a ____________ - Correct Answers -generator
What is the first thing you need to look at when coding a CABG? - Correct Answers -
identify whether an artery or vein or both are being used
identify how many bypass grafts are being done
What is harvesting? - Correct Answers -taking a healthy vessel from somewhere in the
body (saphenous vein is often used)
How many codes should be reported for combined arterial-venous grafting? - Correct
Answers -2--the appropriate arterial graft code and the appropriate combined arterial-
venous graft add-on code
When is the TC modifier used in radiology? - Correct Answers -when only the technical
component is being billed when the technical and professional portions are in one
procedure code
Ipsilateral - Correct Answers -situated or appearing on the same side, affecting the
same side of the body
contralateral - Correct Answers -pertaining to, located on, or affecting the same side of
the body
antegrade - Correct Answers -Extending or moving forward
retrograde - Correct Answers -moving backward; against normal flow
What is NCD and what does it do? - Correct Answers -1. National Coverage
Determinations
2. Explains when Medicare will pay for items or services
3. sets the extent to which Medicare will cover specific services on a national level
What is the LCD? - Correct Answers -1. Local Coverage Determinations
2. decision by an MAC whether to cover a service locally
, What is Preclaims Submission responsible for in the revenue cycle? - Correct Answers -
Responsible for collecting the patient's and responsible parties' information completely
and accurately to determine:
1. Appropriate financial class (Medicare, Medicaid, etc.)
2. Educating patient as to ultimate financial responsibility for services
3. Collecting waivers when appropriate
4. Verifying data prior to procedures/services being performed and submitted for
payment
What is charge capture? - Correct Answers -the process of collecting all services,
procedures and supplies provided during inpatient care
What does Accounts Receivable do? - Correct Answers -Manages the amounts owed to
a facility by customers who received services, but whose payments will be made at a
later date by the patient or their third party payers
What are "days in accounts receivable?" - Correct Answers -average number of days
the facility takes to collect payment
What is the "aging of accounts?" - Correct Answers -monitor the number of accounts
and total dollar value in 30 day increments; longer the account remains unpaid, less
likely to be reimbursed
What is Reconciliation? - Correct Answers --Accounting process used to compare 2
sets of records to ensure figures agree and are accurate
-Key process to determine whether the money expected was the money received
What is a remittance advice? - Correct Answers -notice sent by the insurance company
that contains payment information about a claim
What is an EOB? - Correct Answers -Explanation of Benefits. A document prepared by
the insurance carrier that provide details of how the claim was adjudicated or paid out
Physician reimbursement for PAR provider - Correct Answers -1. Medicare allowed
charge * 80% = Medicare payment
2. Medicare allowed charge * 20% = patient responsibility
3. Physician usual charge - Medicare allowed charge = amount physician must write off
Physician reimbursement for non-PAR provider accepting assignment - Correct
Answers -1. Medicare allowed charge - 5% = payment allowed
2. Payment allowed * 80% = Medicare payment
3. Payment allowed * 20% = patient responsibility
Physician reimbursement for Non-PAR provider - Correct Answers -1. Medicare allowed
charge - 5% = starting point
2. Starting point * 115% = Medicare limiting amount (allowed charge)
WITH COMPLETE SOLUTIONS
the battery in a pacemaker is called a ____________ - Correct Answers -generator
What is the first thing you need to look at when coding a CABG? - Correct Answers -
identify whether an artery or vein or both are being used
identify how many bypass grafts are being done
What is harvesting? - Correct Answers -taking a healthy vessel from somewhere in the
body (saphenous vein is often used)
How many codes should be reported for combined arterial-venous grafting? - Correct
Answers -2--the appropriate arterial graft code and the appropriate combined arterial-
venous graft add-on code
When is the TC modifier used in radiology? - Correct Answers -when only the technical
component is being billed when the technical and professional portions are in one
procedure code
Ipsilateral - Correct Answers -situated or appearing on the same side, affecting the
same side of the body
contralateral - Correct Answers -pertaining to, located on, or affecting the same side of
the body
antegrade - Correct Answers -Extending or moving forward
retrograde - Correct Answers -moving backward; against normal flow
What is NCD and what does it do? - Correct Answers -1. National Coverage
Determinations
2. Explains when Medicare will pay for items or services
3. sets the extent to which Medicare will cover specific services on a national level
What is the LCD? - Correct Answers -1. Local Coverage Determinations
2. decision by an MAC whether to cover a service locally
, What is Preclaims Submission responsible for in the revenue cycle? - Correct Answers -
Responsible for collecting the patient's and responsible parties' information completely
and accurately to determine:
1. Appropriate financial class (Medicare, Medicaid, etc.)
2. Educating patient as to ultimate financial responsibility for services
3. Collecting waivers when appropriate
4. Verifying data prior to procedures/services being performed and submitted for
payment
What is charge capture? - Correct Answers -the process of collecting all services,
procedures and supplies provided during inpatient care
What does Accounts Receivable do? - Correct Answers -Manages the amounts owed to
a facility by customers who received services, but whose payments will be made at a
later date by the patient or their third party payers
What are "days in accounts receivable?" - Correct Answers -average number of days
the facility takes to collect payment
What is the "aging of accounts?" - Correct Answers -monitor the number of accounts
and total dollar value in 30 day increments; longer the account remains unpaid, less
likely to be reimbursed
What is Reconciliation? - Correct Answers --Accounting process used to compare 2
sets of records to ensure figures agree and are accurate
-Key process to determine whether the money expected was the money received
What is a remittance advice? - Correct Answers -notice sent by the insurance company
that contains payment information about a claim
What is an EOB? - Correct Answers -Explanation of Benefits. A document prepared by
the insurance carrier that provide details of how the claim was adjudicated or paid out
Physician reimbursement for PAR provider - Correct Answers -1. Medicare allowed
charge * 80% = Medicare payment
2. Medicare allowed charge * 20% = patient responsibility
3. Physician usual charge - Medicare allowed charge = amount physician must write off
Physician reimbursement for non-PAR provider accepting assignment - Correct
Answers -1. Medicare allowed charge - 5% = payment allowed
2. Payment allowed * 80% = Medicare payment
3. Payment allowed * 20% = patient responsibility
Physician reimbursement for Non-PAR provider - Correct Answers -1. Medicare allowed
charge - 5% = starting point
2. Starting point * 115% = Medicare limiting amount (allowed charge)
