Certification study guide for NHA CBCS Exam

Medical Ethics - correct answer Standards of conduct based on moral principals. Acting within ethical behavior boundries means carrying out one's responsibilities with integrity, decency, respect, honesty, competence, fairness and trust. Compliance Regulations - correct answer Most billing related cases are based on HIPAA and the False Claims Act. HIPAA is an acronym for - correct answer Health Insurance Portability and Accountability Act of 1996. Category 1 CPT codes - correct answer Medical Procedures. Category 2 CPT codes - correct answer Supplemental Codes for Performance Measures. Category 3 CPT codes - correct answer Emerging Technologies. Add on Codes - correct answer Used for procedures that are always performed during the same operative session, as another surgery in addition to the primary service/procedure and is never performed separately. Anesthesia is found - correct answer 00100-01999, . Evaluation and Management (E&M) codes - correct answer Are listed first in the CPT manual because they are used by all the different specialties. Brackets - correct answer Used to enclose synonyms, alternative wording or and explanatory phrase. Bullets - correct answer Represents a new procedure or service code added since the previous edition of the manual. Chief Complaint (CC) - correct answer The reason the patient came to see the physician. Circle with a line through it () - correct answer Exemption from modifier 51. CPT - correct answer Used to report services and procedures by physicians. E&M codes - correct answer Guidelines are found - correct answer At the beginning of each section and used to provide specific coding rules for that section. History (HX) - correct answer The set of information the physician gathers from the patient concerning his/her past. History of Present Illness (HPI) - correct answer A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present. Indented Codes - correct answer Listed under associate and stand alone codes. E Codes - correct answer For durable medical equipment for use in home. Level 1 codes - correct answer Codes found in the CPT manual. Level 2 codes - correct answer National codes for the physician and non-physician service not found in the CPT Level 1. Level 3 codes - correct answer Used locally or regionally and have been eliminated by the CMS since the implementation of HIPAA. The List of Modifiers is found where in the CPT - correct answer Appendix A and in the front of the book. Modifier 50 - correct answer Bilateral procedure. Modifier 24 - correct answer Attach to E/M service code when service is provided during postoperative period to indicate that the service is not part of postoperative care and not included in the Surgical Package. Modifier 26 - correct answer Provider only provided the professional component. Modifier 51 - correct answer Used more than one procedure during the same surgical episode. Modifier 57 - correct answer Modifier 57 is used on E/M services the day before or day of major surgery when the initial decision to perform the surgery is identified. Modifier 78 - correct answer Physician must return to Operating Room to address complication stemming from initial procedure. Modifier 79 - correct answer Procedure or service provided during postoperative period not associated with initial procedure. Modifiers - correct answer Reporting indicators that indicate that the procedure or service has been altered by specific circumstance but has not changed in it's definition of code. Parentheses - correct answer Used to enclose supplementary words, non-essential modifiers. Past, Family and Social History (PFSH) - correct answer Consists of patients personal experiences with illnesses, surgeries, and injuries; Information of illnesses predominant in family' Patients educational background, occupation, marital status and other factors. Pathology and Laboratory - correct answer . Plus sign indicates () - correct answer Add on codes. Radiology - correct answer . Review of Symptoms (ROS) - correct answer Inventory of the constitutional symptoms regarding the various body systems. Stand Alone Codes - correct answer Contain full description to the procedure for a code. Sideways triangle means ( ▶️ ) - correct answer Change in wording between triangles. Bullet means - correct answer New procedure codes. Circle with a line through it means - correct answer Modifier 51 exempt code. Six sections of CPT - correct answer E&M, Anatomical Site, Condition or Disease, Synonym or Eponym, Abbreviation. Three Components for E&M Codes - correct answer 1.History, 2.Physical Exam, and 3.Medical Decision-Making. Three Categories for E&M Codes - correct answer Category I: Procedures that are consistent with contemporary medical practice and are widely performed. Category II: Supplementary tracking used for performance measures. Category III: Temporary codes for emerging technology, services and procedures. 4 contributing factors for E&M Codes - correct answer New or existing patient, History, Physical Exam, Medical Decision making, Time spent can be a 5th factor. Medicare Part A - correct answer Part A is hospital insurance provided by Medicare. Most people do not pay a premium for this coverage. Medicare Part B - correct answer Part B is medical insurance to pay for medically necessary services and supplies provided by Medicare. (Doctors, Outpatient care, Physical and Occupational Therapist, etc.) Medicare Part C - correct answer Part C is the combination of Part A and B. The main difference in Part C is that it is provided through private insurance companies approved by Medicare. Medicare Part D - correct answer Part D is stand-alone prescription drug coverage insurance. Medicaid - correct answer Free or low-cost health insurance coverage through the state. Medicaid categorically needy - correct answer A distinction for individuals who fall into a specific category (or criteria) of mandatory Medicaid eligibility established by the federal government. These categories apply to every state Medicaid program. Medicaid Medically Needy - correct answer Provide Medicaid to certain groups not otherwise eligible for Medicaid, must cover: ▪️Pregnant women ▪️Children under 18: States have option to cover: ▪️Children up to 21 ▪️ Parents and other caretaker relatives ▪️ Elderly ▪️ Individuals with disabilities. Who is the Payer of Last Resort - correct answer Medicaid is always the payer of last resort. Tricare - correct answer Health care program for Uniformed Service members, retirees and their families. Tricare Standard - correct answer Option that provides the most flexibility to TRICARE-eligible beneficiaries. It is the fee-for-service option that gives beneficiaries the opportunities to see any TRICARE-authorized provider. Tricare Extra (PPO) - correct answer A preferred provider option, rather than an annual fee, a yearly deductible is charged. Health care is delivered through a network of civilian health care providers who accept payments from CHAMPUS and provide services at negotiated, discounted rates. Tricare Prime (HMO) - correct answer An HMO type plan in which enrollees receive health care through a Military Treatment Facilities PCM or a supporting network of civilian providers. CHAMPVA - correct answer Comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. Private payer vs Commercial payer - correct answer Private individuals are responsible for securing their own health insurance coverage. Commercial Government, Employer, Group health insurance coverage. Group Health Plans - correct answer An insurance plan that provides healthcare coverage to a select group of people. Group health insurance plans are one of the benefits offered by many employers. These are generally uniform in nature, offering the same benefits to all members of group. Indemnity Insurance - correct answer Health indemnity insurance is a fee for service insurance that is sometimes used when a person is in between health plans, and will cover some (but not all) expenses. HMO - correct answer Health Maintenance Organization. A form of health insurance combining a range of coverages in a group basis. A group of doctors and other medical professionals offer care through the HMO for a flat monthly rate with no deductibles. PPO - correct answer PPO is similar to an HMO, but care is paid for as received instead of in advance in form of a schedule. PPOs may offer more flexibility by allowing for visits to out-of-network professionals. Visits within network require only the payment of a small fee. Point of Service - correct answer Feature of an insurance plan that allows a patient to choose between in-network care and out-of-network care every time he or she sees a doctor. The patient is allowed the freedom to go to whichever doctor is most convenient, although the cost will vary. Disability Insurance - correct answer Policyholder becomes incapable of working. Workman's Comp - correct answer Workman's compensation is a job benefit that provides money and services to employees that are injured or become sick on the job. Woker's comp helps injured and sick