CODING 3 FINAL EXAM STUDY GUIDE
CORRECT 100%
the battery in a pacemaker is called a ____________ - ANSWERgenerator
What is the first thing you need to look at when coding a CABG? - ANSWERidentify
whether an artery or vein or both are being used
identify how many bypass grafts are being done
What is harvesting? - ANSWERtaking a healthy vessel from somewhere in the body
(saphenous vein is often used)
How many codes should be reported for combined arterial-venous grafting? -
ANSWER2--the appropriate arterial graft code and the appropriate combined arterial-
venous graft add-on code
When is the TC modifier used in radiology? - ANSWERwhen only the technical
component is being billed when the technical and professional portions are in one
procedure code
Ipsilateral - ANSWERsituated or appearing on the same side, affecting the same side of
the body
contralateral - ANSWERpertaining to, located on, or affecting the same side of the body
antegrade - ANSWERExtending or moving forward
retrograde - ANSWERmoving backward; against normal flow
What is NCD and what does it do? - ANSWER1. 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? - ANSWER1. Local Coverage Determinations
2. decision by an MAC whether to cover a service locally
What is Preclaims Submission responsible for in the revenue cycle? -
ANSWERResponsible 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? - ANSWERthe process of collecting all services, procedures
and supplies provided during inpatient care
What does Accounts Receivable do? - ANSWERManages 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?" - ANSWERaverage number of days the facility
takes to collect payment
What is the "aging of accounts?" - ANSWERmonitor 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? - ANSWER-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? - ANSWERnotice sent by the insurance company that
contains payment information about a claim
What is an EOB? - ANSWERExplanation 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 - ANSWER1. 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 - ANSWER1.
Medicare allowed charge - 5% = payment allowed
2. Payment allowed * 80% = Medicare payment
3. Payment allowed * 20% = patient responsibility
Physician reimbursement for Non-PAR provider - ANSWER1. Medicare allowed charge
- 5% = starting point
2. Starting point * 115% = Medicare limiting amount (allowed charge)
3. Allowed charge—collected from patient at time of service
4. Starting point * 80% = amount Medicare reimburses patient
5. Patient is responsible for the rest of the bill
When the physician is Non-PAR, how much does Medicare pay the provider? -
ANSWERnothing; the patient pays the entire bill at the time of service and Medicare
reimburses the patient
CORRECT 100%
the battery in a pacemaker is called a ____________ - ANSWERgenerator
What is the first thing you need to look at when coding a CABG? - ANSWERidentify
whether an artery or vein or both are being used
identify how many bypass grafts are being done
What is harvesting? - ANSWERtaking a healthy vessel from somewhere in the body
(saphenous vein is often used)
How many codes should be reported for combined arterial-venous grafting? -
ANSWER2--the appropriate arterial graft code and the appropriate combined arterial-
venous graft add-on code
When is the TC modifier used in radiology? - ANSWERwhen only the technical
component is being billed when the technical and professional portions are in one
procedure code
Ipsilateral - ANSWERsituated or appearing on the same side, affecting the same side of
the body
contralateral - ANSWERpertaining to, located on, or affecting the same side of the body
antegrade - ANSWERExtending or moving forward
retrograde - ANSWERmoving backward; against normal flow
What is NCD and what does it do? - ANSWER1. 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? - ANSWER1. Local Coverage Determinations
2. decision by an MAC whether to cover a service locally
What is Preclaims Submission responsible for in the revenue cycle? -
ANSWERResponsible 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? - ANSWERthe process of collecting all services, procedures
and supplies provided during inpatient care
What does Accounts Receivable do? - ANSWERManages 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?" - ANSWERaverage number of days the facility
takes to collect payment
What is the "aging of accounts?" - ANSWERmonitor 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? - ANSWER-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? - ANSWERnotice sent by the insurance company that
contains payment information about a claim
What is an EOB? - ANSWERExplanation 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 - ANSWER1. 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 - ANSWER1.
Medicare allowed charge - 5% = payment allowed
2. Payment allowed * 80% = Medicare payment
3. Payment allowed * 20% = patient responsibility
Physician reimbursement for Non-PAR provider - ANSWER1. Medicare allowed charge
- 5% = starting point
2. Starting point * 115% = Medicare limiting amount (allowed charge)
3. Allowed charge—collected from patient at time of service
4. Starting point * 80% = amount Medicare reimburses patient
5. Patient is responsible for the rest of the bill
When the physician is Non-PAR, how much does Medicare pay the provider? -
ANSWERnothing; the patient pays the entire bill at the time of service and Medicare
reimburses the patient
