Administrative Duties 8%

Question 1

____sorting of patients and allocation of care or treatment according to the urgency of their needed.

Answer 1

Triage

Question 2

___situations require immediate care

Answer 2

Emergent

Question 3

__means they should be seen within 24 hours

Answer 3

Urgent

Question 4

___can be seen at the next available appt

Answer 4

Routine

Question 5

Always err on the side of caution when you are doing____

Answer 5

triage

Question 6

In triage, if there is any doubt or you have questions____

Answer 6

always ask the physician

Question 7

____triage conversations in the chart

Answer 7

document

Question 8

What information should be gathered when pts present with ocular problems?

Answer 8

Get patient’s name, phone number, determine essence of problem, when symptoms first occurred, duration, which eye, if chemical exposure:Immediately irrigate eye with water x 20 minutes and bring substance in with them to the office or ER

Question 9

What should pt do if they get chemical in the eye?

Answer 9

Immediately flush they eye for 20 minutes with water (before coming into the office), place eyes open under running water rolling eyes around

Question 10

What are the general guidelines with ocular triage?

Answer 10

Confer with physician when in doubt, return call asap if call is not handled immediately, avoid giving general medical advice or discussing diagnosis, answer questions in friendly but non-committal manner (refer to Dr. for definitive answer), if emergency and your physician is not in office, refer to the on call ophthalmologist or ER

Question 11

When making appointments you should not say the following things, what should you instead say?
a. When do you want to come in ?
b. The doctor is running late
c. I called to remind you..
d. Are you a patient here?
e. Cancellation
f. Are you on medicare?
g. You misundertood

Answer 11

a. Would you prefer morning or afternoon
b. The doctor was interrupted in his schedule today
c. I called to confirm
d. When did we last see you?
e. Change in schedule
f. What type of insurance do you have
g. There must have been a misunderstanding

Question 12

What are the things that should be done with arriving patients?

Answer 12

Confirm identity, ask for ID and insurance, avoid asking date of birth or SSN in front of others, Retrieve file of established pts, new patient; who referred?, avoid keeping pts waiting longer than 15 minutes.

Question 13

When should pt have a definite appt scheduled?

Answer 13

For pts with pathology on concern (glc , pituitary tumor), post op pts, if the physician requests a specific follow up appt

Question 14

Why is recall system used?

Answer 14

To remind pts to come back when they are not coming back at a definitive time in a short period of time. These are reminder cards or letter (texts). It is critically important that we use this system so pts aren’t lost to follow up.

Question 15

_____patient should be given priority appt

Answer 15

surgery

Question 16

For post op patients it is good to…

Answer 16

make a courtesy call the day of sx, answer questions quickly, never allow post op pts with concerns to feel ignored or abandoned.

Question 17

There should be a set ___ in office for how to handle incoming test results and letters or reports from other doctors

Answer 17

protocol

Question 18

It is very important that ___test results are reviewed by doctor

Answer 18

all

Question 19

Never file test results away without…

Answer 19

the doctor reviewing first

Question 20

If pt misses an appt or cancels sx ___

Answer 20

record in medical record

Question 21

How should sales reps be handled?

Answer 21

-Ask for business card
-Many physicians want to meet with sales reps to learn about new treatments
-Physician preference dictates how to handle
-Differentiate pharmaceutical, medical equipment and optical sales reps from other types of sales people (ex. advertising sales or insurance sales)
-Be ready to divert sales reps physicians do not want to see or reps taking too much of the phsicians time

Question 22

Medicare part B is for…
Part A is for…

Answer 22

physicians services
hospital services

Question 23

What does it mean if doctor “accepts medicare assignment”?

Answer 23

They agree to let medicare set fees
Cannot bill pt for chargers over and above the “medicare allowable” fees

Question 24

What is the purpose for coding?

Answer 24

To determine the complexity of service and reimburse according to level of complexity.

Question 25

The Health Care Common Procedure Coding System?

Answer 25

HCPCS,

Question 26

System that classifies procedures according to categories for purposes of claims processing

Answer 26

HCPCS

Question 27

HCPCS is coded with

Answer 27

alpha-numeric
Level I: CPT-4 codes: office visits and procedures that we do
Level II: DME (durable medical equipment-optical goods)

Question 28

Code of the procedure that was performed.

Answer 28

CPT (current procedural terminology)

Question 29

Code of diagnosis (why the services were performed)

Answer 29

ICD code (international classification of diseases)

Question 30

The period after the surgery during which all necessary and related services are not seperately payable

Answer 30

Global period

Question 31

Global period varies by ___
Minor is typically ____days
Major is typically ___days

Answer 31

procedure
10
90

Question 32

When pt is in global period and need unrelated service you must bill with a __

Answer 32

modifier code 24

Question 33

What does the modifier code 24 indicated to insurance company?

Answer 33

that we know pt is in post op period but this procedure is unrelated to their recent sx.

Question 34

How many coding systems can we use in ophthalmology and optometry?

Answer 34

2

Question 35

What are the 2 types of codes used in ophthalmology and optometry?

Answer 35

Eye code (92xxx): general evaluation of complete visual system
E&M codes (99xxx): evaluation and management codes; used by all specialties
(We are the only sub-specialties that have their own coding system)

Question 36

E&M codes are harder to document because..

Answer 36

they have more stringent documentation requirements especially regarding HPI.

Question 37

Eye codes can vary by..

Answer 37

different regions of the country and vary by carrier 7-10 elements typical

Question 38

How many elements are there to E&M codes and what are they?

Answer 38

3
(history(HPI, ROS, PFSH), exam, medical decision making)

Question 39

E&M coding is intimately related to how comprehensive your…..

Answer 39

HPI is
(the more descriptive used the higher weight it carries for evaluation in management coding)

Question 40

The exam is comprised of ___elements

Answer 40

12
(VA, tonometry, pupils, adnexa exam, motility)

Question 41

Medical decision making is based on ___elements

Answer 41

4
Dx(how tough to diagnose)
MGMT(how hard to manage)
DATA(how much data needs gathered, do we need to order any tests)
RISK(how much risk is here for the pt)

Question 42

A universally recognized claim for we submit to insurance companies to request payment for a patients services

Answer 42

HCFA 1500 Claim form

Question 43

Medicare has a ______, which is an authorization a pt signs which allows us to release their dx to medicare and if we are accepting pmt from medicare for their charges it will be a release to allow them to pay us

Answer 43

one time authorization
(pt only has to sign one time)
after first time we document “pt request for pmt on file”

Question 44

A written notification to the patient that their insurance probably will not pay for a particular service.
-must list the fee
-must be given to the pt before the service is performed
-give pt a copy
-modifier GA

Answer 44

ABN
Advanced Beneficiary Notice

Question 45

What procedure is excluded from needing an ABN?

Answer 45

Refraction