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Financial Management > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Established patient exam, expanded history, expanded exam, and straightforward clinical decision making.

-What is the correct CPT code?

A

99213

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2
Q

What is fraud and abuse?

A

Fraud = intentional misrepresentation or deception

Abuse = unintentional mismanagement

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3
Q

What is the correct order of coding for a subluxation for medicare?

A

1st code is subluxation, 2nd code is chief complaint (then follow hierachy)

Ex: M99.01, M54.2

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4
Q

Who is eligible for medicare?

A

1) 65 or older
2) On disability, at an age and received social security benefits for at least 2 years
3) People with end stage renal disease or ALS

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5
Q

T/F Abuse is worse than fraud and can include jail time.

A

FALSE.

-Fraud is intentional deception where abuse is unintentional, so fraud is worse

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6
Q

What medicare parts can cover chiropractic care?

A

Usually Medicare Part B and/or Part C (A = Hospital, D = Prescriptions)

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7
Q

What must a DC have to do to enroll in Medicare?

A
  • Need National Provider Identifier (NPI)
  • Use PECOS online system to enroll

(need revalidation every 5 years)

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8
Q

What X-ray modifers can be utilized?

A
  • GX,GY = Medicare, service is definetly not covered
  • 26 = Wrote report, but did not take films
  • TC = took films but did not write report
  • 25 = Duplicate code for services
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9
Q

T/F Medicard fraud is a state offense

A

FALSE

-Medicard fraud is a federal offense

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10
Q

You see a patient and adjust T5, T12, L5, Right SI joint, and Coccyx.

-Which codes and CPT do you use?

A
  • M99.02, M99.03, M99.05, M99.04
  • 98941
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11
Q

What should be included in a treatment plan?

A

-Frequency, number of visits, OATs, start/end dates, what procedures will be used, short term and long term goals, prognosis, and relative and absoulte contraindications.

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12
Q

What is the hierarchy of ICD-10 and why?

A

AAA.BBBC (Ex: S93.401A)

AAA = General location and general condition

BBB = Specific location and specific condition (including laterality)

C = Type of encounter (initial, subsequent, sequale)

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13
Q

What is the hierarchy code once we know all the ICD 10 codes?

A
  • Neurological (Sciatica)
  • Structural (Scoliosis)
  • Functional (Subluxation)
  • Soft tissue/other (Sprain)
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14
Q

What is the “nurses code”?

A

99211

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15
Q

How many key components have to be met for a new patient?

-Established patient?

A

New = 3/3

-Established = 2/3

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16
Q

What must you ask a patient who has been in an accident?

A
  • Where the police called?
  • Was a report filed?
  • Do you have an attorney?

Etc.

17
Q

What information is needed for a work comp case?

A
  • Name of employer
  • Name of work comp carrier
  • Was a report filed?
  • Did injury happen “on the job”
18
Q

What information is needed for a bodily injury case?

A
  • Name of patient insurance
  • Name of person involved in injury (other than patient)
  • Insurances involved or attorney contacted
19
Q

When would you file a health care lien?

A

Personal injury or motor vehicle collision occurence

20
Q

What is expected in a “cash practice”?

A

The same standard of care as if a patient had insurance

  • Document the same
  • DC gives a patient a “super bill” so that the patient can bill the insurance company on his own (NonPAR)
  • Medicare = still have to bill on behalf on the patient (CAN NOT give super bill
21
Q

What is the statue of limitations?

A

Amount of time from the date of the injury/accident in which the injured has to file a lawsuit

22
Q

What 3 things have we learned about a cash practice?

A

1) Not possible to legally have a total cash practice if we take any Medicare patients
2) Still have to prepare insurance billing to give to patient per state law (you just might not have to submit claims) EXCEPTION: Medicare
3) Your documentation should be just as thorough if your patient is paying cash or if he is insurance or going to trial for bodily injury case

23
Q

What is the worst type of audit and why?

A

External audit

-Someone outside your practice is going through and reviewing all your records for medical neccessity.

24
Q

What does unbundling mean?

A

Utilizing multiple CPT codes in place of a single CPT code that would cover all the components provided to the patient

Ex: Adjusting 4 regions on a patient:

-Code 98942 and NOT 98940 4 times

25
Q

What is upcoding?

A

Using specific codes that were not rendered or are not appropriate in order to gain financial compensation

26
Q

What does medicare consider to be the neck region of the spine?

A

Occiput, Cervicals, Atlas, Axis (Occ-C7 or M99.00 to M99.01)

27
Q

What regions of the spine does medicare consider to be the back (NOT low back)?

A

Dorsal or Thoracics, or Costovertebral or Costrotransverse (T1-T12 or M99.02)

28
Q

What regions of the spine does medicare consider to be the low back?

A

Lumbars (L1-L5 or M99.03)

29
Q

What regions of the spine does medicare consider to be pelvis?

A

Right and Left Ilium (Ilium and SI joint or M99.05)

30
Q

What regions of the spine does medicare consider to be sacral?

A

Sacrum and Coccyx (M99.04)

31
Q

What components of E/M should be timed?

-Are these considered key components?

A

Counseling and Coordination of Care

NO! = Key components are History, Examination, and Clinical Decision Making

32
Q

How should time be documented?

A

As units with one unit being 8-22 minutes and 2 units being atleast 23 minutes

33
Q

Which physical medicine/rehab codes are timed?

A
  • 97032 (Electrical Stimulation)
  • 97035 (Ultrasound)
  • 97110 (Therapeutic exercises)
  • 97112 (Neuromuscular re-education)
  • 97124 (Massage)
  • 97140 (Manual therapy techniques)
  • S8948 (Low level laser)
34
Q

Which physical medicine/rehab codes require one on one provider contact with patient?

A
  • 97032 (Electrical stimulation)
  • 97037 (Ultrasound)
  • 97110 (Therapeutic exercises)
  • 97112 (Neuromuscular re-education)
  • 97139 (Unlisted therapeutic procedure)
35
Q

What is the minimum threshold for 1 unit of rehab/physical medicine?

-2 units?

A
  • 8 minutes
  • 23 minutes
36
Q

How should time be documented for E/M codes?

A

If under 30 minutes, document the correct CPT code)

  • 30-74min = 99212-99354
  • 75-104min = 99202-99355-99354
  • >105min = 99202-99354-99355-99355 (keep listing 99355 for each additional 30 minutes)

Financial Management (3 decks)

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