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Medical Billing, Insurance, and Coding - Smith Fall 2020 > Final Review > Flashcards

Final Review Flashcards

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USMLE® Step 1 flashcards
1
Q

charging for a higher procedure than what was provided

A

upcode

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2
Q

individuals covered under Medicare

A

beneficiaries

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3
Q

who is responsible for the administration of the Federal Medicare program

A

DHHS

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4
Q

who is responsible for collecting and handling funds

A

Social Security Administration

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5
Q

largest third party payer

A

government through Medicare

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6
Q

Part A

A

Hospital insurance

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7
Q

Part B

A

Supplemental Insurance

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8
Q

coinsurance

A

20% medicare does not pay

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9
Q

computerized health record limited to one practice

A

EMR

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10
Q

the entire health record compiled from multiple sources

A

EHR

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11
Q

Where are national changes posted?

A

Federal Register

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12
Q

November/December Federal Register

A

Outpatient

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13
Q

October Federal Register

A

Hospital

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14
Q

Parts of RVU

A

Work
Overhead
Malpractice

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15
Q

practice expense

A

overhead

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16
Q

Amount of time, intensity, and technical expertise

A

work

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17
Q

total RVUs of a service is

A

sum of the units established for each component of the service

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18
Q

national dollar amount that is applied to all services paid on the basis of the Medicare Fee Schedule

A

conversion factor

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19
Q

limiting charge does not apply when

A

a nonphysician provider performs a technical component of a service that is on the fee schedule

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20
Q

percentage over the allowable

A

limiting charge

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21
Q

when do the general multiple-procedures not apply

A

when a CPT code description states “additional”

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22
Q

medicare set s the payment level for assistants-at-surgery at

A

16% of the fee schedule amount

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23
Q

how much of the global fee does medicare pay

A

125%

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24
Q

manages claims payment, oversees fiscal audit and/or overpayment prevention and recovery, and develops and monitors the payment safeguards necessary to detect and respond to payment errors or abusive patterns of service delivery

A

CMS

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25
Q

responsible for developing a work plan that outlines the ways in which the Medicare program is monitored to identify fraud and abuse

A

DHHS

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26
Q

oversees Medicare’s payment safeguard program related to fraud, audit, medical review, collection of overpayments, imposition of civil monetary penalties for certain violations of medicare law (CMPS)

A

OBI

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27
Q

establishes the specific regulations in the Internet-Only Manuals for the providers and carriers to follow

A

CMS

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28
Q

group that is responsible for the health care services offered to an enrolled group or person, coordinates or manages the care of the enroller

A

MCO

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29
Q

primary care physician of the patient

A

gatekeeper

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30
Q

providers who form a network and provide services at a discounted rate

A

PPO

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31
Q

which HMO are enrollees usually responsible for paying a portion of the costs when using a (___) provider, pay additional cost for healthcare outside this HMO

A

PPO

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32
Q

which HMO does not use a gatekeeper

A

PPO

33
Q

what is the “total package” approach to healthcare organizations

A

HMO

34
Q

enrollee is assigned a PCP and is the gatekeeper

A

HMO

35
Q

services are prepaid by

A

HMO

36
Q

benefits allow enrollees to receive services outside of the HMOs health care network, but at increased cost in copayments, in coinsurance, or in a deductible

A

POS

37
Q

three sections of the alphabetic index

A
  1. Index to Diseases and Injuries
  2. Table of Drugs and Chemicals
  3. External Cause of Injuries Index
38
Q

provide greater specificity for proper code assignment

A

essential modifier

39
Q

used for alle xclusion notes and to identify those codes that are not usually sequenced as the first-listed diagnosis

A

italicized type

40
Q

equivalent of “unspecified”, information at hand does not permit a more specific code assignment

A

NOS

41
Q

“other specified”, used when ICD-10 does not have any codes that provide greater specificity

A

NEC

42
Q

enclose synonyms, alternative wording, explanatory phrases

A

brackets

43
Q

enclose supplementary words

A

parenthesis

44
Q

located in the Tabular List after an incomplete terms that needs one or more of the modifiers that follow in order to make the condition assignable

A

colon

45
Q

“NOT CODED HERE”, code excluded should not be assigned at the same time as the code

A

Excludes1

46
Q

“Not included here”, condition excluded is not part of the condition it is excluded from and a patient may have both conditions at the same time

A

Excludes2

47
Q

“use additional code” note at the

A

etiology code

48
Q

“Code first” note at the

A

manifestation code

49
Q

“In diseases classified elsewhere” codes are never

A

first-listed diagnosis

50
Q

two codes may be required to fully describe a condition

A

“Code also”

51
Q

T/F A corresponding procedure code must accompany a Z code to describe any procedure performed

A

True

52
Q

Encounter for screening for intestinal Infectious diseases

A

Z11.0

53
Q

encounters for inoculations and vaccinations

A

Z23

54
Q

lingering effect

A

sequelae

55
Q

Z codes are most often assigned in the ______ settigns

A

outpatient

56
Q

two categories of Z codes that report observation are

A

Z03 and Z04

57
Q

when are uncertain diagnoses reported

A

in an inpatient setting

58
Q

Z34

A

Encounter for supervision of normal pregnancy

59
Q

O09

A

Supervision of high-risk pregnancy

60
Q

not specifically manifestation codes but may be due to an underlying case

A

“code first”

61
Q

indicate that this code may be assigned as a principal diagnosis when the casual condition is unknown or not applicable

A

“Code, if applicable, any casual condition first”

62
Q

codes identified with a bullet

A

new codes

63
Q

codes identified with a triangle

A

changed or modified

64
Q

codes identified with a left and right triangle

A

beginning and end of the text changes

65
Q

appendix that lists all modifiers that are used to alter or modify codes

A

A

66
Q

appendix that contains a complete list of the additions to, deletions from, and revisions of the CPT manual

A

B

67
Q

appendix that contains clinic examples of many of the Evaluation and Management

A

C

68
Q

appendix that lists all add-on codes (+)

A

D

69
Q

lightning bolt symbol

A

identifies codes that are being tracked by the AMA

70
Q

complete list of modifier -51 exempt codes

A

E

71
Q

circle with a line through it

A

modifier -51 exempt

72
Q

codes with a bullseye

A

Moderate Sedation codes

73
Q

codes with full description

A

stand-alone

74
Q

codes listed under associated stand-alone codes

A

indented

75
Q

the use of a _____ between code numbers indicates the presence of only those numbers displayed

A

comma

76
Q

range is indicated by a

A

hyphen

77
Q

list of key components (3)

A
  1. history
  2. examination
  3. medical decision making complexity
78
Q

contributory factors (4)

A
  1. counseling
  2. coordination of care
  3. nature of presenting problem
  4. time

Medical Billing, Insurance, and Coding - Smith Fall 2020 (6 decks)

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