October 2016 HBM test yourself PDF version …

1 1. When the ZPIC determines that an overpayment has been made, how is the overpayment collected from the provider?a. By check sent by the provider or by offset on future payments by the MAC b. By seizure of the practice bank accountsc. By notice from the ZPICd. By notice from the OIG2. CERT reviews may be performed by:a. Physiciansb. Nursesc. Codersd. All of the above 3. A Medicare benefit is not considered to meet requirements as a reasonable and medically necessary service based on an LCD. The clinic presents an ABN form to the patient, explaining notice of noncoverage and financial obligation prior to the performance of noncovered services. The patient signs the ABN accepting financial responsibility, and the form is kept on file.

2 Which modifier applies?a. Modifier GA b. Modifier GYc. Modifier GZd. None of the above4. A Medicare patient presents to the clinic requesting a statutorily excluded vaccination. The clinic notifies the patient of financial liability and the patient chooses to receive the service. What protocol is most beneficial to protect the clinic and the patient?a. Applying modifier GYb. Applying no modifier and bill the claim as is c. Presenting an ABN form prior to vaccine administrationd. Both A and C 5. MDM is moderate, but caution is in order because the problem is low severity: An established patient presents to his primary care physician with an ankle injury after an ER visit to his local hospital. While at the hospital, the patient receives an X-ray of his ankle and is told that it is a sprain.

3 He is provided with a pair of crutches and told to keep off the ankle and to follow up with his primary care physician. The patient sees his primary care physician the next day. The physician performs a detailed history and a problem focused exam. He had already personally reviewed the digital image of the X-ray on the hospital s medical record system, which he could easily access due to his affiliation with the hospital. The physician also called the radiologist to speak about the radiology report, also available. At the conclusion of the visit, the physician recommends that the patient continue to stay off the ankle, and intermittently apply ice and elevate the leg. The physician determines the MDM to be moderate (one new problem, moderate complexity data, and low risk), and asks the coder if he can bill 99214 for this service.

4 How should the coder respond?a. You meet the CPT requirements for 99214, and should bill No, you should never bill above 99213 for a low severity You do meet the CPT requirements for 99214, but this is a low severity problem based on CPT and CMS criteria, which usually means 99213. Let s discuss this further. d. I don t have the authority to make that MDM is low, but billing at a higher level is justified: A patient returns to her primary care physician after experiencing dizziness and collapse. Previously, she had experienced dizziness on several occasions without collapse and the physician prescribed meclizine. Now, since the problem appears to be worsening, the physician performs a detailed interval history and comprehensive exam.

5 She also orders an MRI of the brain and blood work and arranges for the patient to consult with a neurologist. Previously, the physician billed 99213. Now, the physician feels she should bill 99214 for this visit, but she determines the MDM to be low (one worsening problem, low complexity data - two tests ordered, moderate risk). She asks her coder for help. How should the coder respond to the physician?a. You meet the CPT requirements for 99214 and should bill that because you documented a detailed history and a comprehensive physical You should bill 99213 because you should never bill above the level of You meet the CPT requirements for 99214 and should bill that because this is a moderate severity problem that meets the medical necessity requirement.

6 D. I don t have the authority to make that For a provider to bill an office E/M code based on time, the documentation must include:a. Amount of total face-to-face time spent with the patient at the A statement that at least 50 percent of the visit was engaged in counseling and/or coordination of A description of the counseling and/or care coordination activities performed at that All of the above Healthcare Business Monthly Tests Your KnowledgeGet One CEUT hese questions are answered in articles throughout this news answering all questions correctly, you will receive one CEU at the time of your yourself PDF versionOctober 2016 HBMH ealthcare Business Monthly Tests Your KnowledgePage 2test yourself PDF version8.

7 Services showing evidence of cloning will not be valid for reimbursement because ..a. The codes do not include payment for copy and The services are not clearly It is not possible to determine how much work was actually done in that encounter. d. A service was not HEDIS is:a. A tool for consumers to compare health plans. b. A pilot prospective payment A quality reporting system with a physician payment initiative A new, mandatory method for submitting medical claims to Which is the proper CPT code to describe Ultroid treatment?a. 46999b. 46900c. 46930 d. 4694711. A complete list of CPT unlisted codes can be found in:a. CPT Appendix CPT codebook CPT Evaluation and Management Services There is not a complete list of unlisted codes in the CPT codebook.

8 12. True or False: When a CPT Category III code exists to describe a procedure, you may select either the Category III code or an appropriate CPT Category I unlisted code. a. Trueb. False 13. True or False: Insurance carriers are able to adjust premiums at their Trueb. False 14. In the context of the Military, direct care is:a. Services provided in a military healthcare facility. b. Care purchased on behalf of military Care provided specifically to overseas military Any care provided to non-military You do NOT need to issue an ABN when: a. You believe Medicare may not pay for an item or Medicare usually covers the item or Medicare may not consider the service medically reasonable and necessary for this patient, in this particular instance, and the claim is expected to be The service is statutorily excluded, or never covered.

9 16. Assuming there are no changes in a patient s care, an ABN is valid for how long? a. On the date of service, onlyb. For one monthc. For six monthsd. For one year 17. Which code best reflects the placement of stent in intracranial portion of the carotid artery?a. 37215b. 37216c. 37999d. 61635 18. Which of the following is NOT bundled into 37217 and 37218?a. Imaging performed of the head/neck vessels on the contralateral side where a stent is not placed b. Ipsilateral cervical and cerebral diagnostic imagingc. Closure of vesseld. Open vessel exposure19. Which is the correct hierarchy to determine the most extensive procedure?a. Stent with atherectomy (lowest), artherectomy, stent, angioplasty (highest)b. Arthrectomy (lowest), stent with artherectomy, angioplasty, stent (highest)c.

10 Angioplasty (lowest), stent, atherectomy, stent with atherectomy (highest) d. Stent (lowest), angioplasty, atherectomy, stent with atherectomy (highest)20. To report an E/M service using time as the key or deciding factor, which documented percentage of the visit must be dedicated to counseling and coordination of care?a. 25 percentb. 50 percent c. 75 percentd. 100 percentOctober 2016 HBM