HCM 425 Midterm Exam - Questions and Answers

HCM 425 Midterm Exam - Questions and Answers CPT modifiers __________ the meaning of services and procedures performed by providers. clarify and alter HCPCS level II was introduced in 1983 after Medicare found that its payers used more than 100 different coding systems, making it ______ difficult to analyze claims data HCPCS furnishes health care providers and suppliers with a ______ language for reporting professional services, procedures, supplies, and equipment. standardized Although the majority of procedures and services are reported using CPT (HCPCS level I), that coding system does not describe ________ (services) and certain other services reported on claims submitted for Medicare and some Medicaid patients. DMEPOS HCPCS level II national codes are five characters in length, and they begin with letters _____, followed by four numbers. A-V Because HCPCS level II is not a reimbursement methodology or system, its procedure, product, and service codes _____ coverage (e.g. payment). do not guarantee HCPCS level II codes are developed and maintained by ______ and do not carry the copyright of a private organization, which means they are in the public domain and many publishers print annual coding manuals. CMS Medicare defines __________ as equipment that can withstand repeated use in the patient's home and not in the absence of illness or injury. durable medical equipment Which supply patients with durable medical equipment? DMEPOS dealers DMEPOS claims are submitted to DME __________. Medicare administrative contractors HCPCS level II temporary codes are maintained by the __________ and other members of the HCPCS National Panel, independent of permanent national codes. CMS HCPCS level II modifiers are attached to any CPT and/or HCPCS level II codes to __________ performed by providers. clarify services and procedures For certain items or services reported on a claim submitted to the DME MAC, the DMEPOS dealer must receive a signed certificate of medical necessity from the __________ before submitting a claim to Medicare. treating physician A provider often considers diagnoses that do not receive direct treatment during an encounter because they impact treatment of other conditions. It is appropriate to report codes for such diagnoses on the CMS-1500 claim because they have been __________. medically managed The procedure or service provided is linked with the _________ that provided medical necessity for performing the procedure or service. diagnosis Which is a form required by Medicare for all outpatient and physician office procedures/services that are not covered by the Medicare program? advance beneficiary notice Medical practices and health care facilities should routinely participate in an auditing process, which involves reviewing patient records and CMS-1500 or UB-04 claims to __________. assess coding accuracy and completeness of documentation CMS develops national coverage determinations on an ongoing basis, and __________ create(s) edits for NCD rules, which are local coverage determinations. Medicare administrative contractors The outpatient code editor (OCE) is software that edits outpatient __________ by hospitals, community mental health centers, comprehensive outpatient rehabilitation facilities, and home health agencies. claims submitted Which part of the SOAP note contains the chief complaint and the patient's description of the presenting problem?