A Buck Ch16
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| The coders' responsibility is to ensure that the data are as accurate as possible not only for classification and study purposes but also to obtain appropriate reimbursement | show 🗑
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| show | True
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| show | True
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| Medicare defines fraud as an intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes it knowing that the deception could result in some unauthorized benefit to himself or some other person | show 🗑
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| Kickbacks are allowed under certain circumstances | show 🗑
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| show | True
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| The Medicare program was established in | show 🗑
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| The Medicare Part A pays for | show 🗑
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| Medicare Part B pays for | show 🗑
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| Who handles the day-to-day operation of the Medicare program for the CMS | show 🗑
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| show | 80 %
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| show | Direct payment is made on all clains, faster processing and a 5% higher fee schedule
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| show | ICD-9-CM, CPT, HCPCS
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| show | the government
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| show | 1989
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| show | The relative value units for each service, a geographic adjustment factor to adjust for regional variations in the cost operating a health care facility and a national conversion factor
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| Services that are performed primarily in office settings are subject to a payment discount if they are performed in outpatient hospital departments. This is called | show 🗑
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| show | 100%, 50%, 25%, 25%
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| Medicare sets the payment level for assistants at surgery at what percentage of the fee schedule amount for the global surgical service | show 🗑
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| When an unlisted procedure is billed because no other code exists to describe the treatment, payment is based on a mazimym of this percentage of the value of the intraoperation services originally performed | show 🗑
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| What edition of the Federal Register would hospital facilit6ies be especially interested in | show 🗑
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| What edition of the Federal Register would outpatient facilities be especially interested in | show 🗑
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| What is the largest third-party payer | show 🗑
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| What government organization is responsible for administering the Medicare program | show 🗑
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| What are the three items that the Medicare beneficiaries are responsible to pay before Medicare will begin to pay for services | show 🗑
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| Where and when were the DRGs first developed | show 🗑
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| What was the state that first used the DRGs on a large scale | show 🗑
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| show | 25
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| The creation of the PRO was made possible under a provision of what act | show 🗑
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| Which of the following is not a patient attribute for classification into a DRG | show 🗑
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| What is the name of the document that is produced by CMS that defines the type and number of health records that must be reviewed for a patient record | show 🗑
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| A complication is defined as a condition that increases the patient's length of stay in the hospital by at least 1 say in at least what percent of cases | show 🗑
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| show | 482
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| show | Social Security Administration
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| show | CMS
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| Peer Review Organization | show 🗑
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| Resource Based Relative Value Scale | show 🗑
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| show | OBRA
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| Diagnostic Related Group | show 🗑
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| show | APG
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| Maximum Annual Allowable Charge | show 🗑
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| show | RVU
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| Geographic Practice Cost Indiees | show 🗑
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| show | PPS
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| show | OIG
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| Department of Health & Human Services | show 🗑
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| In the role as a medical coder, it is your responsibility to ensure that you code _ & _ to optimixe reimbursement for services provided | show 🗑
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| The complexity of a hospital's case load is referred to as a hospital's | show 🗑
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| A computer program called a __ is used to input the principal diagnosis and other critical information about a patient | show 🗑
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| The __ program was developed by congress to monitor the necessity of hospital admissions and review the treatment costs and medical records of hospitals | show 🗑
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| show | conversion factor
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| show | fee schedule
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| For endoscopic procedures Medicare allows the full value of the highest valued endoscopy, plus the difference between the nest highest endoscopy and the __ endoscopy | show 🗑
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| List the three components of the relative value unit | show 🗑
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| Name the two types of fraud alerts | show 🗑
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| show | disabled, blind and those 65 years & over
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