A concise statement describing the symptoms, problems, conditions, diagnosis, or other factors that is the reason for the encounter, usually stated in the patient's words.
What is a Chief Complaint
100
Type of service provided by a physician whose:
a. opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician
What is a CONSULT
100
2 Types of Hospital charges .
One is between 24-48 hrs.
What are Inpatient and Observation charges
100
Terms such as :
a."Routine Visit", "No Complaints", "No Problems"
AS OPPOSE TO
a. Patient complains of _________
b. Chief Complaint is _________
c. Follow up of __________
What is Documentation Do's and Don'ts
100
A visit in which the patient has not been seen by the practice/provider within last 3 years
What is a NEW patient visit
200
When counseling and/or coordination of care dominates more than 50% of the physician's patient encounter.
What is: Time Billing
200
3 R's that have to be documented in a chart note to support charging for a consult.
What is the Request, Reason, Report
200
3 types of Hospital visit for which a provider can charge a professional fee
What are Admit, subsequent visit, and discharge visits
Two types of E/M codes that differentiate between New and established patient visits
What are Office visits and preventive medicine codes
300
Codes that require documentation to consist of a history, exam, and medical decisions making used for coding professional fees of providers
What are: Evaluation and Management Codes
300
Two words that are often confused when a patient is sent from a primary care physician to a specialist.
What are referral and consult.
300
2 E/M codes used to report last day of patients stay in hospital
What are Hospital Discharge Codes 99238, 99239
300
An individual who participates in an approved graduate medical education(GME) program but that we do not charge for their services using E/M codes
What is A Resident
300
E/M codes which require all three key components be met or exceeded to support the charge code
What is A New Patient Visit
400
Providers who:
a. work independently to doctors
b. bill to commercial payers using a wrap number,
c. share/split visits with doctors
d. bill in the clinic setting,
e. can not share/split consult
What is a MIDLEVEL (PA/NP)
400
Dermatologist sees patient at request of family practitioner and assumes care of dermatitis
What is a REFERRAL - Not a consult
400
Patient presents to office for a physical and also has a laundry list of medical conditions. The doctor sees the patient and determines the medical conditions are signficant.
What is problem-focused E/M instead of Preventive Medicine
400
Units used with a gross revenue charge that adds value to the payment to providers for their services charged using the E/M codes
What are RVU's (Relative Value Units)
400
New and established rules differ from all other insurance carriers. The time frame is 2 years and includes all providers in the group regardless of the speciality.
What is La. Medicaid?
500
Charging at higher levels without supporting doucumentation
What is Maximizing/upcoding/overbilling
500
Pediatrician sees patient and detects a possible heart murmur. He/she then sends the patient to a pediatric cardiologist. The pediatric cardiologist reviews the other providers note and sees request, states the reason for the request, documents his note and how it will be returned.
What is a CONSULT
500
Well visit for a healthy 65 years and older
What is 99397 Preventive Medicine Code
500
National Authority which dictates rules and regulations governing Evaluation and Managment codes.
What is CMS - Centers of Medicare and Medicaid Services
500
A site that uses the same tax identification number but consist of different specialties