Working with Encounter Forms
When should the insurance specialist update the encounter form?
When codes change
What is HPSA is an acronym for?
Health Professional Shortage Area
RA is an acronym for?
Remittance Advice
How is the Alphabetic Index organized?
By condition
What is UHDDS an abbreviation for?
Uniform hospital discharge data set
What information is typically NOT included on an encounter form?
Patient's health plan benefits
Coverage decisions that help providers determine medical necessity under Medicare
What is the first step the medical billing specialist should check when reviewing RAs?
To match up claims with the RA using the unique claim control number
Which of the following codes is considered a category code? 1. S82 2. S82.1 3. S82.111
S82 (Category codes have three characters)
What modifier is used for the professional work of interpreting and reporting on radiological studies?
Modifier 26
If utilizing paper forms, how can a practice be sure that all visits have been entered in the practice management program?
By prenumbering
The modifier GZ is appended to procedure codes for noncovered Medicare services when what?
The item is expected to be denied as not medically necessary but there is no signed ABN due to circumstances
How often are claim adjustment reason codes and remark codes updated?
Three times a year
A hyphen in the Alphabetic Index is a reminder to the coder that they need to do what?
Look further in the Tabular List to select the right code
What modifier is used when a procedure is started but then stopped because of an event such as problems with the patient’s tolerating it?
Modifier 53 (discontinued procedure)
What are the procedures that ensure billable services are recorded and reported for payment called?
Charge capture
The modifier GA is appended to procedure codes for noncovered Medicare services when what ?
The item is expected to be denied and there is a signed ABN
What do MOA remark codes explain?
Medicare payments decisions
Some conditions require two codes, one for the etiology and one for what?
Manifestation
Of the four types of examinations that a physician can perform, which level is the most complete?
Comprehensive
What type of questions should physicians be asked regarding billing and coding issues?
Essential
The modifier GY is appended to procedure codes for noncovered Medicare services when what?
The item is excluded and an ABN is not required
What is sent to patients by payers after claims are adjudicated?
Explanation of Benefits (EOB)
What is a nonessential modifier?
A supplementary word or phrase that helps define a code in ICD-10-CM (i.e., congenital, both eyes, acquired)
What are the three components to consider when selecting an Evaluation and Management code?
The type of history, the physical examination, and the medical decision-making