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128 Cards in this Set
- Front
- Back
Medicare is the largest single medical benefits program in the United States |
True
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The AMA is responsible for the operation of the Medicare program and for selections medicare administrative contractors (MACs)
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False
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Medicare part d is a prescription drug coverage plan
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True
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Medical Savings Programs help people with high income and asset levels pay for healthcare coverage.
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False
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A benefit period begins the first day the patient visits the physician and ends when the patient is cured/healed.
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False
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Lifetime reserve days (45 days) may be used only once during a patient's lifetime and are usually reserved for use during the patient's final, terminal hospital stay.
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False
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Medicare Part B also covers some health patient is not covered by medicare Part A
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True
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Medicare limits hospice care to four benefit: two periods of 90 days each, one 30- day period, and a final "lifetime" extension of unlimited duration.
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True
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Respite care is the permanent hospitalization of a terminally ill, dependent hospice patient for the purpose of providing relief for the nonpaid person who has the major day-to-day responsibility for care of that patient.
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False
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When a patient uses Medicare hospice benefits, all other Medicare benefits stop, with the exception of physician services or treatment for conditions not related to the patient's terminal diagnosis.
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True
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Medicare part B helps cover physician services, outpatient hospital care, and other services not covered by Medicare Part A
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True
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Medigap is designed to supplement all insurance benefits by paying for services that they do not cover.
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False
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Mac's replaced carriers and fiscal intermediaries and process both Medicare A and B claims.
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True
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MSA enrollees are required to pay an annual Medicare B premium.
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False
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The purpose of obtaining the ABN is to ensure payment for a procedure or service that might not be reimbursed under Medicare.
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True
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Medicaid provides medical and health-related services to individuals and families with low incomes.
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True
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States are not required to provide Medicaid coverage for individuals who. receive federally assisted income-maintenance payment.
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False
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Each state administers its own Medicaid program, and AMA monitors the programs.
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False
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The BBA allows states to provide 12 months of continuous Medicare coverage (without reevaluation) for eligible children under the age of 19.
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True
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In many cases, Medicare eligibility will depend on the patient's monthly income.
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True
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Retroactive eligibility is never granted to patients who had high medical expenses prior to filing for Medicaid
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False
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States must provide home health services to beneficiaries who are entitled to receive nursing facility services.
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True
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States are not permitted to require nominal deductibles, coinsurances, or copayments for certain services performed.
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False
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The medicaid eligibility verification system allows providers to electronically access the state's eligibility file.
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True
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Medically necessary services are furnished primarily for the convenience of the recipient or provider.
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False
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When a PACE participant needs to use a noncontract providers there is no limit on the amount that these noncontract providers can charge.
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False
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Each time upon check-in a Medicaid patient should present a valid Medicaid ID card
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True
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Preauthorization is not required as part of the Medicaid program.
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False
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When a patient has both Medicare and Medicaid, Medicaid pays first
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False
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Health affairs refers to the office responsibility for both military readiness and peacetime health care.
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True
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TRICARE sponsors are uniformed service personnel who are active-duty, retired, or deceased.
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True
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TRICARE service centers are business offices that assist TRICARE sponsors with health-care needs.
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True
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Nurse advisors are available 24/7 to treat sponsors for nonmedical emergencies.
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False
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TRICARE case management coordinates and monitors a beneficiary's healthcare options and services.
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True
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Beneficiary counseling and assistant coordinators (BACs)were previously called that collection assistant officers
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False
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CHAMPVA is always the first payer before Medicare.
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False
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TRICARE offers three healthcare options.
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True
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The catastrophic cap benefits protects TRICARE physicians from devastating financial loss due to medical malpractice.
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False
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All active-duty members are enrolled in TRICARE prime and are not eligible for TRICARE extra.
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True
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TRICARE Standard provides beneficiaries with the greatest freedom in selection of civilian providers, yet is the most expensive.
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True
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TRICARE claims are submitted to the TMA
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False
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TRICARE Extra is a managed-care options similar to an HMO.
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False
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TRICARE standard enrolls participating providers.
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False
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When a patient has a supplemental health plan in addition to TRICARE, the participating provider submits just one claim.
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True
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The worker must physically be on company property to qualify workers' compensation.
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False
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Permanent disability refers to an employee's diminished capacity to work to return to work
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True
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Schedule loss of use (eyesight, hearing, or body part) compensation is a lifetime benefit.
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False
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According to the law, when a patient requests treatment for a work-related injury or disorder and has signed the first report of injury form, the patient has given consent for the filing of compensation claims and reports.
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False
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If the employer disputes the legitimacy of the claim, a first report of injury report must be filed anyway.
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True
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A detailed narrative progress/supplemental report is filed to document any significant change in the workers medical or disability status.
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True
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A health information specialist should personally sign the original and all photocopies of progress reports before filing them for the position.
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False
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The employer must be notified by mail when an injured worker presents for the first visit without a written or personal referral from the employer.
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False
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OSHA was created to protect employees against injuries from occupational hazards in the workplace.
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True
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The first report of injury form is completed in triplicate when the patient first seeks treatment.
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False
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Worker's Compensation is not the same program as Workmen's Compensation.
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False
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Federal agencies reimburse FECA for Worker's Compensation expenses through annual premiums charged to workers.
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False
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A comprehensive record of all vaccinations administered and any accidental exposure incidences must be retained for 30 years.
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False
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Worker's Compensation is standardized from state to state.
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False
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All providers must except the compensation payment as payment in full.
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True
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The health insurance specialist employed in a physician's office assigns ICD-9-CM codes to procedures documents by the healthcare provider.
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False
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The ICD-9-CM is organized into three volumes.
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True
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An advanced beneficiary notice is signed by the patient to acknowledge that the healthcare provider is a subscriber to the Medicare program.
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False
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An inpatient is a person admitted to a hospital for treatment with the expectation that here she will remain in the hospital for a period of 24 hours or more.
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True
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The first-listed diagnosis and the primary diagnosis are the same thing.
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False
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Codes that describe signs and symptoms, as opposed to definitive diagnoses, are never acceptable for reporting purposes when the physician has not documented an established or confirmed diagnosis.
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False
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Preadmission testing is routinely completed prior to an inpatient admission or outpatient surgery to facilitate the patient's treatment and reduce the length of stay.
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True
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V codes are located in the index and are assigned for patient encounters when a circumstance other than a disease or injury is present.
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False
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E codes are located in the Tabular List of Diseases and describe external causes of injury, poisoning, or other adverse reactions affecting a patient's health.
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True
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Supplementary words located in parentheses after a main term in the ICD index to diseases are nonessential modifiers that do not have to be included in the diagnostic statement for the code number listed (after parentheses) to apply.
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True
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Coding conventions are rules that apply to the assignments of iCD-9-CM codes and are always found in the guidelines.
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False
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A principal procedure is a procedure performed for definitive treatment rather than diagnostic purposes, or one performed to treat a complication, or one that is closely related to the principal diagnosis.
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True
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A lesion is a neoplasm defined as any discontinuity of tissue that is not malignant.
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False
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An adverse effect or adverse reaction is the appearance of a pathologic condition caused by ingestion or exposure to a chemical substance that is properly administered or taken.
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True
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A late of fact as a residual effect or sequelae of a previous acute illness, injury, or surgery.
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True
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ICD-10-CM is the abbreviation for the International classification of diseases, 10th edition, clinical modification.
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False
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All provider-based offices and outpatient health care settings will continue to report CPT and HCPCS level II codes for procedures and services.
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True
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Regular code updates to ICD-9-CM, ICD-10-CM, and ICD-10-PCS were discontinued on October 1, 2011.
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True
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Effective October 1, 2011, ICD-9-CM became a legacy coding system.
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False
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ICD-10-CM requires seven characters for each code.
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False
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ICD-10-CM, when compared to ICD-9-CM, will provide better data for conducting research.
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True
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The seventh character and ICD-10-CM is known as an extension.
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True
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ICD 10 PCS replaces volume 2 to the ICD-9-CM.
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False
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CMS is responsible for updating to ICD 10 PCS on an annual basis.
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True
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Eponyms are diseases or syndromes that are named for people.
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True
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Parentheses are used in ICD 10 CM to identify manifestation codes.
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False
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There are two types of Includes notes and ICD 10 CM.
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False
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The see instruction after A main term directs the coder to refer to another term in the index to locate a code.
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True
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The table of neoplasms is located in the tabular list of ICD 10 CM.
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False
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Qualifiers are supplementary terms that further modify some terms and other qualifiers.
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True
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HCPCS is a reimbursement methodology or system; it is important to understand that, just because codes exist for certain products or services, coverage is not guaranteed.
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False
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HCPCS level II temporary codes are maintained by the AMA and other members of the HCPCS national panel, independent of permanent level II codes.
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False
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Whenever a permanent code is established by the HCPCS National Panel to replace a temporary code, the temporary code is deleted and cross-referenced to the new permanent code.
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True
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HCPCS modifiers clarify services and procedures performed by providers.
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True
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When using the HCPCS manual, it is important to code and verify directly from the index.
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False
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Some services must be reported by assigning both a CPT and HCPCS level II national code. The most common scenario uses the CPT code for the administration of an injection and HCPCS code to identify the procedure.
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False
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HCPCS level II modifiers are alphabetic (two letters) or alphanumeric (one letter followed by one number).
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True
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OPPS requires hospitals and ambulatory surgery centers report product-specific HCPCS level II C codes with CPT codes to obtain reimbursement for biologicals, devices, drugs, and other items associated with implantable device technologies.
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True
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IV chelation therapy is an experimental type of chemical endarterectomy which is used to treat arteriosclerosis.
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True
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That NCCI policy manual states that the HCPCS code Q0091 (screening Pap smears) does not include the transportation of the specimen to the laboratory.
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False
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The CPT provides a uniform language that describes medical, surgical, and diagnostic services to facilitate communication among providers, patients, and insurers.
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True
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The symbol identifies add-on codes for procedures that are commonly, but not always, performed at the same time and by the same surgeon as the primary procedure.
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True
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Conscious sedation, marked by a triangle symbol, is the administrative of moderate sedation or analgesia that results in a drug-induced depression or consciousness.
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False
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Guidelines are located at the beginning of each CPT section and should be carefully reviewed before attempting to code
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True
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Descriptive qualifiers are trims that clarify the assignment of a CPT code and are always found at the beginning of a main clause or after the semicolon.
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False
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The CPT index is organized by alphabetical main terms representing procedures or services, organs, anatomical sites, conditions, eponyms, or abbreviations
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True
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End-Stage renal dialysis and hemodialysis services would be reported with codes from the surgery section of CPT.
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False
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Unbundling means assigning multiple codes to procedures/services when just one comprehensive code should be reported
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True
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The separate procedure code is always reported if the procedure or service performed is included in the description of another reported code
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False
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When billing multiple surgical procedures performed during the same operative session, the surgical procedure performed first should be coded first on the claim
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False
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The professional component of a radiological examination covers the supervision of the procedure and the interpretation and writing of a report describing the examination and it's findings
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True
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The technical component of an examination covers the use of the equipment, supplies provided, and employment of the radiologic technicians
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True
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Single code numbers are assigned to organ-or disease-oriented panels, which consists of a series of blood chemistry studies routinely ordered by providers at the same time for the purpose of investigating a specific organ or disorder. The panel is very specific, but substitutions of so,e tests are allowed.
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False
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Chemotherapy administrative in addition to other cancer treatments, such as surgery and/or radiation therapy, is called adjuvant chemotherapy
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True
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An ambulatory surgical center (ACS) is a federally licensed, Medicare-certified supplier of surgical Healthcare Services that must accept assignment of medical claims
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False
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CPT codes directly affect DRG assignment.
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False
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DRG's are organized into manually exclusive categories called major diagnostic categories (MDCs).
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True
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A Medicare administrative contractor (MAC) is a third-party payer that contracts with Medicare to carry out the operational functions of the Medicare program
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True
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The ESRD composite payment rate system bundles ESRD drugs and related laboratory work with that composite rate payment.
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True
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The IPPS five-day window requires outpatient pre-admission services provided by a hospital on the day of, or during the five day prior to, a patient's admission to the covered by the IPPS DRG payment
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False
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Medically manage diagnoses are also known as secondary diagnoses or coexisting diagnoses
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True
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It is recommended that an authentication legend be generated when the patient is discharged
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False
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A waiver is required by Medicare for all outpatient and physician office procedures/services that are covered by the Medicare program
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False
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Auditing processes involve reviewing patient records and CMS-1500 or UB-04 claims to process coding accuracy and completeness of documentation
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False
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Chargemaster's are used to select procedures, services, and supplies provided to hospital emergency department patients and outpatients
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True
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Local coverage determinations (LCDs) specify under what clinical circumstances A service is covered
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True
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Primary purpose of the patient record is to provide continuity of care
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True
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Veterans health information systems and technology architecture (VistA) electronic health record was developed by the AMA
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False
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Operative reports may very from short narrative descriptions to formal dictated reports
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False
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