Chapter 8 Review

Front 1

What is durable medical equipment?

Back 1

Supplies used primarily in the patient's home and used for medical purposes

Front 2

What do HCPCS Level ll codes allow?

Back 2

DMEPOS dealers to submit a claim for a product or service as soon as it is approved by the Food and Drug Administration (FDA), even though there is no code that describes the product or service.

Front 3

When are HCPCS Level ll modifiers used?

Back 3

When the information provided by a HCPCS code descriptor has to be supplemented to identify specific circumstances that may apply to an item or service

Front 4

How long is the ACA grace period before an insurer can discontinue someone's coverage for failure to pay a monthly premium?

Back 4

Ninety days

Front 5

What is the AMA?

Back 5

American Medical Association

Front 6

What is the AMA responsible for?

Back 6

Annual updates; the two levels of HCPCS codes

Front 7

What does HCPCS do?

Back 7

Furnished health care providers and suppliers with a standardized language for reporting professional services, procedures, supplies, and equipment

Front 8

What do the HCPCS Level l codes report?

Back 8

Procedures and services using the CPT manual

Front 9

What is the HCPCS National Panel responsible for?

Back 9

Making decisions about additions, revisions, and deletions to the permanent national alphanumeric codes

Front 10

What are the HCPCS Level ll types of codes?

Back 10

Permanent national codes, Dental codes, Miscellaneous codes, temporary codes, and modifiers

Front 11

What are the HCPCS Level ll codes maintained by?

Back 11

The CMS

Front 12

What types of codes are the HCPCS Level ll codes considered when a DMEPOS dealer submits a claim for a product or service?

Back 12

Miscellaneous codes

Front 13

What is Orthotics?

Back 13

The branch of medicines that deals with the design and fitting of orthopedic devices

Front 14

What happens to a HCPCS Level ll code when a permanent code is established by the HCPCS National Panel to replace a temporary code?

Back 14

The temporary code is deleted and cross-referenced to the new permanent codes

Front 15

When does Medicare give HCPCS Level ll codes the highest priority?

Back 15

If the CPT code is general and the HCSPCS Level ll code is more specific

Front 16

CPT and HCPCS Level ll codes

Back 16

Both are national codes published by the American Dental Association

Front 17

Where are the HCPCS Level ll codes contained?

Back 17

HCPCS Level ll Standard Edition by the AMA

Front 18

What organization published the coding manual for CDTs?

Back 18

The American Dental Association

Front 19

What do G codes help identify?

Back 19

Professional health care procedures and services that do not have codes identified in CPT and are temporary codes

Front 20

how do you identify HCPCS Level ll modifiers?

Back 20

They are either alphabetic (two letters) or alphanumeric (one letter followed by one number)

Front 21

Which HCPCS Level ll codes are reported to the local MAC?

Back 21

Codes that begin with the letters D, G, M, P, or G

Front 22

Where should you code from and where do you verify your findings?

Back 22

Tabular section, then index

Front 23

What kind of codes are used to report DMEPOS?

Back 23

HCPCS Level ll codes (miscellaneous)

Front 24

What was the previous name of the CMS?

Back 24

HCFA

Front 25

What are NOC (not otherwise classified) codes labeled as?

Back 25

Miscellaneous codes

Front 26

What is the Hospital Patient prospective payment system (OPPS)?

Back 26

Provides authority for CMS to implement a prospective payment system (PPS) under Medicare for hospital outpatient services (Section 4523 of the Balances Budget Act in 1997

Front 27

What does OPPS require?

Back 27

Hospitals and ambulatory surgery centers to report product-specified HCPCS Level ll C codes with CPT codes to obtain reimbursement for biological, devices, drugs and other items associated with implantable device technologies

Front 28

What is the Modifier-UE used for?

Back 28

"Used equipment" products

Front 29

Where are J codes found?

Back 29

The Table of Drugs (medications)

Front 30

What is found in the index?

Back 30

The location of services or procedures

Front 31

What does MAC stand for?

Back 31

Medicare Administrative Contractor

Front 32

What does the MAC do?

Back 32

Processes Medicare claims, enroll health care providers in the Medicare program and educated providers on Medicare billing requirements

Front 33

What else does the MAC do (Section 1861)?

Back 33

Handles claims appeals and answer beneficiary and provider inquiries (Social Security Act defines the items and services for which Medicare may pay as well as the provider types recognized by the Medicare program

Front 34

What is the Medicare Carriers Manual (MCM)?

Back 34

Guidelines established by Medicare about coverage for HCPCS Level ll service/ consult when descriptor of HCPCS Level ll code

Front 35

What are the three characteristics of the HCPCS Level ll coding system?

Back 35

Ensuring uniform reporting of medical products or services, uses code descriptors to identify similar products or services rather than brand names, not a reimbursement methodology for making coverage or payment determinations

Front 36

When assigning both a CPT and HCPCS code, which would a health care provider used for the administration of an injection and then medication?

Back 36

CPT, then HCPCS

Front 37

How are claims that contain miscellaneous codes revised?

Back 37

Manually by the payer and must have a complete description of the product or service, pricing information for product or service, documentation to explain why the item or service is needed

Front 38

What do temporary codes do?

Back 38

Allow payers the flexibility to establish codes that are needed before the next January 1st update

Front 39

What are transitional pass-through payments?

Back 39

Temporary additional payments made for certain innovative medical devices, drugs, and biological provided to Medicare beneficiaries

Front 40

Where are H codes reported to?

Back 40

State Medicaid agencies that are mandated by state law to establish separate codes for identifying mental health services

Front 41

What do most state Medicare programs use?

Back 41

Healthcare Common Procedure Coding System to report Professional services, procedures, supplies, and equipment

Front 42

What is IV chelation therapy?

Back 42

An experimental type of chemical endarterectomy which is used to treat arteriosclerosis

Front 43

What does the NCCI policy manual state?

Back 43

HCPCS code Q0091 (screening pap smears) includes services necessary to procure and transport the specimen to the lab